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The Nursing Role in Reproductive and Sexual Health, Study notes of Nursing

National University (NU)Nursing

The nursing role in reproductive and sexual health, including the concept of unitive and procreative health, the male and female reproductive systems, menstruation, and uterine deviations. It also covers the theory of evolution and the story of creation in the book of Genesis. detailed information on the external and internal structures of the male and female reproductive systems, including the production of spermatozoa and the process of ovulation. It also discusses the menstrual cycle and the characteristics of menstruation.

Typology: Study notes

2021/2022

Available from 04/05/2023

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CARE OF MOTHER, CHILD,
AND ADOLESCENT
LECTURE | SECOND SEMESTER
MIDTERMS
NUR
214
WEEK 2 – THE NURSING ROLE IN REPRODUCTIVE AND SEXUAL HEALTH
CONCEPT OF UNITIVE AND PROCREATIVE HEALTH
PROCREATION
• The production of offspring (reproduction)
o Fertilization that leads to pregnancy
PROCREATIVE HEALTH
• Moral obligation of parents to have the
healthiest children through all natural and
artificial means available.
UNITIVE AND PROCREATIVE HEALTH
• The union and consummation of marriage
ordered towards procreation.
THEORY OF EVOLUTION
• Asserts that all life forms are the result of
procreation
• It is based on the idea that all species are
related and gradually change over time
• All life is related and has descended from a
common ancestor
• The theory is defended on common features
and ascending complexity
STORY OF CREATION IN THE BOOK OF GENESIS
• Making of all things from nothing by an act of
God
• Single pair of ancestors (Adam and Eve)
o We all came from Adam and Eve
• Man and woman are to be “two-in-one-flesh”
• “Increase and multiply”
o
“Humayo kayo at magpadami”
o Procreation = magpadami
• Stewards of creation
THE MALE REPRODUCTIVE SYSTEM
• Andrology is the study of the male
reproductive organs. The male reproductive
system consists of both external and internal
divisions.
EXTERNAL STRUCTURE
• Scrotum
o Rugated skin – capable of being
stretched
o When the weather is cold, the scrotal
muscle contracts to get closer to the
body. The scrotal muscle relaxes to fall
away from the body in hot weather
because it must be kept at a
temperature that is 1°F lower than the
body temperature for the spermatozoa
to survive.
o One scrotum is slightly lower than the
other. So, the other one would follow as
the first one slipped through. As a
result, they avoid colliding, which would
prevent friction.
o Candidates for infertility are individuals
with undescended testes or testes that
are attached to the body.
• Testes
o Production of spermatozoa
o Leydig cells or interstitial cells
synthesize and secrete the male sex
OUTLINE
1.1. Concept of Unitive and Procreative Health
1.2. Theory of EVOLUTION
1.3. The Male Reproductive System
1.4. The Female Reproductive System
1.5. Menstruation
1.6. Phases of the Menstrual Cycle
1.7. Tests
1.8. Genes
1.9. Sexuality
1.10. Human Sexual Response Cycle
1.11. Responsible Parenthood and Family
Planning
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CARE OF MOTHER, CHILD,

AND ADOLESCENT

LECTURE | SECOND SEMESTER

NUR

WEEK 2 – THE NURSING ROLE IN REPRODUCTIVE AND SEXUAL HEALTH

CONCEPT OF UNITIVE AND PROCREATIVE HEALTH

PROCREATION

  • The production of offspring (reproduction) o Fertilization that leads to pregnancy PROCREATIVE HEALTH
  • Moral obligation of parents to have the healthiest children through all natural and artificial means available. UNITIVE AND PROCREATIVE HEALTH
  • The union and consummation of marriage ordered towards procreation. THEORY OF EVOLUTION
  • Asserts that all life forms are the result of procreation
  • It is based on the idea that all species are related and gradually change over time
  • All life is related and has descended from a common ancestor
  • The theory is defended on common features and ascending complexity STORY OF CREATION IN THE BOOK OF GENESIS
  • Making of all things from nothing by an act of God
  • Single pair of ancestors (Adam and Eve) o We all came from Adam and Eve
  • Man and woman are to be “two-in-one-flesh”
  • “Increase and multiply”

o “Humayo kayo at magpadami”

o Procreation = magpadami

  • Stewards of creation THE MALE REPRODUCTIVE SYSTEM
  • Andrology is the study of the male reproductive organs. The male reproductive system consists of both external and internal divisions. EXTERNAL STRUCTURE
  • Scrotum o Rugated skin – capable of being stretched o When the weather is cold, the scrotal muscle contracts to get closer to the body. The scrotal muscle relaxes to fall away from the body in hot weather because it must be kept at a temperature that is 1°F lower than the body temperature for the spermatozoa to survive. o One scrotum is slightly lower than the other. So, the other one would follow as the first one slipped through. As a result, they avoid colliding, which would prevent friction. o Candidates for infertility are individuals with undescended testes or testes that are attached to the body.
  • Testes o Production of spermatozoa o Leydig cells or interstitial cells synthesize and secrete the male sex

OUTLINE

1.1. Concept of Unitive and Procreative Health 1.2. Theory of EVOLUTION 1.3. The Male Reproductive System 1.4. The Female Reproductive System 1.5. Menstruation 1.6. Phases of the Menstrual Cycle 1.7. Tests 1.8. Genes 1.9. Sexuality 1.10. Human Sexual Response Cycle 1.11. Responsible Parenthood and Family Planning

CARE OF MOTHER, CHILD,

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hormones (e.g., testosterone), and are the principal cell type found in the interstitial supporting tissue, located between the seminiferous tubules. o Seminiferous tubules are the specific area for the production of sperm cells.

  • Penis INTERNAL STRUCTURES
  • Epididymis o Responsible for the conduction of sperm from the testes to vas deferens o Tightly coiled tube o 20ft long. It takes 12 to 24 days just for the travelling period of the sperm. o 64 days to reach maturity o Gives 5% of seminal fluid in the sperm
  • Vas deferens o When the sperm are at the epididymis

level, they are not motile ( di

gumagalaw). They do not move, they

only become motile as they pass to the length of the vas deferens because the vas deferens is surrounded by veins and arteries called spermatic cord.

  • Seminal vesicles o Produces 30% of seminal fluid which is alkaline in nature o It has mucin, protein, and sugar. Seminal fluid is very nutritious and abundant which is why the sperm is surrounded by the seminal fluid on the outside structure for motility and survival.
  • Prostate gland o It gives 60% of seminal fluid o That's why when men get older and the frequency of their sexual intercourse is still the same, there are tendencies that their prostate gland will enlarge o Because if the prostate gland keeps on contracting and the seminal fluid keeps on coming out, there are cases of hypertrophy, and we call that one as benign prostatic hypertrophy. o And because the urethra passes to it like a hole in a donut. the moment it grows and contracts, the urethra gets stuck. And when the urethra is stuck, the tendency is that it can interfere not only with fertility but also with urination. That's why the men who no longer have a straight flow of urine, there are cases that maybe when they get old, their prostate gland hypertrophies. o The prostate gland can be removed
  • Bulbourethral glands o And before it comes out, bulbourethral gland will also give 5% of seminal fluid to the sperm to protect it from being immobilize by the naturally low pH level of the urethra. o Urethra is acidic in nature which is same as the vagina.
  • Urethra
  • It is composed of an erectile muscle.
  • Ischiocavernosus Muscle – it is the one who is responsible for contraction
  • Erectile Tissue: Corpus cavernosum and Corpus spongiosum
  • Glans – sensitive ridge of tissue and that is the reason why it is covered by a fold of skin called prepuce.
  • Prepuce – protection of glans penis THE FEMALE REPRODUCTIVE SYSTEM
  • Gynecology: study of the female reproductive system EXTERNAL STRUCTURES
  • Mons veneris o Is a part of adipose tissue that protects the junction of the bone (symphysis pubis) from trauma

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INTERNAL STRUCTURES

  • Cervix is not part of internal structures because cervix is already a part of the uterus
  • Ovaries o Produces an egg cell o Maturation of oocytes (ovulation) o Produces hormone such as estrogen and progesterone o Ovaries is kept in place by a supporting

ligament ( nakalawit). It is not encased

by a layer of peritoneum so that when ovulation occurs, it will only be caught by the fimbriae (hair-like structure) and guided to the length of the fallopian tube. o Ovaries don’t move and the only thing that moves the ovaries is the fimbriae together with the peristaltic movement of the fallopian tube. It will guide the ova to the length of the fallopian tube (site of fertilization) o Specific site of fertilization is the ampulla portion or the outer third of the fallopian tube.

  • Fallopian tubes o Open end just like a vagina. o Since there is a pathway between the fallopian tube and the vagina, pregnancy and delivery is possible. However, it is also the reason that's why it is possible for you to introduce an ascending infection. And when there is an ascending infection, it can come out of the fallopian tube and can lead to peritonitis (a redness and swelling (inflammation) of the lining of your belly or abdomen). Any procedure done during the labor process should be of sterile technique. - Uterus o Organ of menstruation and the containment of the products of conception. o Uterine wall layers ▪ Perimetrium composed of connective tissue ▪ Myometrium composed of muscle. It is the one responsible for the contraction of the uterus and the expulsion of the fetus at the time of delivery. Myometrium also prevents your menses to come out at the time of your menstrual period. ▪ Endometrium composed of mucous membrane. When the endometrial tissue is supposed to come off as a product of menses but implants in many parts of a woman's body. That is considered to be a reproductive problem called endometriosis. Composed of a mucus membrane. Because the uterus has a mucus membrane, it is very responsive to many events in a woman during the menstrual period. When estrogen levels are high, the lining of the uterus thickens. When the progesterone level is high, the blood supply to the uterus increases. The end part of the endometrium with the mucus membrane is called the endocervix. Because when the woman is pregnant, the endocervix can be filled with lots of mucus and that serves as a protection against infection. That appears at the time of delivery called operculum. o Uterine blood supply o Uterine nerve supply o Uterine supportive structures - Vagina

CARE OF MOTHER, CHILD,

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LECTURE | SECOND SEMESTER

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UTERINE DEVIATIONS

  • Bicornuate uterus : oddly shaped “horns” at the junction of the fallopian tubes
  • Anteversion : the entire uterus tips far forward
  • Retroversion : the entire uterus tips far back
  • Anteflexion : the body of the uterus is bent sharply forward at the junction with the cervix
  • Retroflexion : the body of the uterus is bent sharply back just above the cervix THE BREAST MAMMARY GLANDS OR BREASTS
  • Form early in intrauterine life
  • Remain in a halted stage of development until a rise in estrogen at puberty causes them to increase in size o This increase occurs mainly because of growth of connective tissue plus deposition of fat
  • Glandular tissue of the breasts o Necessary for successful breastfeeding o Remains undeveloped until a first pregnancy begins
  • Boys, especially those who are obese, may notice a temporary increase in breast size at puberty, termed gynecomastia. o What makes the male different from the female? Because for males, there are only a transient increase in breast size. In women, it is a result of estrogen which is the one responsible for thelarche (beginning breast development caused by estrogen production). - The ampulla serves as the reservoir for milk before breastfeeding. It has many connective tissue partitions containing a number of lobules. - It has 20 small openings to which milk is secreted. - Montgomery's tubercles. That's why the surface of the areola is rough because of a number of sebaceous glands which protects the nipple from cracking especially when breastfeeding. - Acinar/Acini cells – production of milk MENSTRUATION - Menstrual cycle : episodic uterine bleeding in response to cyclic hormonal changes - Purpose: to bring an ovum to maturity and renew a uterine tissue bed that will be necessary for the ova’s growth should it be fertilized. CHARACTERISTIC DESCRIPTION Beginning (menarche) Average age at onset, 12.4 years; average range, 9-17 years Interval between cycles Average, 28 days; cycles of 23-35 days not unusual Duration of menstrual flow Average flow, 4-6 days; ranges of 2-9 days not abnormal Amount of menstrual flow Difficult to estimate; average 30-80 ml per menstrual period; saturating a pad or tampon in less than 1 hr. is heavy bleeding Color of menstrual flow Dark red; a combination of blood, mucus, and endometrial cells Odor Similar to marigolds

CARE OF MOTHER, CHILD,

AND ADOLESCENT

LECTURE | SECOND SEMESTER

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has been reversed because the blood supply has increased, preparation for pregnancy should conception takes place. And when you ovulate, the viscosity of secretions that used to be very sticky, you are now considered to be wet, you will become slippery. The characteristic of secretion is copious, thin, watery, and that is the spinnbarkeit property of the cervical mucus. ISCHEMIC PHASE

  • When there is no fertilization, regression of the corpus luteum starts until its tenth day.
  • Progesterone and estrogen decrease which causes sloughing off of the uterine lining and the capillaries rupture
  • This is the end of the menstrual cycle which contains blood, mucus, endometrial tissues, and the unfertilized ovum
  • The menses is the only external marker of the cycle, and it also marks the first day of the next cycle. MENSES
  • Composed of a mixture of blood from the ruptured capillaries; mucin; fragments of endometrial tissue; and the microscopic, atrophied, and unfertilized ovum.
  • Menses is the end of an arbitrarily defined menstrual cycle
  • The first day of menstrual flow is used to mark the beginning day of a new menstrual cycle
  • A menstrual flow contains only 30 to 80 ml of blood. TESTS THE FERN TEST
  • This test is done when there is preterm labor
  • Checking for an ovulatioN
  • Letter A: Ferning pattern of cervical mucus with high estrogen level
  • Letter B: incomplete ferning during the secretory phase of cycle
  • An interesting property of cervical mucus just before ovulation, when estrogen levels are high is the ability to form fernlike patterns on a microscope slide when allowed to dry. This pattern is known as arborization or ferning
  • When progesterone is the dominant hormone, as it is just after ovulation, this fern pattern is no longer discernible. THE SPINNBARKEIT TEST
  • Midpoint of a menstrual cycle is another way to demonstrate high levels of estrogen are being produced and, by implication, ovulation is about to occur
  • Another property of cervical mucus is the ability to stretch into long strands.
  • The level of estrogen is high, bringing down the progesterone at its lowest to trigger the

CARE OF MOTHER, CHILD,

AND ADOLESCENT

LECTURE | SECOND SEMESTER

NUR

hypothalamus and release the anterior pituitary gland of the LH releasing factor and eventually the LH itself. And because the level of estrogen and progesterone is high, it will now push the mature ovum at the surface of the ovary until on the following day and that is on the ovulation day of a woman.

  • How do we know you’re ovulating? A woman's secretions that used to be sticky, will thin out. It becomes like a raw egg white. When you are washing your vagina and you have that raw egg white like, the characteristic of the spinnbarkeit property is that you can stretch it to 10 - 13 centimeters before it breaks.
  • Another sign of ovulation is that a certain degree of pain can be felt either on the left or on the right lower quadrant called mittelschmerz.
  • Another sign of ovulation is an increase in basal body temperature brought about by the corpus luteum. PHASES OF MENOPAUSE
  • Perimenopausal is a term used to denote the period during which menopausal changes are occurring
  • Postmenopausal describes the period following the final menses
  • Climacteric refers to the total changes that occur at this life stage
  • The age range at which menopause occurs is wide, between approximately 40 to 55 years, with a mean age of 51 years BASIC PRINCIPLES OF HUMAN GENETICS
  • Genetic material – composed of chromosomes and genes found in the nucleus of each body cell
  • Chromosomes – threadlike strands composed of hereditary material known as DNA GENES
  • The basic physical and functional unit of heredity
  • Small segment of DNA, composing each chromosome
  • Vary in size from a few hundred DNA bases to more than 2 million bases
  • Act to make molecules of proteins DEOXYRIBONUCLEUC ACID (DNA)
  • Hereditary material
  • Nearly every body cell has the same DNA
  • Mostly located in cell nucleus

ALLELES ( a-le-li)

  • A variant form of a gene
  • An alternative form of versions of a gene
  • Humans as diploid organisms = 2 alleles at each genetic locus on a chromosome
  • 1 allele is inherited from each parent INHERITED TRAIT
  • Genetically determined
  • Passed from parent to offspring (Mendelian Rule)
  • Most traits not strictly determined by genes, but influenced by both genes and environment MENDELIAN GENETIC
  • Traits passed down by dominant and recessive alleles of one gene AUTOSOMAL DOMINANT
  • One mutated copy of the gene in each cell in sufficient for a person to be affected by an autosomal dominant disorder
  • In some cases, an affected person inherits the condition from an affected parent
  • In others, the condition may result from a new mutation in the gene and occur in people with no history of the disorder in their family
  • Examples of Genetic Conditions: o Huntington Disease o Marfan Syndrome AUTOSOMAL RECESSIVE
  • In autosomal recessive inheritance, both copies of the gene in each cell have mutations
  • The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition

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  • It encompasses and gives direction to a person’s physical, emotional, social, and intellectual responses throughout life.
  • It is a multidimensional phenomenon that includes feelings, attitudes, and actions
  • Has both biologic and cultural diversity components
  • It encompasses and gives direction to a person’s physical, emotional, social, and intellectual responses throughout life.
  • Biologic gender is the term used to denote a person’s chromosomal sex: male (XY) or female (XX)
  • Gender identity or sexual identity is the inner sense a person has of being ale or female, which may be the same as or different from biologic gender.
  • Gender roles is the male or female behavior a person exhibits, which, again, may or may not be the same as biologic gender or gender identity. SEXUAL ORIENTATION
  • Heterosexuality
  • Homosexuality
  • Bisexuality
  • Transsexuality SEXUAL EXPRESSION
  • Abstinence
  • Masturbation
  • Erotic Stimulation
  • Fetishism
  • Voyeurism
  • Sadomasochism HUMAN SEXUAL RESPONSES (MASTERS AND JOHNSON, 1966)
  • 600 men and women
  • 10,000 sexual activities
  • The sexual experience is unique to each individual; how body responds to sexual arousal has common features HUMAN SEXUAL RESPONSE CYCLE
  • Excitement
  • Plateau
  • Orgasm
  • Resolution
  • Effect of menstrual cycle and pregnancy EXCITEMENT PHASE
  • Begins with the onset of erotic feeling and sensation which occurs with physical and psychological stimulation (sight, sound, emotion, or thought) that causes parasympathetic nerve stimulation TWO PRIMARY PHYSIOLOGIC CHANGES:
  • Vaso congestion – increased blood supply (arterial dilation and venous constrictions in genital area and other different body parts)
  • Myotonia – an increased muscular tension (contraction) EXCITEMENT PHASE MALE FEMALE
  • Erection of the penis and nipples of the breast (parasympathetic nerve stimulation)
  • Scrotal thickening and elevation of the testes (muscle contraction)
  • Presence of clear lubricating droplets at the urethral meatus (bulbourethral gland)
  • Increased in temperature, perspiration, RR, HR, and BP)
  • Increased muscle tension in both smooth and skeletal muscle
  • Erection of the clitoris and nipple of breast (increased size = Vaso congestion); sensitive to touch and temperature; center of sexual arousal and orgasm in female; increased arterial blood supply
  • Presence of mucoid fluid or lubrication of the vaginal walls (Bartholin’s gland)
  • Vagina widens in diameter and increases in length
  • Increase in size and change in the color of the labia, uterus, and breasts
  • Flushing of the skin
  • Increased in temperature, perspiration, RR, HR, and BP
  • Increased muscle tension in both smooth and skeletal muscle.

CARE OF MOTHER, CHILD,

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LECTURE | SECOND SEMESTER

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PLATEAU PHASE

  • Period during which sexual tension increases to levels nearing orgasm, which may last from 30 seconds to 3 minutes. PLATEAU PHASE MALE FEMALE
  • Vaso congestion leads to full distention of the penis
  • HR (100- 175 bpm) and RR ( cpm)
  • The clitoris is drawn forward and retracts under the clitoral prepuce
  • The lower part of the vagina becomes extremely congested (formation of “orgasmic platform”)
  • HR (100- 175 bpm) and RR ( cpm) ORGASMIC PHASE / ORGASM
  • During this phase of the women, the uterus contracts similar to what is happening during the labor process. In any cases of bleeding, no matter how slight it is, she can no longer have intercourse because if she has intercourse, the threatened abortion may become an imminent abortion. The cervix used to be closed suddenly opens.
  • It is the involuntary climax of sexual tension, accompanied by physiologic and psychologic release
  • It lasts for 3 - 10 seconds ; shortest stage in the sexual response cycle; intense pleasure affecting the whole body. ORGASMIC PHASE / ORGASM MALE FEMALE
  • Muscle contractions surrounding the seminal vessels and prostate project semen
  • A vigorous contraction of muscles in the pelvic area – expels blood and fluid from area of congestion into the proximal urethra
  • Contractions are followed immediately by 3 - 7 propulsive “ejaculatory contractions”, occurring at the same time interval as in women which forces semen from the penis
  • An average of 8 - 15 contractions at intervals of one every 0. seconds RESOLUTION PHASE
  • It is the 30 - minute period during which the external and internal genital organs return to unaroused state or pre-coital stage RESOLUTION PHASE MALE FEMALE
  • Refractory period occurs during which further orgasm is impossible from a few hours or days, depending on age and other factors.
  • Women do not go through this period, so it is possible for women to have additional orgasms immediately after the first if properly stimulated THE INFLUENCE OF THE MENSTRUAL CYCLE ON SEXUAL RESPONSE
  • During the luteal phase (the second half of the menstrual cycle), increased fluid retention and Vaso congestion in the woman’s lower pelvis occurs
  • Because some Vaso congestion is already present at the beginning of the excitement stage of the sexual response, women appear to reach the plateau stage more quickly and achieve orgasm more readily during this time.
  • Women also may be more interested in initiating sexual relations during this time.

CARE OF MOTHER, CHILD,

AND ADOLESCENT

LECTURE | SECOND SEMESTER

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INTERVENTIONS RELATED TO PROMOTING

REPRODUCTIVE AND SEXUAL HEALTH

Nursing Diagnosis Possible Nursing and Therapeutic Interventions Risk for infection related to high-risk sexual behaviors

  • Teach clients strategies related to reducing their specific at-risk behavior
  • Work with clients to identify which strategies would best work for them. Altered sexuality patterns related to chronic illness
  • Review with clients’ factors that might impact on their pattern of sexuality, such as fatigue and self-image, and suggest strategies to minimize these factors Unsatisfactory altered sexuality patterns in an uncomplicated pregnancy related to knowledge deficits
  • Explore with the couple what factors might be contributing to the change in sexuality pattern, including cultural and religious beliefs, and give appropriate information related to knowledge deficits EVALUATING OUTCOMS RELATED TO PROMOTING REPRODUCTIVE AND SEXUAL HEALTH Nursing Diagnosis Possible Nursing and Therapeutic Interventions Risk for infection related to high-risk sexual behaviors
  • Client will report that he or she is taking precautions to prevent contracting sexually transmitted diseases Altered sexuality patterns related to chronic illness
  • Client reports that a satisfactory pattern of sexuality has been achieved Unsatisfactory altered sexuality patterns in an uncomplicated pregnancy related to knowledge deficits
  • Couple reports that their anxiety related to sexual relations during the pregnancy has decreased.
  • Couple reports achievement of a mutually satisfying pattern of sexuality. RESPONSIBLE PARENTHOOD AND FAMILY PLANNING RESPONSIBLE PARENTHOOD
  • Is the will and ability of parents to respond to the needs and aspirations of the family and children
  • It is a shared responsibility of the husband and the wife to determine and achieve the desired number, spacing, and timing of their children according to their own family life aspirations, considering psychological preparedness, health status, socio-cultural, and economic concerns. ELEMENTS OF RESPONSIBLE PARENTHOOD
  1. Awareness and preparedness of duties and responsibilities of parents
  2. Promotion and protection of the rights of children
  3. Nurturing parent and child relationship and observance of effective communication
  4. Effective shared home management
  5. Practicing family planning
  6. Promoting safe motherhood and child health nutrition
  7. Fostering community involvement and participation. REPRODUCTIVE LIFE PLANNING
  • Includes all the decisions an individual or couple make about whether and when to have

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children, how many children to have, and how they are spaced.

  • Counseling may include the topics of avoiding conception, increasing fertility, and/or what to do if contraception has failed
  • Ideal spacing is 3 years to give time for the body to recover.
  • When you are pregnant you need additional 300 calories and when you are breastfeeding mother, you need an additional 500 calories. CONTRACEPTIVES An ideal contraceptive should be:
  • Safe
  • Effective
  • Compatible with spiritual and cultural beliefs and personal preferences of both the user and sexual partner
  • Free of bothersome side effects
  • Convenient to use and easily obtainable
  • Affordable and needing few instructions for effective use
  • Free of effects (after discontinuation) on future pregnancies. CATEGORIES OF COMMONLY USED BIRTH CONTROL METHDOS
  • Natural family planning o Fertility awareness method – the woman relies on her fertile days (ovulate)
  • Barrier methods o Chemical in made or mechanical in made o Spermicides
  • Hormonal contraceptives o It has a component of either an estrogen or progesterone o Subcutaneous implant, vaginal ring, transdermal patch, pills which contains progesterone alone (progestine)
  • Intrauterine devices (IUDs) o Counted as barrier method in old books because they believe that the presence of a foreign body inside the uterus can prevent implantation. It has its own action that it causes a local inflammatory reaction in the area that can prevent a woman from getting pregnant
  • Surgical methods o Bilateral tubal ligation for female and vasectomy for male. NATURAL FAMILY PLANNING
  • Also called “periodic abstinence methods” o No chemical or foreign material into body o Failure rate ranges from 3% to 25% o Need for couple to be conscious of time period when woman is most likely to be fertile o Life span of the sperm is 7 days. Although the functional ability of the sperm to fertilize an egg cell is about 48 - 72 hours (2-3 days) but the sperm is still alive for 7 days. o The sperm deposited in the vagina will reach the cervix only after 8 0 seconds and reach the fallopian tube only after 5 minutes. o So, when the sperm gets inside, that means anytime a woman ovulates, and the sperm is still alive, there is a possibility that the woman will still get pregnant. o There’s about 400 million of sperm for ejaculation.
  • Abstinence o 0% failure rate o Most effective method to prevent sexually transmitted infections (STIs)
  • Periodic Abstinence o A method to avoid pregnancy by avoiding sex on the days a woman may conceive
  • Lactation amenorrhea method (LAM) o Safe method with failure of 1% to 5% if ▪ Infant under 6 months of age ▪ Breastfeeding with no supplements ▪ Menses has not returned
  • Coitus interruptus o 25% effective; doest not prevent STIs
  • Postcoital douching

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  • Combined oral contraceptive pills or COCS
  • If you are taking combined oral contraceptive pills, it produces a pseudopregnancy state. (fake pregnancy)
  • Hormones that cause fluctuations in the normal menstrual cycle to prevent ovulation or normal transport o Oral ▪ Should be taken everyday ▪ It takes 7 days for the pills to effect ▪ When the woman is taking pills and wants to get pregnant, it takes about 6-8 months for the anterior pituitary gland to recover. They are given fertility pills in the form of clomid or clomiphene citrate o Transdermal ▪ Every week either in upper arm or torso (4th^ week no patch) o Intravaginal ▪ Vaginal ring ( 4 th^ week no ring) o Intramuscular ▪ depo provera shots
  • Oral contraceptives (combination of hormones) o Monophasic o Biphasic o Triphasic ORAL CONTRACEPTIVES (PROGESTIN ONLY)
  • POP (Progestin Only Pills)
  • Can be used by breastfeeding mothers
  • Prolactin can only be produced by the body after placental delivery
  • Transdermal patches
  • Every week
  • The advantage of vaginal ring is that when it is placed in the vagina, the hormone will be released immediately and will not pass anywhere unlike pills
  • Hepatic first pass or first pass effect. These are the drugs that before being released into the systemic circulation, first pass through the liver, which is why the pills are contraindicated for those with liver disease.
  • Lunelle shot is the combination of estrogen and progesterone. (Every month injection)
  • Depo provera – used in health center contains only progesterone alone, can be used even when you are breastfeeding(every three months injection) CONTRACEPTIVES: INTRAUTERINE DEVICES (IUDS)
  • A small plastic device inserted into the uterus to prevent fertilization and/or decrease sperm motility by creating a local inflammatory reaction on the area o Copper T380 – lasts for 10 years o Mirena IUS – lasts for 5 years

CARE OF MOTHER, CHILD,

AND ADOLESCENT

LECTURE | SECOND SEMESTER

NUR

  • Warning sign: a string missing, longer or shorter. It can cause ectopic pregnancy
  • Progestasert which has 1 year effectivity
  • Contraindicated for people who have multiple sexual partners. It is easier for the infection to climb through the string leading to pelvic inflammatory disease. CONTRACEPTIVES: SURGICAL METHODS
  • Isthmus – thinnest part of fallopian tube, irreversible.
  • Vasectomy – vas deferens is cut, reversible but doctors consider this as irreversible because you are not producing a viable sperm because your body is producing an auto immune response killing your own sperm
  • No scalpel vasectomy – no scalpel, a sharp instrument is penetrated, can still do ejaculation, 95% seminal fluid no sperm REPRODUCTIVE LIFE PLANNING: EMERGENCY POSTCOITAL CONTRACEPTION
  • Morning after pill
  • For use in emergency only (such as rape) o High-dose progestin-based pills o Insertion of copper IUD
  • Levonorgestrel 1.5mg are available over the counter without a prescription by males or females
  • One or two pills containing a high dose of levonorgestrel, a progestin, are taken anytime within 72 hours (3 days) of unprotected coitus to interrupt a pregnancy.
  • Teratogenic. Harmful effects to the body. When the baby does not come out or the mother does not menstruate, anticipate DNC or dilatation and curettage. The child needs to be removed because if it is not removed, it can have a congenital defect REPRODUCTIVE LIFE PLANNING: ELECTIVE TERMINATION OF PREGNANCY (INDUCED ABORTION)
  • Termination of pregnancy performed by a knowledgeable health care provider to end a pregnancy before fetal viability
  • Reasons that elective terminations are most often requested are for a pregnancy that: o Threatens a woman’s life, such as pregnancy in a woman with class IV heart disease o Involves a fetus found on amniocentesis to have a chromosomal defect o Is unwanted because it is the result of rape or incest o Is unwanted because a woman chooses not to have a child at this time in her life for such reasons as being too young, not wanting to be a single parent, wanting no more children, having financial difficulties, or from failed contraception 2020 NATIONAL HEALTH GOALS RELATED TO REPRODUCTIVE LIFE PLANNING
  • Increase the proportion of adolescents who receive formal instruction on abstinence before 18 years of age from a baseline of 8 7.2% to a target of 95.9%
  • Increase the proportion of females less than 15 years of age who have never had sexual intercourse from a baseline of 82.9% to a target of 91.2% of males, from 82% to 90.2%
  • Reduce the proportion of females experiencing pregnancy despite use of a reversible contraceptive method from a baseline of 12.4% to a target of 9.9%

CARE OF MOTHER, CHILD,

AND ADOLESCENT

LECTURE | SECOND SEMESTER

NUR

Altered sexuality pattern related to fear of pregnancy (^)?