Maternal Role Attainment Theory by Ramona Mercer =This mid-range theory serves as a framework for nurses in providing appropriate health care interventions to mothers, helping them develop a strong maternal identity. developmental and interactional process, in which the mother bonds with her baby while acquiring competence and expressing joy in her role as a mother.

Ramona Mercer spent more than 30 years doing research about parenting in low and high risk situations as well as transition into the maternal role. She began with a study of mothers who gave birth to infants with a birth defect (1971-1973). She focused next on teenage mothers during their first year of motherhood. Mercer also participated in a cross-cultural comparison of mothers’ responses to cesarean and vaginal births. Her research has provided clinicians with information on how to make a difference in the lives of new parents.

 Adaptation theory by Sister Calista Roy - adaptation occurs when people responds positively to environmental changes, and it is the process and outcome of individuals and groups who use conscious awareness, self-reflection, and choice to create human and environmental integration. = According to Roy’s Model, a person is a bio-physical-social being in constant interaction with a changing environment. = He or she uses innate and acquired mechanisms to adapt.

Casey’s Model of Nursing = Anne Casey is an English nurse who developed a nursing theory that focuses on the nurse working in partnership with the child and his or her family. = It was the earliest attempts to develop a nursing model designed specifically for child health nursing. = The five aspects of the theory are child, family, environment and the nurse. = The philosophy of Casey’s model is that the best people to care for the child are the members of the family, with health care professionals assisting. This necessitates a relationship between the parents and nurse.

Theory of comfort by Katharine Kolcaba= According to the model, comfort is an immediate desirable outcome of nursing care. According to Kolcaba, comfort is the produce of holistic nursing art. = According to this theory, comfort exist in three forms: 1. Relief- if specific comfort needs of a patient are met, the patient experiences comfort in the sense of relief. Ex. A patient who receives pain medication in post-operative care is receiving relief comfort. 2. Ease- addresses comfort in a state of contentment. Ex. The patient’s anxieties are calmed. 3. Transcendence - is described as a state of comfort in which patients are able to rise above their challenges.

Uterus • thick walled muscular organ; Hosts the developing fetus • Produces vaginal and uterine secretions • Passes the anatomically male sperm through to the fallopian tubes • shape: non-pregnant- pear shape; pregnant- ovoid

Muscular Compositions - endometrium- lines the non-pregnant uterus (inner layer); muscle layer for menstruations, sloughs off during menstruations - myometrium- the largest part of the uterus; muscle layer for delivery process- the power of labor responsible for the contraction of the uterus - perimetrium- the outer layer, protects the entire uterus

oogenesis- ( the production and development of an ovum)

infundibulum- distal part, about 2cm long, trumpet /funnel shape and covered by fimbria- guides the ovum into the FT

2. Ampulla- the outer 3rd, and also the longest portion-5cm long; the site of fertilization

3. Isthmus- is the site of sterilization, portion that is being cut in BTL

4. Interstitial- the most proximal, lies within the uterine wall, the site of ectopic pregnancy

Mons pubis/ veneris- • a pad of fatty tissues that lies over the symphysis pubis • covered by skin and at puberty covered by pubic hair • serves as cushion or protection to the symphysis pubis

2. Labia Majora- • large lips longitudinal fold, extends symphysis pubis to perineum

3. Labia Minora • are two small folds of skin, lacking fatty tissue • extend backward on each side of the opening into the vagina • They lie inside the labia majora and are some 4 cm (about 1.5 inches) in length.

4. Clitoris • anterior, pea shaped erectile tissue with lots of sensitive nerve endings • site of sexual arousal

5. Fourchette • posterior, tapers posteriorly of the labia minora • sensitive to manipulation, torn during delivery • site for episiotomy

6. Vestibule- an almond shape area that contains the

a. skenes gland- mucus secreting substance for lubrication

b. vaginal orifice- external opening of the vagina

c. bartholin’s glands- 2 small mucus secreting substance (secrets alkaline)

d. urinary meatus- small opening for urethra, serve for urination

e. Hymen- This is a piece of skin that partially covers the opening to the vagina

7. Perineum • muscular structure • space between the anus and the vulva

MALE REPRO

Epididymis- • 5 meters coiled tubules • site for the maturation of sperm

2. vas deferens/ spermatic cord • conduit for spermatozoa or pathway of sperm

3. seminal vesicles • two convoluted pouch that lie along the lower portion of the bladder secretes: - fructose- glucose that has a nutritional value -prostaglandin

4. Bulbo urethra/ cowper’s gland • supplies alkaline fluid- for safe passage of spermatozoa

5. urethra • hollow tube leading from the base of the bladder • passes through the prostate gland, to the meatus

Penis- • the male organ for copulation and urination • composed of three cylindrical masses of erectile tissue -2 corpora cavernosa -1 corpus spongiosum

2. The testes- • the distal end of the organ is bulging, sensitive ridge called-glans penis * prepuce- retractable casing that protects the nerve-sensitive glans •

2 ovoid glands, about2-3 cm wide that rest in the scrotum • its lobule contains interstitial cells – -Leydig Cells- that produce testosterone and -seminiferous tubule - that produce spermatozoa

3. The scotum- • rugated, skin covered muscular pouch suspended from the perineum • serves as the cooling mechanism of testes - < 2 degrees C

4. Urethral orifice/ urinary meatus • is the opening of the urethra, It is the point where urine exits the urethra • it is where semen exits

TERMS

Menarche- 1st mens

Dysmenorrhea- painful mens

Metrorrhagia- bleeding between mens

o Menorrhagia- excessive mens

o Amenorrhea- absence of mens

o Menopause- cessation of mens / average of 51 y/o

Menstruation  is defined as the cyclical shedding of the endometrium- the lining of the uterus or womb

Phases of Menstrual cycle:  Menstrual phase (From day 1 to 5)  Follicular phase (From day 1 to 13)  Ovulation phase (Day 14)  Luteal phase (From day 15 to 28)

Brain structures called the hypothalamus and pituitary gland control the menstrual cycle. The hypothalamus triggers the pituitary gland to make hormones that trigger the ovaries to release estrogen and progesterone. These hormones make the lining of the uterus (womb) thicker to prepare the body for pregnancy.

Fertilization  the union of an ovum and spermatozoon  Occurs in the ampulla of the fallopian tube

Pre embryonic stage A. zygote- fertilized ovum B. morula- mulberry like ball with 16-50 cells; 4 days free floating and multiplication C. blastocyst- enlarging cells that forms a cavity that later becomes the embryo

Decidua- thickened endometrium  Basalis- ( base) – part of endometrium located under fetus where placenta is delivered  Capsularis- encapsulate the fetus  vera- remaining portion of the endometrium

Hegar’s sign– softening of the lower uterine segment  Braxton Hicks – periodic uterine tightening  Ballotement – bouncing of the fetus against examiner’s hand  Uterine soufflé – blowing sound heard over the pregnant uterus that is synchronous with the mother’s heartbeat and is due to the rush of blood through the large uterine vessels

operculum – mucus plug to seal out bacteria and help prevent infection  Goodell’s sign – softening of the cervix

Chadwick’s sign – color change of the vagina from pink to violet  Leukorrhea – whitish vaginal discharge

*Pathogenic Anemia- Iron Deficiency anemia- most common hematological disorder

shortness of breath (SOB) -is the most common problem is due to the enlarged uterus and increased oxygen demand  residual volume- (the amount of air remaining in the lungs after expiration) decreased up to 20% by the pressure of the diaphragm  Tidal volume – ( volume of air inspired) is increased by 30%-40%  total oxygen consumption increases by as much as 20% Management: Position- side-lying lateral expansion of the lungs elevate head of bed IV. Gastrointestinal  Morning sickness- N&V due to increased HCG Eat dry crackers or dry CHO diet 30 mins before arising bed Small frequent feeding Vomiting in pregnancy -excessive- hyperemesisgravidarum - metabolic alkalosis, F & E imbalance Mngt: -replace fluid - monitor I & O  Constipation- progesterone, decreased activity, slow peristalsis Increase fiber in the diet; fruits ( papaya, mango, pineapple, watermelon etc except guava) Exercise Increased fluid intake  Flatulence- Avoid gas forming food like- cabagge, bread,  Heartburn- pyrosis, the reflux of the gastric content to the esophagus Small frequent feeding, avoid 3 full meals, avoid fatty and spicy food, sips of milk Avoid lying after eating, remain upright for atleast 30mins 16 ptyalism- increase salivation –- mngt, mouth wash  Hemorrhoids- pressure of the gravidarus Hot sitz bath Avoid prolonged standing, walking Avoid carrying heavy objects eat fiber rich foods to prevent constipation V. VI. VII. Urinary System  frequency during the 1st and 3rd tri, due to pressure on the bladder  nocturna- (urination at night) avoid drinking water before going to sleep Muskulo skeletal  LORDOSIS- the pride of pregnancy  Waddling gait- awkward walking due to relaxation. Causes softening of joints and knees, prone to falls- wear low heeled shoes  Leg cramps- pronged standing, over fatigue, Ca & phosphorus imbalance, Mngt: increase Ca in the diet- 1pint/day or 3-4 servings/day ( cheese, yogurt, head of fish, broccoli, Vit D for increased Ca absorption Exercise- dorsiflexion Integumentary System  Striae gravidarum- pink or reddish streak appearing on the sides of the abdominal wall and sometimes on the thighs due to stretching and rupture of the connective tissue of the skin  linea nigra – a narrow brown line running from the umbilicus to symphysis pubis  melasma – ( chloasma) the “mask” of pregnancy, darken areas that may appear on the face as well on the cheeks and across the nose; this is due to increased melanocyte- stimulating hormone  vascular spiders – (telangiectases) fiery-red branching spots seen on skin of pregnant women particularly on the thighs

Duration of Pregnancy Full-term- 38-40 weeks pre-term- < 37 weeks post term- > 40 weeks abortion - < 24 weeks

Labor - is a coordinated sequence of involuntary, intermittent uterine contractions

1. Uterine stretch theory ( any hallow organ stretched, will always contract & expel its content) – contraction action

2. Oxytocin theory – post pit gland releases oxytocin. Hypothalamus produces oxytocin

3. Prostaglandin theory – stimulation of arachidonic acid – prostaglandin- contraction

4. Progesterone Deprivation theory – before labor, decrease progesterone will stimulate contractions & labor

5. Theory of aging placenta – life span of placenta 42 wks. At 36 wks degenerates (leading to contraction – onset labor).

Shultz “shiny” – begins to separate from center to edges presenting the fetal side shiny Dunkan “dirty” – begin to separate form edges to center presenting natural side – beefy red or dirty

Puerperium – covers 1st 6 wks post partum  Involution – the return of the repro organ to its non-pregnant state.

Taking in phase – dependent phase (1st three days)  mother – is passive, cant make decisions, activity is to tell child birth experiences.

Taking hold phase – dependent to independent phase (4 to 7 days)  mother- is active, can make decisions

Letting go – interdependent phase – (7 days & above)  Mother - redefines new roles may extend until child grows