Assessment and Health Promotion - Reproduction and Sexuality

3rd SEMESTER EXAM 1: Assessment and Health Promotion - Reproduction and Sexuality

Female Reproductive System - Internal Structure

  • Vagina

    • Muscular, collapsible hollow tube

    • Extends to the beginning of the uterus

  • Cervix

    • Acts as the doorway to the uterus

  • Uterus

    • Hollow organ that nourishes and grows the baby

    • Musculature is thick when not pregnant and thins during pregnancy

    • Composed of three layers:

    • Endometrium (Inner)

    • Myometrium (Middle)

    • Perimetrium (Outer)

  • Fallopian Tubes

    • Connect to the ovaries via fimbriae

  • Ovaries

    • Responsible for hormone and egg storage

    • Contains all eggs a woman has at birth; no new eggs are produced thereafter

Ovulation

  • Definition: Release of the egg (ova) from the ovary

    • Egg tracks through the fimbriae and moves along the fallopian tube

    • Fertilization typically occurs in the outer 2/3 of the fallopian tube

    • When egg and sperm meet, this is termed "conception" of pregnancy

    • The fertilized egg must travel to the uterus and burrow into the uterine wall for a conducive environment for a healthy pregnancy

Ectopic Pregnancy

  • Occurs when pregnancy happens in the fallopian tube, not conducive for life

    • Always ends in miscarriage

    • Can be treated without rupture via medications; therapy may involve removal of the fallopian tube if a rupture occurs

Reproductive Conditions

  • Cystocele: A condition where the uterus falls onto the bladder (common post-menopause)

  • Rectocele: A condition where the uterus falls onto the rectum

  • Hysterectomy: Removal of the uterus, which can lead to the prolapse of other organs into the space vacated by the uterus

Skeletal Pelvis

  • Anatomy: Round opening in the middle, wider part referred to as iliac crest

  • False Pelvis: Connected by cartilage; can shift during childbirth and may fracture

  • Ischial Spine: The narrowest point of the pelvis, critical for assessing fetal descent during labor

Reproductive Cycle

  • Menarche: First menstruation, typically starts around 12 years of age

  • Puberty: Transition to sexual maturity

  • Menstrual Cycle Definition: Day 1 of bleeding to the next Day 1 of bleeding

  • Menstruation Characteristics:

    • Initial cycles are unpredictable and painless for about a year and often anovulatory

    • Average duration is 5 days with an average blood loss of 50 ml (range: 20-80 ml)

    • Composition includes blood, mucous, and epithelial cells

Hormonal Changes

  • During the cycle, levels of prostaglandins rise post-ovulation, leading to uterine contractions that help move sperm forward

  • Ovulation Specifics:

    • Egg remains viable for about 24 hours post-release

    • Cervix softens and dilates slightly due to prostaglandins, facilitating sperm entry

    • Cervical mucus becomes thin and egg-white in consistency, optimal for sperm mobility

    • pH shifts in the vagina to support sperm viability

  • Basal body temperature dips slightly immediately after ovulation, then spikes

Menopause

  • Represents the cessation of ovulation and menstruation

    • Average age: 51

    • Must go 12 months without a menstrual cycle for diagnosis

    • Symptoms can include:

    • Hot flashes

    • Headaches

    • Depression

    • Anxiety

    • Insomnia

    • Osteoporosis

    • Vaginal dryness

    • Decreased libido

    • Weight gain

Pharmacology for Menopausal Symptoms

  • Hormone Replacement Therapy (HRT): Involves administering estrogen and progesterone to alleviate discomfort

    • Not used frequently due to risks of heart attack and stroke; contraindicated in women with estrogen-sensitive cancers

  • Alternative Medications: SSRIs, anti-anxiety drugs, topical estrogen for vaginal dryness, sleep aids

Types of Care for Pregnancy

  • Pre-conception Care: Focus on minimizing risks of teratogens, optimizing health pre-pregnancy

  • Prenatal Care: Involves screening for maternal and fetal problems and managing labor and delivery

  • Fertility Control/Treatment: Contraception, diagnostics, and treatments for infertility or menstrual problems

    • Includes perimenopause/menopause care.

Assessment of the Woman

  • History Taking: Detailed OB and medical history, specific complaints

  • Physical Examination: Review systems and conduct pelvic examination

    • External examination: Lesions, STDs, deformities

    • Internal examination: Speculum and bimanual examinations

    • PAP test for cervical cancer is crucial

    • Pre-examination Precautions: No vaginal intercourse 24 hours before, do not come in if bleeding

Violence Against Women

  • Intimate Partner Violence (IPV): Significant issue affecting women's health

    • Facts: 1 in 4 women experience abuse in their lifetime

    • Signs include overuse of healthcare services, unexplained injuries, and controlling behavior by partner

  • Assessment Using Abuse Assessment Screen: Questions to identify potential abusive relationships

    • Guidance on how to approach discussions of abuse

  • Readiness to Escape: Importance of assessing the victim's readiness to leave an abusive situation, and assist in creating an escape plan

Infertility and Contraception

  • Definition: Inability to achieve spontaneous pregnancy

  • Common Causes of Infertility:

    • More issues likely in females. Common factors include:

    • Unexplained (30%)

    • Varicocele in males, causes overheating and sperm death

    • Ovulatory dysfunction in females (40%), includes not releasing an egg regularly

    • Mechanical factors, including endometriosis (30-50%) which obstruct normal fertilization

    • Less than 10% for cervical factors

Improving Chances of Conceiving

  • Recommendations include limiting intercourse to 2-3 times a week, tracking ovulation, and maintaining intimacy

  • Erectile Dysfunction: Involves inability to maintain an erection, can be organic or functional; managed with medications like Viagra or counseling for psychological reasons

Contraception Overview

  • Definition: Intentional prevention of pregnancy during intercourse

    • Important considerations: Age, health, compliance, and risks of undesired pregnancy

    • Half of U.S. pregnancies are unplanned

Methods of Contraception

  • Natural Methods: Coitus interruptus, fertility awareness, abstain during fertile periods

  • Barrier Methods: Condoms, diaphragms, cervical caps

  • Hormonal Methods:

    • Oral contraceptives (combining estrogen & progestin) or progestin-only pills

    • Side Effects and Contraindications: Discuss history of DVT, CAD, and smoking risks

    • Effectiveness affected by various medications hindering hormonal birth control

  • Permanent Methods: Sterilization (male or female), easier recovery in males with no effect on sexual function

Genetics, Conception, and Fetal Development

Genetics and Chromosomal Abnormalities

  • Female chromosomes: XX; Male chromosomes: XY

    • All humans have 46 chromosomes, 23 from each parent

  • Common Chromosomal Abnormalities:

    • Trisomy 21 (Down's syndrome) and Trisomy 18 (Edward's syndrome)

  • Age: Older parental age increases risk of chromosomal damage

Conception Process

  • Union of Egg and Sperm: Marks the beginning of pregnancy

    • Average sperm transit time to reach the egg is 4-6 hours

    • Two-thirds of pregnancies occur in the upper section of the fallopian tube

  • Implantation: Occurs 8-14 days after conception into the uterine wall; spotting may occur around this time

Multi-Fetal Gestation

  • Dizygotic Twins (Fraternal): Result from two separate eggs fertilized by two sperm

    • Occurs in 1 in 43 births; each twin has separate placenta

  • Monozygotic Twins (Identical): Results from a single fertilized egg that splits post-fertilization; may share placenta and membranes

Fetal Development Timelines

  • Pregnancy lasts approximately 40 weeks, divided into trimesters:

    • Week 1-11: 1st Trimester

    • Week 12-27: 2nd Trimester

    • Week 28-40: 3rd Trimester

Intrauterine Development

  • Early development involves the formation of the amniotic sac and the placenta

  • Placenta: Functions as the interface between maternal and fetal blood, facilitating gas exchange and nutrient transfer

    • Composed of chorionic villi which invade the uterine wall and connect to uterine capillaries

    • At term, will cover about half of the uterine wall

Critical Fetal Development

  • Critical period for congenital anomalies is conception to 8 weeks

    • Major organs form during this time, emphasizing the importance of maternal health

    • Fetal heart begins to beat near the end of the 3rd week post-conception

Body Changes in Pregnancy

Terminology in Pregnancy

  • Gravida: Number of pregnancies

  • Parity/Multipara: Number of pregnancies lasting 20 weeks or more

Pregnancy Terms

  • Viability: Typically considered at 24 weeks gestation

  • Gestational Age: Measured from the first day of the last menstrual period (LMP)

  • OB History: Document pregnancy outcomes using GTPAL (Gravida, Term, Preterm, Abortion, Living Children)

Signs and Symptoms of Pregnancy

  • Presumptive Signs: Subjective signs felt by the woman (amenorrhea, fatigue)

  • Probable Signs: Observed by clinician (positive pregnancy tests)

  • Positive Signs: Confirmations from diagnostic tools (fetal heart tones, imaging)

Uterine Changes**

  • Softening of the cervix and increased vascularity noted early in pregnancy

  • Uterus grows significantly as the fetus matures

  • Breast Changes: Increase in vascularity, pigmentation, and development of colostrum

Metabolic Changes**

  • Increased blood volume and physiologic anemia due to blood plasma increase

    • Heart rate increases, impacting blood pressure dynamics

  • Respiratory changes due to rib cage modifications

Nutrition and Health in Pregnancy

Importance of Nutrition

  • Proper nutrition during pregnancy helps prevent low birth weight and intrauterine growth restriction

  • First Trimester: Critical for embryonic and fetal development; Folic acid is vital to prevent neural tube defects

  • Caloric Needs: Increase of 400-500 calories per day during pregnancy; 500 calories during lactation

Nutritional Assessments and Interventions

  • Regular assessments including dietary recalls to evaluate nutritional status

  • Address common discomforts such as nausea and constipation with dietary adjustments

Managing Nutrition-Related Problems**

  • Potential issues such as anemia or gestational hypertension require tailored nutritional focus

  • Provide dietary education to support healthy pregnancy outcomes

Pregestational Conditions Impacting Pregnancy

Diabetes**

  • Risk factors: high blood sugar levels characterized by hyperglycemia due to Dysfunction in insulin production or action

  • Types of Diabetes: Type 1, Type 2, Gestational Diabetes; management of diet and insulin is key

Risks During Pregnancy**

  • Uncontrolled diabetes can lead to complications such as fetal macrosomia and congenital anomalies

  • Monitor maternal health closely, providing proper education and resources for management.