MALE
External genitalia
Penis: reproductive and urinary elimination.
Scrotum: External sac that houses testes.
Protects the testes from trauma & testicular
temperature regulation.
Internal reproductive organs
Testes: produce male sex hormone and from
spermatozoa
Ductal system: “ vas ...
Reproductive System
Female
MALE External genitalia
External genitalia ❖ mons pubis
❖ Penis: reproductive and urinary elimination. ❖ labia majora and minora
❖ Scrotum: External sac that houses testes. ❖ Clitoris
Protects the testes from trauma & testicular ❖ Vestibule
temperature regulation. ❖ perineum
Internal reproductive organs
Internal reproductive organs ❖ Vagina: muscular tube that leads from the vulva to the
❖ Testes: produce male sex hormone and from uterus
spermatozoa ❖ Cervix: dips into the vagina and forms fornices, which are
❖ Ductal system: “ vas deferens” the tube in which arch-like structures or pockets.
sperm begin the journey out of the body. ❖ Ovaries :two sex glands homologous to the male testes,
❖ Accessory glands: The seminal vesicles are are located on either side of the uterus. (Hatfield 55)
paired glands that empty an alkaline, fructose-rich Fallopian tubes: The paired fallopian tubes (also known as oviducts)
fluid into the ejaculatory ducts during ejaculation. are tiny, muscular corridors that arise from the superior surface of the
Prostate: muscular gland that surrounds the first part of the uterus near the fundus and extend laterally on either side toward the
urethra as it exits the urinary bladder. The alkaline fluids ovaries. The fallopian tubes have three sections
secreted by these glands are nutrient plasmas with several ❖ Isthmus
key functions, including the following: ❖ Ampulla
❖ Enhancement of sperm motility (i.e., ability to ❖ infundibulum
move) Uterus: uterus, or womb, is a hollow, pear-shaped, muscular
❖ Nourishment of sperm (i.e., provides a ready structure located within the pelvic cavity between the bladder and
source of energy with the simple sugar fructose) the rectum.
❖ Protection of sperm (i.e., sperm are maintained in The uterus is divided into four sections.
an alkaline environment to protect them from the ❖ cervix
acidic environment of the vagina) (Hatfield 51) ❖ uterine isthmus
❖ corpus
❖ fundus (Hatfield 53)
Cellular development
Menstrual cycle Soma cells:
❖ Makeup organs and bodily tissue of the human body.
Two main components : Ovarian cycle and Uterine cycle ❖ Gametes: germ cells/ sex cells found only in the reproductive
Ovarian cycle : Cyclical changes in the ovaries occur in glands
response to two anterior pituitary hormones: ❖ Nucleus: contains 23 pairs of chromosomes
follicle-stimulating hormone (FSH) and luteinizing hormone ❖ Each parent donates 1 par of chromosomes ( 46 Chromosomes
(LH). There are two phases of the ovarian cycle, each equals little Mikey)
named for the hormone that has the most control over that ❖ Each parent donates 22 pairs of autosomes: genetic traits such
particular phase. The follicular phase, controlled by FSH, as eye color, hair color, ear wax consistency.
encompasses days 1 to 14 of a 28-day cycle. LH controls ❖ One pair of sex chromosomes
the luteal phase, which includes days 15 to 28
❖ Follicular phase
❖
Fetal development
Luteal phase
Uterine cycle: changes that occur in the inner lining of the
uterus. These changes happen in response to the ovarian Pre-embryonic stage : 3-4 weeks
hormones estrogen and progesterone. gestation
There are four phases to this cycle: Embryonic: 5-10 weeks gestation
❖ Menstrual Fetal: 11-40 weeks gestation
❖ Proliferative
❖ Secretory
❖ ischemic.
Signs of pregnancy
❖ Presumptive: subjective data the
woman reports to the HCP for
example, “ My breasts hurt”
❖ Probable : objective data such as
cervical changes
❖ Positive : diagnostic confirmation
such as, fetal heartbeat & ultrasound
Fetal bradycardia ❖ Maternal hypotension ❖ Mild : > 5 BPM from baseline
❖ Supine hypotensive syndrome ❖ Moderate: 6-25 BPM from baseline
❖ Fetal decompression ❖ Severe: < 25 BPM from baseline
❖ Late fetal hypoxia ❖ Absent : No fluctuation in fetal heart rate
❖ Cord compression
❖ Abruptio placenta
❖ Vagal stimulation
Accelerations & Decelerations
Variability Accelerations: must be 15 BPM above the FHR baseline for 15
seconds 15x15 window
FHR drops from baseline then recovers, usually jagged and Decelerations : A decrease in FHR during uterine contraction ”
erratically shaped. Can happen at anytime during contraction mirrors contractions usually a U shape
Periodic changes : variations that occur during a contraction.
Nursing interventions : Left Side. IV bolus of fluids, O2 6l mask, ❖ Reassuring periodic changes : must be 15 BPM
Notify HCP above the FHR baseline for 15 seconds ( 15x15 window)
❖ Benign periodic changes: Early decelerations
A great way to remember this is L.I.O.N
Decreased or absent variability: Non reassuring, acute treatment Episodic changes: occur in association with medication
and monitoring are indicated. administration or analgesia
Decreased or absent variability: medications, narcotics, mag
Wandering baselines with no variability could indicate
sulfate ( preeclampsia, preterm), terbutaline, fetal sleep (
❖ Congenital defects normally 20 minute cycles), prematurity, fetal hypoxemia.
❖ Metabolic acidosis
Fetal decelerations
The nurse should administer 02 and the baby needs to be
delivered as quickly as possible.
Memory trick
Early decelerations : A decrease in FHR during uterine contraction mirrors
uterine contractions . caused by uterine squeeze
❖ FHR slows as the contraction begins
V: variable deceleration C: cord compression ❖ Lowest point coincides with the highest point ACME of the
E:early deceleration H: head compression contraction
A: acceleration O: ok ❖ Deceleration ends with the contraction
Late deceleration Placental insufficiency Late deceleration: occurs after the peak of contraction due to uteroplacental
insufficiency, pitocin, HTN, diabetes, placental abruption.
❖ Too many decelerations will indicate a need for C-section
❖ Prepare for fetal resuscitation
Variable decelerations: may indicate cord compression. Occur at different
times during a contraction, resulting in fetal HTN that causes the aortic arch
to slow the FHR. usually abrupt and sudden.
Measures to clarify NONreassuring FHR patterns
❖ Fetal stimulation
❖ Fetal scalp sampling
❖ Fetal scalp oximetry
, Hematologic Changes
❖ Blood volume increases by
45-50%
PREGNANCY ❖
Weight gain
A woman should increase her
❖ Red blood cell count caloric intake by 300 kcal/day
during 2nd & 3rd trimesters.
Signs of pregnancy
increases up to 30%
❖ Recommended weight gain
❖ Plasma increases up tp 50%
depends on pre pregnancy BMI.
❖ Hemoglobin decreases ❖ Presumptive: subjective data ❖ FIRST TRIMESTER : 3-4 lb total
❖ Hematocrit decreases the woman reports to the HCP ❖ REMAINDER OF PREGNANCY: 1
❖ for example, “ My breasts hurt” lb per week.
❖ Total weight gain: 25-35 lb for a
Cardiac changes
❖ Probable : objective data such
as cervical changes woman with a normal BMI
❖ Positive : diagnostic
❖ Blood pressure slightly
confirmation such as, fetal
decreases
heartbeat & ultrasound
Nutrition
❖ Heart rate increases by
10-15 BPM
❖ Cardiac output increases ❖ When a woman isn't getting the proper nutrients this can cause
Amenorrhea which can inhibit the ability to become pregnant.
❖ Lack of folic acid can cause neural tube defects( spina bifida) and cause
damage to the growing fetus.
❖ Deficits in Vit C have been shown to also cause birth defects and
Integumentary changes
cancer.
❖ Pica:
❖ Chloasma : “ pregnancy mask” ❖ persistent ingestion of nonfood substances such as clay, laundry
brown blotchy areas on the skin of starch, freezer frost, or dirt.It results from a craving for these
substances that some women develop during pregnancy.
the face, cheeks, nose and
❖ These cravings disappear when the woman is no longer pregnant.
forehead.
❖ Pica is associated with iron-deficiency anemia, but it is unknown
❖ Linea nigra: a dark line down the whether iron deficiency is the cause or the result
middle of the skin on the abdomen
Nutritional requirements
❖ Striae: develop in response to
increased glucocorticoid levels.
Also known as stretch marks ❖ Proteins: Growth and repair of fetal tissue, placenta, uterus,
breasts, and maternal blood volume
❖ Minerals: Prevent deficiencies in the growing fetus and maternal
stores
Musculoskeletal changes
❖ Iron : Formation of hemoglobin; essential to the oxygen-carrying
capacity of the blood
❖ Calcium: Nerve cell transmission, muscle contraction, bone
❖ Lordosis: Excessive inward building, and blood clotting
curvature of the spine ❖ Phosphorus: Promotes strong bone growth
❖ Diastasis rectus abdominis: ❖ Zinc: Fetal growth and maternal milk production
tearing of the rectus abdominis ❖ Iodine : Promotes normal thyroid activity, preventing specific birth
muscles defects
Vitamin requirements
Respiratory changes Folic acid (Vitamin B9)
❖ Nasal mucosa edematous due to ❖ Necessary for formation of the nervous system
vasocongestion ❖ Prevents up to 70% neural tube defects
❖ Nasal congestion and voice ❖ Diet should include at least 400 mcg of folic acid per day
changes possible
❖ Accommodations to maintain lung Vitamin A
capacity ❖ Recommended intake via beta-carotene
❖ May feel short of breath when ❖ Too much can be toxic to the fetus
❖ Too little can stunt fetal growth and cause impaired dark adaptation
eupneic
and night blindness
❖ Third trimester diaphragm pressure
Vitamin C
❖ Essential in the formation of collagen, a necessary ingredient to
GI changes
wound healing
Vitamin B6
❖ Necessary for the healthy development of the
❖ Intestines are displaced fetus’s nervous system
upwards & to the side. Vitamin B12
❖ Pressure changes in the ❖ Needed to maintain healthy nerve cells, RBCs, form DNA
esophagus & stomach
which leads to heartburn.
❖ constipation
, Assessment
Admission
❖ Birth imminence Components of assessment
❖ Fetal status Obstetric History
❖ Maternal status ❖ Number and outcomes of previous pregnancies in
❖ Risk assessment GTPAL (gravida, term, preterm, abortions, living)
format (see Chapter 7 for a detailed explanation of
these terms)
❖ Estimated delivery date
❖ History of prenatal care for current pregnancy
Assessment of reproductive history
❖ Complications during pregnancy
❖ Dates and results of fetal surveillance studies, such
as ultrasound or nonstress test (NST)
Gravida: Number of pregnancies the woman has had regardless
❖ Childbirth preparation classes
of outcome
❖ Previous labor and birth experiences
Nulligravida: never been pregnant
Current Labor Status
Multigravida: more than one pregnancy
❖ Time of contraction onset
Parity: the client communicates outcome of previous pregnancies
❖ Contraction pattern including frequency, duration,
GTPAL :
and intensity
G: Gravida – the total number of pregnancies regardless of
❖ Status of membranes
outcome
❖ Description of bloody show or bleeding
T: Term – the number of pregnancies that ended at term (at or
❖ Fetal movements during the past 24 hours
beyond 38 weeks’ gestation)
Medical–Surgical History
P: Preterm – the number of pregnancies that ended after 20
❖ Chronic illnesses
weeks and before the end of 37 weeks’ gestation either
❖ Current medications
A : Abortions – the number of pregnancies that ended before 20
❖ Prescribed
weeks’ gestation either spontaneous or induced
❖ Over-the-counter
L: Living – the number of children delivered who are alive when
❖ Herbal remedies
the history is taken
Social History
❖ Marital status
❖ Support system
❖ Domestic violence screen
❖ Cultural/religious considerations that affect care
Prenatal visits
❖ Amount of smoking during pregnancy
❖ Drug and alcohol use during pregnancy
Ist visit : Desires/Plans for Labor and Birth
❖ Presence of a partner, coach, and/or doula (see
❖ Family History, Medical Surgical History,
Chapter 7 for discussion of doulas)
Social History, Teaching, Avoiding
❖ Pain management preferences
teratogenic, substance ingestion, Alcohol, ❖ Other personal preferences affecting intrapartum
tobacco, illegal drugs, etc., Diet, nutrition, and nursing care
exercise, Infection control ❖ Presence of a birth plan
❖ Medication use ❖ Desires/Plans for Newborn
❖ Determining due dates ❖ Plans for feeding—breast or formula
❖ Naegele's rule ❖ Choice of pediatrician
❖ Add seven days to the date of the first day of ❖ Circumcision preference, if the infant is male
the LMP, then subtract three months (and ❖ Rooming-in preference (Hatfield 208)
add a year)
❖ Pelvic examination
❖ Practitioner sizes the uterus to estimate term
❖ Obstetric sonogram: High frequency sound
waves reflect off fetal and maternal pelvic
Tips
structures, allowing structure measurement If a woman presents with ℅
bleeding ask her how man
sanitary napkins she has
saturated in an hour.
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