MCN 4th Quiz

MCHN 2 - LECTURE 4th
Quiz Coverage
Factors: FEMALES (35%)

NURSING CARE OF CLIENTS WITH GENERAL
DISTURBANCES IN REPRODUCTION AND SEXUALITY Cervical ➢ And vaginal: Factors that immobilizes sperm
OUTLINE:
Uterine ➢ Tumors or poor endometrial development
I. Infertility
II. Sexual Dysfunction ➢ Anovulation or faulty or inadequate production
Ovarian
III. Infection of ova
REFERENCE: Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal ➢ Poor ova transport from fallopian tube to the
Tubal
uterus
& child health nursing: Care of the Childbearing &
Childrearing Family (Eight ed., Vol. 1.) Factors: BOTH (20%)
INFERTILITY (SUBFERTILITY) Environmental ➢ exposure to radiation and chemicals

- Inability to conceive a child or sustain a pregnancy to birth
after at least 1 year of unprotected sex ➢ Abuse use of drugs
- Inability to conceive a child affects as many as 40% of Drugs ➢ Prolonged maintenance of drug that can lead
couples who desires children to infertility
- Couples exploring fertility testing, come in all different
patterns: Diet/Exercise ➢ Heavy exercise or faulty eating habit
➢ Many are married couples
➢ Some have plans to marry UNEXPLAINED (10%)
➢ Some desires to remain single but wants to bear
a child Assessment and Evaluation of Infertility
➢ some are gay or lesbian History:
- When a couple would pursue fertility counseling, they - Get thorough investigation or history taking of the couple
usually have fears and anxiety, not only about the inability & perform physical assessment due to the wide variety of
to conceive, but about what this condition means to their factors that may be responsible for infertility
future and their families.
● Female - continue to show low self-esteem as if the fault
Types of Subfertility: of being infertile is on them, wherein factors could also
Primary Subfertility Secondary Subfertility
apply to men.
○ Pregnancy History
No history of conception; no With history of viable pregnancy ➢ Current and past reproductive problems such
previous conception but unable to conceive at present as infection
➢ Assess for the overall health
Sterility - inability to conceive because of a known condition, ➢ Symptoms of thyroid dysfunction
ex. absence of uterus ➢ Any pelvic or abdominal operations that
could’ve compromised the blood flow of the
Causes of Infertility: pelvic organ
➢ Frequency of using vaginal douching, vaginal
Factors: MALES (35%)
prescriptions or sprays, which could interfere
➢ Problems & disorders concerning extragonadal with vaginal pH
endocrine, such as those originating in the ➢ Exposure to occupational hazards (x-rays or
hypothalamus, pituitary or adrenals toxic substances)
Pretesticular
➢ Have adverse effect on spermatogenesis; ➢ Assess whether the px can detect ovulation
Problems concerning in the amount of sperm or (s/s → breast tenderness, mid-cycle wetness,
low sperm count etc.)
○ Primary vs Secondary Subfertility
Primary defects of the testis (shape & morphology of
Testicular
the sperm) ➢ Hx of abortion to rule out subfertility
○ Intercourse
➢ Factors that affecting the ability of the sperm to ○ Menstrual History
travel from the site of production (testicle) to ➢ Age of menarche
leave the body upon ejaculation ➢ Length and regularity of menstrual period
➢ Problems are more on sperm motility ➢ Amount of blood flow
➢ Such as the problems that develop due to
Post-testicular
autoimmunity that immobilizes sperm
➢ Difficulties during menstruation
➢ Another is the problems in ejaculation or
(dysmenorrhea)
deposition, preventing spermatozoa from being ➢ History of contraceptives
placed close enough to the woman’s cervix, to
allow ready penetration & fertilization. ● Males
KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 1 .
MCHN 2 - LECTURE 4th Quiz Coverage
○ General health ➢ This factor may interfere with improper
➢ Nutrition deposition of the sperm
➢ Alcohol intake ➢ Another problem attributed to psychological
➢ Drug or tobacco use causes
➢ Congenital problems such as hypospadias ➢ Adolescents may experience this until they
➢ Childhood illness such as mumps, chitis, UTI become more experienced in sexual activity
➢ Illnesses or low-grade infections
● Ova..
➢ Occupation: Work habit
- Monitor and check for production of ova or ovulation
○ Reproductive History
○ Anovulation
➢ STDs
➢ Absence of ovulation
➢ Surgical history (operation or repair of hernia
➢ Common cause of infertility
that could have compromised the testes)
➢ Frequency of coitus and masturbation ➢ Genetic condition → Turner’s Syndrome or
hypogonadism, in which there are no ovaries to
➢ Failure to achieve ejaculation or premature
produce ova, resulting from imbalance caused
ejaculation
by Hypothyroidism. This interferes with the
➢ Coital position used, use of lubricants and hypothalamus, pituitary, & ovarian interaction
past contraceptive measures
➢ Ovarian tumor
○ Previous Children
■ Feedback stimulation to the pituitary
● Both
■ Ova is not produced due to absence of
○ Lifestyle (STD's, contraceptives, smoking, exercise,
ovulation
occupation)
■ Excessive exposures to x-ray, substance
abuse, general illness, poor diet, and
Diagnosis:
stress can lead to decrease or absence
• Sperm / Semen Analysis..
in ovulation
○ Abstain from sexual intercourse within 2-4 days prior
■ The most frequent cause is naturally
to the procedure
occurring variations of ovulatory
○ During the procedure, the male is instructed to
patterns such as PCOS → can also lead
ejaculate by masturbation in a clean & dry specimen
to anovulation
jar, in which the spermatozoa would then be
➢ Diagnostic Test:
examined under a microscope within 1 hour.
■ Ovulation recording → Record basal
○ The number of spermatozoa is counted and,
body temperature at least one month
appearance and motility are noted
to determine the woman’s
○ Average ejaculation should produce 2.5-5ml of semen
temperature every morning, before
and should contain a minimum of 20 million
getting out of bed using a specialized
spermatozoa per mL of fluid.
thermometer or tympanic
○ Average normal sperm count is 50-200 million per ml
thermometer. Plot temperature daily
○ The male is also instructed on a repeat of procedure
on a monthly graph, noticing conditions
after 2-3 months because spermatogenesis is an
that might affect temperature such as
ongoing process that needs 30-90 days for a new
colds, infection or sleeplessness. A
sperm to reach maturity
woman’s temperature will slightly go
○ Ejaculation Problem or Sperm transport disorder
down in the middle of menstrual cycle,
➢ Includes erectile dysfunction or impotence and
& rises sharply indicating ovulation.
Premature ejaculation
Towards the end of the cycle,
○ Erectile dysfunction/ Impotence à inability to
temperature on 24th day starts to
achieve erection (primary & secondary)
decline indicating that progesterone
➢ Primary Erectile Dysfunction → was not able to levels are falling and she didn’t
achieve erection or ejaculation ever since conceive.; least costly
➢ Secondary Erectile Dysfunction → has achieved
erection or ejaculation in the past but in the ● Tubal patency (PID related) ..
present time is experiencing difficulty - Assess for the fallopian tube structure via UTZ or x-ray
➢ Difficult to solve when associated with stress. imaging
Solution to the problem is to include - Not only it can determine the patency of the fallopian
Psychological & sexual counseling counselling, tube, but also assess the depth and consistency of the
and administration of medication & drugs such endometrial linings
as Sildenafil or Viagra. - Assess for the tubal patency to determine tubal
➢ Inadequate sperm count transport problems
- Difficulty on tubal transport usually occurs because of
the scarring that has developed on the fallopian tube.
○ Premature Ejaculation or Ejaculation Before This is typically caused by Chronic Salpingitis - a
Penetration condition in which is one of the causes of Pelvic

Inflammatory Diseases (PID), resulting on a ruptured this helps date the endometrium and accuracy of
appendix from the abdominal surgery involving the analysis
infection that spread to the fallopian tube and left
adhesion formation in the tubes. Management:
● Pharmacologic
Diagnostic Test: ○ Sildenafil (Viagra)
○ UTZ (sonohysterosalpingogram) ■ Used to treat male sexual function problems
➢ Ultrasound technique designed for inspecting such as impotence or erectile dysfunctions, in
the uterus and fallopian tube combination with sexual stimulation.
➢ A sterile Saline solution is introduced through a ■ This works by increasing blood flow to the penis
narrow catheter inserted into the uterine cervix to help a man get and keep an erection
➢ A transvaginal UTZ transducer is inserted in the ○ Dapoxetine
vagina to inspect the uterus for any ■ A selective serotonin reactive inhibitor which is
abnormalities such as septal deviation, or specially formulated for premature ejaculation.
presence of myomas, and also to assess for the ■ This increases the time it takes to ejaculate and
patency of the fallopian tube can improve the control of ejaculation. It starts
to work quickly, so it is taken when one would
➢ Because this is a minimally invasive technique, it
can be done anytime during the menstrual cycle. anticipate sex, rather than taking it every day.
■ One should take it 1-2 hours before an individual
○ Transvaginal Hydrolaparoscopy
would engage in sexual activities.
➢ Allows direct visualization of female
○ Hormone therapy (Clomiphene citrate or clomid,
peritoneal cavity
letrozole, bromocriptine)
➢ A trocar is passed through the vagina into the ■ For couples who are unable to have children,
pouch of douglas, and an optic scope is hormone treatment can increase the chance of
placed through the trocar sleeve allowing pregnancy.
close examination of the uterus, ovaries, ■ The inability to have children can be attributed
fallopian tube, and peritoneum to hormonal imbalance, although hormonal
➢ No abdominal incision is required and the causes can be both present in men and women.
procedure can be accomplished in the office ■ This is usually performed for women. Hormone
setting treatment done on women aims to promote egg
○ Uterine endometrial biopsy maturation and triggers ovulation, which
➢ Used as a test for ovulation or to reveal an increases the likelihood of fertilization
endometrial problem ■ Clomiphene Citrate or Clomid → oral medication
➢ Usually done 2-3 days before expected that is often used to treat certain types of female
menstrual flow, or day 25-26 of a typical 28 days infertility. Clomid works by making the body
cycle think that estrogen levels are lower than they
➢ The procedure will start with a paracervical block are, which causes the pituitary gland to increase
or anesthesia, then a thin probe and biopsy secretion of FSH and LH. Clomiphene Citrate
forceps are introduced through the cervix blocks estrogen receptors.
➢ Mild to moderate discomfort from maneuvering ■ High levels of FSH stimulates the ovaries to
the instruments produce an egg cell or multiple follicles that will
➢ There may be a moment of sharp pain as the develop and release during ovulation.
biopsy specimen is taken from the anterior- ■ High level of LH stimulates ovulation
posterior uterine wall ■ Letrozole → widely used in women with breast
➢ Possible Complication: cancer. Sold under the trade name Femara.
■ Excessive bleeding Belongs to the classification aromatase inhibitor.
■ Pain Aromatase is an enzyme responsible for the
■ Infection production of estrogen in the body. Letrozole
● Acute PID works by inhibiting aromatase, thereby
● Cervicitis suppressing estrogen production.
■ Uterine perforation ■ Clomiphene Citrate and Letrozole therapy result
in the pituitary gland to produce more hormones
➢ Contraindications:
to stimulate the ovaries.
■ Pregnancy or suspected pregnancy
■ FSH and LH can cause development of ovulation
■ Infection such as PIDs and Cervicitis
in women who are anovulatory or increase the
➢ Instruct women that there would be vaginal
number of eggs developing in the ovaries of
spotting after procedure
women who already ovulates
➢ Instruct to call healthcare provider if there is ■ Bromocriptine → belongs to the group of
fever and large amount of bleeding with passage medicine Ergot Alkaloids. This blocks the release
of large clots of hormone prolactin from the pituitary gland.
➢ Instruct the women to inform the healthcare Prolactin affects the menstrual cycle and milk
agency about the return of menstrual flow as production. Bromocriptine is used to treat:

✓ Certain menstrual problems like ■ Alternative lifestyle to both fertile and
amenorrhea in women infetile couple
✓ stops milk production in some men & ■ For many infertile couple who have been
women who have abnormal milk through the rigor and frustration of infertility
leakage. testng and unsuccessful regimen
✓ infertility in men and women that is due ■ Advantages:
to overproduction of prolactin ✓ It allows time for both to pursue their
○ Antibiotic therapy careers
■ Given if underlying cause is brought about by ✓ Travel more and pursue hobbies
infection such as in PID ✓ Continue education
● Cannalization of fallopian tube or Recanalization Of Client Education:
fallopian tube 1. Provide information of the different tests and procedures
○ A nonsurgical procedure to clear the blockage in the and possible outcomes
fallopian tube. 2. Self-care awareness regarding infertility
○ Performed through a speculum placed in a vagina, ➢ Avoid douching → can alter pH of vaginal secretion
and a small plastic tube is inserted into the cervix to ➢ Promote retention of sperm after coitus → right
the uterus, then a liquid contrast agent is injected positioning
through a catheter and the uterine cavity is examined ➢ Maximize the potential for fertilization →
on a nearby monitor using an xray camera. monitoring of ovulation and right timing of coitus
○ If blockage is determined and is located on one or
➢ Avoid anxiety and stress
both fallopian tube, thread a small catheter through
➢ Maintain adequate nutrition (for both)
the first catheter into the fallopian tube to clear the
3. Empowering realistic expectations
blockage
● Adhesiolysis ➢ Help them set up realistic goals and expectations
○ The removal of adhesions in any part of the to prevent devastation
abdominal cavity 4. Provide emotional support
○ Adhesions can form from any type of trauma to the ➢ Help them get through by uplifting them
abdomen. However, they are the most common side emotionally and offering genuine encouragement
effects of abdominal surgery. to reassurance and compassion
○ Infertility adhesion can cause female reproductive 5. Create or refer to support groups
problems by obstructing ovaries or fallopian tubes. ➢ Often described to be extremely isolating, they
○ It can also be a cause of painful intercourse in some may feel like they are the only couple experiencing
people this
○ If doctors suspect adhesions are causing the ➢ Let them communicate with couple who have the
reproductive issue, they may recommend surgery to same experience
remove the adhesions. ➢ Talking to others with the same situation can be a
○ A laparoscope (a long thin tube that contains a stress reliever and can help battle the feelings of
camera and light) is inserted into an incision and isolation
helps the surgeon find the adhesions to remove them 6. Promote a positive self-image
➢ With this, we help them recognize their own assets
Nursing Management: and potential while being realistic with their
● Educate/Counseling couples on the variety of tests liabilities and limitations
○ Couples have to undergo series of diagnostic testing ➢ Negative self-image focuses on the faults and
and procedures in order to determine problems of weaknesses, distorting failures and imperfections
infertility ➢ Self-image is important because how we think
○ Prior to availing the tests, inform the how procedure about ourselves affects how we feel about
is being performed and what is expected of them ourselves and how we interact with others and the
● Allow couples to express thoughts on subfertility and world around us
sterility
➢ A positive self-image can boost our physical,
○ Infertility causes anxiety and emotional stress to the
mental, social, emotional, and spiritual well-being
individual or couple
○ Listen to them and help them express their concerns
ALTERNATIVE INSEMINATION
○ Let them ventilate their feelings of anxiety
■ Relieves the tension and air out the feelings - Other management for
of frustration and disappointments infertility
● Reinforce options on alternative childbirth techniques - also known as artificial
○ Surrogate mothers insemination
■ Women who agree to carry pregnancy to - Instillation of sperm into the
term for an infertile couple female reproductive tract to aid
○ Adoption - viable alternative for an infertile couple conception
○ Child-free living
- Types: (the routes where the sperm is being introduced)

➢ Intracervical insemination→ installed into the - Removing 1 or more mature
cervix oocyte from a woman’s
➢ Intrauterine insemination→ injected directly in the ovary through laparoscopy
uterus - It is then fertilized by
- The couple could either choose from using the husband’s exposure to sperm under
sperm or a donor’s sperm laboratory conditions
➢ Artificial insemination by husband outside the woman’s body
➢ Artificial insemination by donor or therapeutic - About 40 hours after
donor insemination fertilization, the laboratory grown fertilized ova are
inserted into the woman’s uterus. Ideally one or more of
- This technique can be used if:
them will implant and grow.
➢ The man has inadequate sperm count
- Indicated to couples who have not able to conceive
➢ Woman has vaginal or cervical factors that because:
interferes with sperm motility
➢ Woman has a blocked or damaged fallopian tube
➢ Man has known genetic disorders and he does not
➢ Man has oligospermia (low sperm count)
want to transfer to his offspring
➢ Woman has cervical factors that interferes the
➢ Man has had a vasectomy but wishes to have
sperm’s motility (e.g. antisperm antibody causing
children again
immobilization of the sperm)
- Cryopreserved sperm
➢ Unexplained infertility for a long duration
➢ Sperm is placed in a sperm bank to be frozen
➢ Women can opt to have donors or donor ovum if
➢ This can be done for men who have testicular
she has genetic disorders or known sex-linked
cancer. Before they undergo radiation, they can
disorders which could be passed to the children
have their sperm cryopreserved for future use
- Before the procedure:
Advantage Disadvantages ➢ Women is given an ovulation-stimulating agent →
Clomiphene citrate (Clomid)
Can be used after years of Slower motility than unfrozen sperm
➢ Beginning about the 10th day of the menstrual
storage
Lower rate of conception cycle, the ovaries are examined daily by ultrasound
● But no increase in the incidence of to assess the number and the size of the
genital anomalies in children developing ovarian follicle
conceived by this method ➢ When a follicle appears to be mature, the woman
- Preparation for women for artificial insemination: is given an injection of hCG which causes ovulation
in 38-42 hours
➢ Record basal body temperature
- Harvesting procedure:
➢ Monitor ovulation
■ Assess cervical mucus or use ovulation predictor
➢ A needle is introduced intravaginally guided by
kit to predict her likely days of ovulation ultrasound
➢ On the day after ovulation, the selected sperms are ➢ The oocyte is aspirated from its follicle
delivered to her cervix using a device similar to a ➢ Often many oocyte ripens at once and perhaps as
cervical cap or diaphragm (intracervical many as 3-12 can be removed
insemination) ➢ Oocytes are incubated for at least 8 hours to
➢ Or they inject the sperm directly into the uterus ensure viability
using a flexible catheter (intrauterine ➢ Meanwhile, the husband or the donor supplies a
insemination) fresh semen specimen
- If therapeutic donor insemination is selected, the donors ➢ The sperm cells and oocytes are mixed and allowed
are usually volunteers to incubate in a grown medium
➢ Who has no hx of disease - After fertilization of the chosen oocyte:
➢ No family hx of possible inheritance disorders ➢ The zygote formed almost immediately begin to
➢ Blood type and Rh factor should match the woman divide and grow
to prevent incompatibility ➢ By 40 hours of fertilization, they will have
- If a woman desires to get a frozen sperm or a sperm from undergone their first cell division
the sperm bank, she can select according to her desired ➢ Fertilized eggs are examined and if they are
physical and mental characteristics normal, they are transferred back to the uterine
- Legal issues that need to be considered: cavity through the cervix by means of a thin
➢ Depending on the state on what specific law catheter
regarding inheritance about child support, ➢ In some instances, progesterone may be given to
responsibility concerning children conceived by the woman if the she cannot produce enough
this method progesterone on her own to support the
➢ Religious & ethical beliefs that prohibits them from implantation
using this method ➢ Once pregnancy is successfully established, the
- Takes about 6 months to achieve conception woman’s prenatal care is the same as that for any
IN VITRO FERTILIZATION pregnancy

✓
Result of early learning pattern in
Nursing Considerations: which sexual relations were viewed
● Supply support and counseling to sustain the couple as bad and sinful
through this process ■ Psychological counseling is needed to
● Couples needs empathic support from their reduce this response
healthcare providers through this difficult time ➢ Vestibulitis
■ Inflammation of the vestibule
SEXUAL DYSFUNCTION ■ Due to:
- A problem that can happen during any phase of the sexual ✓ Endometriosis - abnormal placement
response cycle and prevents the individual from of the endometrial tissue
experiencing satisfaction from sexual activity ✓ Vaginal infection
✓ Hormonal changes - those that occur
1. Desire disorders at menopause and causes vaginal
➢ Lack of sexual desire or interest in sex drying
➢ Decrease in sexual desire can be a side effect of ✓ Psychological component may be
medicine or a chronic disease (e.g. peptic ulcer, present
chronic pulmonary disorders) that causes frequent ■ Treatment is aimed at the underlying cause
pain or discomfort ■ Encouraging open communication between
➢ This can interfere the overall well-being of the the sexual partners is necessary
person and sexual activity
➢ A concern for both men and women Premature Ejaculation
2. Arousal disorders ➢ Ejaculation before penile-vaginal contact
➢ Inability to become physically aroused or excited ➢ Also used to mean ejaculation before sexual partner
during sexual activity achieves satisfaction
➢ Can be caused by physical and physiological factors ➢ Can be unsatisfactory and frustrating to both partners
or both ➢ May be due to doubt about masculinity and fear of
➢ Careful assessment is needed to help clarify the impregnating a woman which prevents the men from
cause of the problem sustaining an erection
➢ Sexual counseling for both partners to reduce may be
3. Orgasm disorders helpful in alleviating the problem
➢ Delay or absence of orgasm
➢ Failure of women to achieve orgasm can be a result Persistent Sexual Arousal Syndrome - excessive sexual arousal
of: in the absence of desire
✓ Poor sexual technique Etiology:
✓ Concentrating too hard on achievements ● Urologic problems
✓ Negative attitude towards sexual ● Chronic conditions - peptic ulcer, pulmonary problems
relationships ● Hormonal imbalances
● Alcohol and drugs
➢ Treatment is to relieve the underlying cause
● Nerve damage
✓ May include instruction and counseling for
● Psychological in origin
the couple about sexual feelings and needs
➢ Occurs in both men and women Signs and Symptoms:
➢ Instruction and counselling can help ● Lack of sexual desire = decrease in libido
● Difficulty aroused
4. Pain disorders (Dyspareunia) ● Pain during intercourse
➢ Pain during intercourse
➢ Since the reproductive system has a sensitive Management:
nerve supply, when pain occurs in response to ● Counselling and behavior modification
sexual activities, it can be acute or severe and ○ Counsel and educate couples about sex, sexual
impairs the person’s ability to enjoy this segment behaviors and responses
of life ○ This may help an individual overcome his and her
➢ Vaginismus anxiety about sexual functions
■ Involuntary contraction of the muscles at ○ Open dialog with the partner about the needs and
the outlet of the vagina when coitus is concerns also help overcome many barriers to a
attempted healthy sex life
■ Muscle contraction prohibits penile ● Sildenafil - drug for erectile dysfunction
penetration ● Mechanical aids
■ Occur in: ○ Aids a vacuum device in penile implants and may
✓ Women who were raped help men with erectile dysfunction
○ A vacuum device has been approved for women
but it can be costly

○ Dilators may help women who have experienced ■ Infects the urinary tract
narrowing of the vagina ■ Often causes no symptoms
● Psychotherapy - counseling with a trained counselor can ○ In women:
help a person address: ■ Infects the vagina
○ Sexual trauma from the past ■ Might cause symptoms
○ Fear and anxiety ■ Increases the risk in acquiring other STIs
○ Feeling of guilt
○ Poor body image Signs and Symptoms:
○ These may have an impact on sexual function ● Discharges - changes in color, odor, amount
● Vaginal itching and irritation (causes redness and
Nursing Consideration: swelling)
● Educate on preventing sexual dysfunction ● Odor
● Diet modification ● Dysuria - painful urination
● Control health and treat health problems if comorbidities ● Pain or bleeding (light; spotting) upon sex
are present
Nursing Considerations:
INFECTION ● Explain the importance of complete course of antibiotic
Vaginitis therapy to - prevent resistance to the drug
● Avoid irritants
- Inflammation of the vagina that can result from
○ Douching
discharges, itching and pain
○ Scented products unto the vagina
- The cause is usually a change in the normal balance of
■ Pads
the vaginal bacteria or an infection
■ Tampons
- Reduced estrogen level after menopause and some skin
■ Soaps
disorder can also cause vaginitis
○ Rinse soap from outer genital area after a shower
and dry the area well to prevent irritation
Atrophic vaginitis
■ Do not use harsh soaps with deodorant,
- Thinning of tissues and less moisture (e.g. menopause,
antibacterial action, or bubble bath
estrogen)
○ Regularly change sanitary pads
● Practice protected sex - use of latex condoms
Etiology:
○ For both male and female, latex condoms may help
● Yeast infection - antibiotics,
in avoiding infection spread by sexual contact
hormone therapy, diabetes
○ Overgrowth of fungal
organisms. Usually Pelvic Inflammatory Disease (PID)
caused Candida - Infection of the female
albicans in the vagina reproductive organs spreading
○ Candida albicans can from the vagina to uterus,
also cause infection in other moist areas of the fallopian tubes or ovaries
body such as: - Ascending infection in the
■ Mouth in the form of oral thrush upper genital tract caused by
■ Skin folds polymicrobial organisms
■ Nail beds - This may include infection of
○ The fungus can also cause diaper rash any of the ff. anatomical
● Bacterial vaginosis - STI structure:
○ This common cause results from the change of ➢ Endometrium ➢ Uterine serosa
normal bacteria in the vagina
➢ Oviduct ➢ Broad ligaments
○ To overgrowth of one of several organisms
normally in the vagina (e.g. lactobacilli) are ➢ Ovary ➢ Pelvic peritoneum
outnumbered by other bacteria such as anaerobes ➢ Uterine wall
○ If anaerobic bacteria become too numerous, they Signs and Symptoms: mild - difficult to recognize; some do not
upset the balance and cause bacterial vaginosis show s/s
○ This type of vaginitis is linked to sexual intercouse. ● Pain in your lower abdomen and pelvis
Especially if a person has multiple sexual partners ● Heavy vaginal discharge with an unpleasant odor
or a new sex partner ● Abnormal uterine bleeding, especially during or after
○ But it also occurs in women who are not sexually intercourse, or between menstrual cycles
active ● Pain or bleeding during intercourse
● Trichomoniasis ● Fever, sometimes with chills
○ Caused by Trichomonus vaginalis (one-celled ● Painful or difficult urination
parasite)
○ Spread through sexual intercourse with individuals Etiology:
who have the infection ● STDs (gonorrhea & chlamydia- most common) - acquired
○ In men: during unprotected sex
● Less commonly: Signs and Symptoms: has a significant impact on the quality of
○ Bacteria can enter into the reproductive tract life but in most cases, they will gradually improve overtime with
anytime and the normal barrier created by the treatment
cervix is disturbed ● Dysuria, nocturia, hematuria
○ Can happen during menstruation, childbirth, ○ Pain while urinating
miscarriage or abortion ○ Frequency and urgency in peeing particularly at
● Rarely: night
○ Bacteria can enter into the reproductive tract ○ Stopped peeing
during the Insertion of intrauterine device (IUD) → ● Pain in the abdomen, groin or lower back
form of long-term birth control ● Pain in the area between the scrotum and rectum
○ Any medical procedures that involve inserting ● Pain or discomfort of the penis or testicles
instruments in the uterus ● Fever → typical sign of infection
● Enlargement or tenderness of the prostate gland upon
Risk Factors: rectal examination
● Sexually active > 25 years of age ● Sexual problems can be present:
● More than one sexual partner or ○ Erectile dysfunction
being in a relationship with a ○ Painful ejaculation
partner who has had multiple ○ Pelvic pain after sex
partners
● Unprotected sex Epididymitis
● Douching regularly - upset the - The tube or the epididymis at the back of the testicle
balance of good and harmful becomes swollen and painful
bacterias (can mask symptoms) - Often caused by an infection
● History of PID or STIs - Usually treated with antibiotic
- If the testicles are also
Diagnosis: affected, it can be called
● Pap smear epididymo-orchitis
● Culture & Sensitivity Testing (vaginal secretions)
● UTZ Signs and Symptoms:
● A swollen, red or warm
Nursing Consideration: Aims to reduce the risk of pelvic scrotum
inflammatory disease ● Testicle pain and tenderness
● Encourage to practice safe sex and use of contraception ● Dysuria → pain upon urination
○ Use condoms every time an individual engages into ● Discharge from the penis
sex ● Pain or discomfort in the lower abdomen or pelvis
○ Limitation of #’s of sexual partners ● Blood in the semen
○ Ask about potential partner sexual history ● Fever → typical sign of fever
○ The use of birth control pills does not protect
against the development of PID. Using barrier Etiology:
methods such as condoms helps reduce the risk of ● Current UTI (less common in men)
PID. ● STI - More likely in younger men < 35 y.o.
● Avoid douching - upsets the balance of bacteria in the ○ Chlamydia
vagina ○ Gonorrhea
● Groin injury (epididymitis)
Treatment: ○ Undergone surgery to the groin, prostate and
● Antibiotics (same with partner) - since PID is commonly bladder
caused by STIs
● Temporary abstinence Treatment:
● Antibiotic
Prostatitis
- Inflammation or swelling Nursing Consideration:
on the prostate gland ● Lie down with elevated scrotum
- Can be very painful and ● Cold packs over scrotum to alleviate pain and discomfort
distressing but will often ● Avoid lifting heavy objects
get better eventually ● Abstinence
- Prostate → a small gland ● Avoid alcohol, caffeine, spicy and acidic foods that irritate
that lies in between the bladder
penis and bladder; it produces fluid that is mixed with ● Encourage increase in water intake
sperm to create semen
- Can come at any age but usually between the ages 30-50
years old

NURSING CARE OF CLIENTS WITH SPECIFIC Treatment:
DISTURBANCES IN REPRODUCTION & SEXUALITY ● Steroid Cream
OUTLINE: ● Circumcision
I. Infants
A. Phimosis
B. Hypospadias
C. Epispadias & Exstrophy Complex
D. Cryptorchidism
E. Hydrocele
II. Adolescents
A. Varicocele HYPOSPADIAS
III. Adult Women - Abnormal ventral placement of
A. Breast Cancer the urethral opening on the
B. Fibrocystic Breast underside of the penis.
C. Fibroadenoma of the Breast - This is a kind of birth defect or
D. Dysmenorrhea congenital condition in which the
E. Imperforated Hymen opening of the urethra is on the
F. Premenstrual Syndrome underside instead at the tip.
G. Menopausal Syndrome - The urethra is the tube through
IV. Adult Men which urine drains from the
A. Benign Prostatic Hyperplasia bladder and exits from the body.
- This is common and doesn’t cause
REFERENCE: Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal difficulty caring for this infant
& child health nursing: Care of the Childbearing & - Surgery usually restores the appearance of the child’s
Childrearing Family (Eight ed., Vol. penis.
- With successful treatment of hypospadias, most males
INFANTS can have normal urination
PHIMOSIS
- The inability to retract the foreskin Signs and Symptoms:
from the glans of the penis ● Opening of the urethra is at the location other than the
- A condition in which the foreskin tip of the penis
can’t be pulled back or retracted ● Downward curvature of the penis → Chordee
from around the tip of the penis ● Hooded appearance of the penis because only the top
- A tight foreskin is common in baby half is covered by foreskin, and there is abnormal pain
boys who aren’t circumcised, but during urination
usually stops being a problem by
the age of 3. Nursing Consideration:
- Can occur naturally or be the result of scarring ● No circumcision or circumcision should be avoided as this
- Young boys may not need treatment unless it makes foreskin should be used for surgical repair
urination difficult or causes other symptoms ○ Surgery is performed for the correction of
- BALANITIS: hypospadias and the insertion of catheter is
➢ inflammation of the phimotic foreskin or the placed for urinary diversion
inflammation of the glands or head of the penis due ○ Part of the nursing care is catheter care
to infection or other causes ● Urinary diversion: position drainage bag at lower level
➢ Can be uncomfortable and sometimes painful, but it ○ To facilitate continuous flow of the urine
is not usually serious that can be relieved with ○ Part of the nursing care is catheter care
topical medication ○ Aseptic technique should be observed to prevent
ascending infection
Nursing Consideration ● Avoid tub baths, straddle toys, sand boxes, swimming and
● Proper hygiene rough activities
● Do not forcibly retract the skin or else other problems ○ Most children will self-limit their activity, so if the
might occur such as Paraphimosis child is older and active, encourage quiet play
● Paraphimosis during the first few weeks after surgery
○ a urologic emergency in which the retracted ○ Avoid contact sports, gyms, straddle toys, sand
foreskin of an uncircumcised male can’t return to its boxes, swimming and rough activities while the
normal anatomical position. catheter is in place.
○ It is important to recognize this condition promptly
as it can result in gangrene and amputation of the Pharmacologic Management:
glans penis ● Anticholinergic (Oxybutynin)
○ Used to treat Bladder spasm for patient with
hypospadias
Treatment: CRYPTORCHIDISM
● Surgical correction at 6-12 mos. Of age - Failure of one or both testes to descend through the
● Testosterone (pre-op medications) to increase the size of inguinal canal into the scrotum
the penis - Also known as Undescended Testicle
● The goal of the treatment: - Usually, 1 testicle is affected but 10% of cases, both
○ Improve the physical appearance testicle are undescended
○ To be able to void in standing position - Undescended testicle is uncommon in general, but
○ To have a sexually adequate organ common among babies born prematurely
- The vast majority of the time the testicle moves into the
proper position on its own within the first few months of
life.
- If your son has undescended testes that don't correct
itself, surgery can relocate the testicle into the scrotum.
Signs and Symptoms:

● Absence of testes in the scrotum
EPISPADIAS & EXSTROPHY COMPLEX ○ Main sign of undescended testicle
- Bladder exstrophy: ○ Testicles formed in the abdomen during fetal
development, on the last couple of months of
➢ severe defect involving the musculoskeletal
normal fetal development, the testicle gradually
system and urinary, reproductive and intestinal in
descend in the abdomen through a tubelike
some cases
passageway in the groin or inguinal cavity into the
➢ Congenital anomaly, that is present at birth, scrotum
which occurs when the skin over the lower ○ With an undescended testes, that process
abdomen, or abdominal wall at the bottom part (mentioned above) stops or it is delayed
of the stomach is not formed properly ● Can be either:
➢ The bladder is open and exposed to the outside of ○ Acquired undescended testes
the abdomen ○ Retractile testes on warm baths
➢ Exstrophy → turned inside out
➢ All boys with bladder exstrophy also have
epispadias, and occurs on its own
- Epispadias:
Boys Girls
➢ Failure of urethra to close; ➢ The opening of the urethra

opening at the dorsal of the is higher and wider than
penis usual
➢ The urethra is not formed ➢ The labia are further apart
properly than normal Treatment:
➢ The urethra may be short in ➢ the clitoris is split into 2. ● Spontaneous descend c/in 6 mos. Of life
split & as a result, it emerges at ○ Testicles move onto its proper position on its own
the top surface of the penis ● Surgery is ideal at 12-18 mos. of life
➢ This may involve at the full ○ In cases of testicles not descending on its own, or
length of the penis, making the doesn’t correct itself, surgery is performed to
penis short and broad
relocate the testes back into the scrotum
● Orchiopexy → done at 6-24 mos. of life
Nursing Consideration: ○ Surgical procedure in which the undescended
● Clamp cord with soft umbilical tape or silk suture testicle is moved down to its proper place in the
○ Remember that the bladder is open and exposed scrotum
to the outside of the abdomen
● Parenteral support Nursing Consideration:
○ The key dimension to effective parenting ● Pain management
○ We have to take note that this patient is a special ○ Since the patient will undergo surgical procedure,
patient, because they need special care pain medications are given
○ Parents should show indication that the child is ● Keep post-op site free from stool and urine
accepted and loved ○ Take note of the anatomical position of the site
and the possibility of being contaminated with
Treatment: stool and urine
● Surgery ● Avoid rough sports and straddling
○ Surgery performed in the genital area, particularly
the scrotal area

● Remind the parents to teach child Testicular Self ADOLESCENTS
Examination (TSE) starting puberty - Are likely to face a range of health and social challenges.
In this area, some of the reproductive disturbances that
would alter their normal wellbeing is expounded.
VARICOCELE
- Elongation, dilatation &
tortuosity of the veins of the
spermatic cord.
- An enlargement of the vein
HYDROCELE within the loose bag of skin
- Presence of peritoneal fluid in the scrotum between the that holds the testicle or
parietal and visceral layers of the tunica vaginalis. scrotum.
- Most common painless scrotal swelling in children - Similar to varicose veins we
- Swelling in the scrotum that occurs when the fluid collects would see on the legs
in the thin sheet surrounding the testicle - Common cause of:
- Common in newborns ➢ Low sperm production
- Usually isn’t painful or harmful and disappears without ➢ Decrease sperm quality, which can cause
treatment by age 1 infertility, however, not all varicocele would affect
- Other boys and adult men can develop hydrocele due to sperm production
inflammation or injury within the scrotum ➢ Can also cause the testicle to fail to develop or
shrink
Types of Hydrocele: - Most varicocele develop overtime
- Communicating: - Most varicocele are easy to diagnose and may not need
➢ A hydrocele that has an opening into the treatment
abdominal cavity - If varicocele causes symptoms, it’s often that it could be
➢ The opening allows the abdominal fluid to pass repaired surgically
into the scrotum
➢ open process vaginalis Signs and Symptoms:
● Wormlike mass above the testes
➢ If it doesn’t go away on its own and is not treated,
● Decreased testes
it can lead to an Inguinal Hernia (parts of the
● Decreased dihydrotestosterone
intestine or intestinal fat pushes through an
● Rarely causes pain, but pain may vary from sharp to dull
opening into the groin)
○ Increased pain when standing or physical exertion
- Noncommunicating:
over long periods
➢ Less serious than the former
○ Pain worsens over the course of the day
➢ Usually remains the same size or has a very slow ○ Relieves when the person lies down on his back
growth ○ Causes impairment in fertility
➢ No connection with peritoneum; secondary to
trauma, infection, torsion. Treatment:
● Varicocelectomy
○ Surgical procedure that removes the enlarged
veins and it is done to restore proper blood flow to
the reproductive organ
ADULT WOMEN
BREAST CANCER
- Cancer that forms into the cells of the breast after a skin
cancer.
- Most common cancer diagnosed in women
Treatment: - Can occur in both men and women, but is more common
● Surgery in women
○ Communicating hydrocele corrected w/in 1 year - Survival rates have increased and the number of deaths
Nursing Consideration: associated with this disease is steadily declining
● Swelling & discoloration is temporary - Decline in death rates is largely due to factors such as:
● Dressing change every day ➢ Early detection
● Bathe 3 days after surgery ➢ New personalized approach to treatment
● Avoid straddle toys for 2-4 weeks. ➢ Better understanding of the disease

● Radiation Therapy
○ Cancer treatment that uses beams of intense
energy to kill cancer cells
○ Most often used x-rays, but proton or other types
of energy can also be used
○ Most often refers to external beam radiation
therapy
○ Damages cells by destroying the genetic material
that controls how cell grows and divide
○ Both healthy and cancerous cells are damaged
Signs and Symptoms ○ Goal: to destroy as few healthy cells as possible
● A breast lump or thickening that feels different from the ○ Normal cells can repair the damage caused by
surrounding tissue radiation
● Change in the size, shape or appearance of a breast
particularly during SBE Nursing Consideration:
● Changes to the skin over the breast, such as dimpling ● Chemotherapy support
● Nipple changes or A newly inverted nipple ○ Hope aids in overall health and well-being of an
● Peeling, scaling, crusting or flaking of the pigmented area individual
of skin surrounding the nipple (areola) or breast skin ○ Support from family, friends and healthcare
● Redness or pitting of the skin over your breast like a skin provider has a value to participate as the patient
of an orange deal with the disease treatment
● Hydration
○ Providing adequate hydration can counter the
effect of dehydration
○ Dehydration accounts for a significant number of
unplanned visits in cancer clinics or emergency
room
● Address body change concerns
○ Body image concerns have been attributed to loss
of breast from surgery which results physical
changes such as:
■ Scarring from the adjuvant treatment
(additional treatment to prevent cancer
from returning)
Treatment: ○ All of which has an impact on overall quality of
● Lumpectomy life, particularly body image perception
○ Surgical procedure to remove
the cancer or other abnormal FIBROCYSTIC BREAST
tissue from the breast - Nodular or glandular breast tissue
○ Aka breast-conserving surgery - Breasts are composed of tissue that feels lumpy or rope-
○ A wide location incision, only like in texture
portion of the breast is - More than half of women experience fibrocystic breast
removed changes at some point in their life
○ A small amount of tissue around the lump is taken - Medical professionals have stopped using the term
to help ensure that all cancer cells and abnormal fibrocystic breast disease, and simply refer to it as
tissues are removed fibrocystic breast.
○ Only the tumor is removed - Breast changes because Fibrocystic breast isn’t really a
● Mastectomy disease and breast changes categorized as fibrocystic is
○ Surgical procedure wherein all breast tissues is considered normal
removed as a way to treat or prevent breast - Although many women with fibrocystic breasts don’t
cancer have symptoms, some women experience breast pain,
○ For those with early stage of cancer, this may be a tenderness and lumpiness, especially in the upper outer
treatment option area of the breast.
● Chemotherapy - Breast symptoms tend to be most bothersome, just
○ Drug treatment that uses powerful chemicals to before a woman’s menstruation
kill fast growing cells in the body - Simple self-care measures can usually relieve discomfort
○ Most often used to treat cancer, since cancer cells associated with fibrocystic breast
grow and multiply more quickly than most cells in - Etiology: Estrogen
the body
○ Many different chemotherapeutic drugs are
available, and can be used alone or in
combination to treat a wide variety of cancer
Signs and Symptoms: FIBROADENOMA OF THE BREAST
● Breast lumps with fluctuating size - Solid, non-cancerous breast lumps that occur most often
○ Especially during or nearing menstruation in women between the ages 15 and 35.
● Generalized breast pain or tenderness - Hormonal in nature
● Green or dark brown non-bloody nipple - Cause is unknown, but they might be related to the
○ Secretions are present reproductive hormones
● Monthly increase in breast pain or lumpiness from mid - Occur more often during the reproductive years, and can
cycle (ovulation) to menstruation become bigger during pregnancy or with the use of
hormone therapy
- This might shrink after menopause when hormone level
decreases
Signs and Symptoms:

● Firm, smooth, rubbery or hard and has a well-defined
shape lump
● Painless, moveable
Diagnosis:
● Clinical and Self Breast Complex fibroadenomas
○ The doctor checks for unusual areas by visually and - Contains changes such as an overgrowth of cell or
manually examining the breast and the lymph hyperplasia that can grow rapidly
nodules located in the lower neck and underarm - A pathologist makes a diagnosis of a complex
area fibroadenoma, after reviewing the tissue from a biopsy
○ If the medical hx and the clinical examination
indicates normal breast changes, additional test Juvenile fibroadenomas
may not be needed - The most common type of breast lump found in girls in
● Mammogram adolescence between the age of 10-18 years old
○ Routine mammogram is performed usually in - This fibroadenoma can grow large, but most shrink over
women 45 years and above time, and some disappears
○ Women are advised to take annual routinely
mammogram Giant fibroadenomas
○ If the doctor detects a breast lump or prominent - Can grow larger than 2 inches (5 cm)
thickening in the breast tissue, the need for - They might need to be removed because they can press
mammogram increases. on or replace other breast tissue
○ This exam focuses on specific areas concerned in
the breast Phyllodes tumor
○ The radiologist will closely examine the area of - Although usually benign, some can become cancerous or
concern when interpreting the mammogram malignant
- Doctors usually recommend that this tumor should be
removed
● Ultrasound
○ Uses soundwaves to produce image of the breast
Treatment:
and is often performed along with the
● Fine-needle aspiration
mammogram
○ For breast lumps that feels a lot like a cyst, to see
○ This is better for evaluation on younger women’s if fluid can be withdrawn from the lump
dense breast tissue ○ This procedure can be done in the clinic
○ Breast tissues tightly packed with lobules, ducts ○ This procedure may collapse the cyst and resolves
and connective tissue, utz can also help the doctor the discomfort
distinguish between fluid filled cyst and solid mass.
● Lumpectomy or Surgical excision
○ To remove the lump
Treatment: ● Biopsy to evaluate the lump
● Fine-needle aspiration
○ Monitoring of the changes of size or feel
● Surgical excision ○ Can shrink or disappear on their own
● Cryoablation
○ A minimally invasive procedure; Treatment of
cancer by killing cancer cells with extreme cold
Nursing Considerations and approximately 1 in 1,000 girls are born with what is
● Instruct to wear firm support bra especially after a called imperforate hymen
lumpectomy procedure - Imperforate hymen
● Avoid caffeine and fats ➢ No opening to the vagina is present
● Warm pack for discomfort ➢ Many girls will not be aware that they have an
imperforate hymen until they begin their
menstrual period and experience complications
due to blood pooling in the vagina
Signs and Symptoms:
● Abdominal pain and swelling, back pain → often come
and go each month
● Lack of a menstrual cycle → despite having other signs of
sexual maturity (developing breast and pubic hair)
DYSMENORRHEA ● Back pain
- Pain at the suprapubic area or lower abdomen during or ● Dysuria (painful urination), unable to void → can occur
shortly after menstruation when pooled blood is pressed against the urethra
- Primary Dysmenorrhea → due to prostaglandin release;
8-48 hours from the start of the first day of menstruation Diagnosis:
➢ Occurs at menarche and continues throughout life ● Gynecologic Exam
○ Imperforate hymen diagnosed in girls > 10 years
➢ Commonly on the first 3-5 year after menarche or
old are often found by chance
after ovulation has established
○ Doctors may suspect an imperforate hymen
➢ Usually lifelong
following a routine newborn check
➢ Can cause severe and frequent menstrual ○ If a doctor suspects an imperforate hymen, they
cramping for severe and abnormal uterine can order vaginal or pelvic ultrasound
contraction ○ Imperforate hymen can be mistaken for other
- Secondary Dysmenorrhea → due to pathologic pelvic conditions such as transverse vaginal
condition; Dull pain that radiates to buttocks and thighs septum → a thick mass blocking the vagina and
➢ Due to physical or pathologic cause ultrasound can help confirm the diagnosis
➢ Usually starts later in life ● Ultrasound → rule out transverse vaginal septum or mass
➢ May be caused by another
medical conditions like PID
and endometriosis
RF:
● Obese
● Smoking
● Drinking alcohol during period (can
prolong menstrual pain)
● Early menarche (> 11 y.o)
● Nulliparity
Treatment:
● Hymenectomy → surgically cut
Nursing Consideration:
away part of the hymen using a
● Heating pad or hot baths - can help alleviate pain
scalpel or laser
● Massage on lower back - relieve cramping
● Yoga, acupuncture, transcutaneous electrical nerve
Nursing Consideration:
stimulation (TENS), aromatherapy - divert and lessen pain ● NSAIDs - for pain
sensation ● Antibiotics as ordered
● Diet modifications: low salt and sugar ● Dilator-application
● NSAIDS
PREMENSTRUAL SYNDROME
IMPERFORATED HYMEN
- It is estimated that as many as 3 of every 4 menstruating
- Most females are born with a hymen
women have experienced some form of premenstrual
- Hymen
syndrome
➢ Is a thin membrane that stretches across the - Symptoms reoccur in a predictable pattern
vagina - Physical and emotional changes that women experience
➢ Generally, has a ringlike appearance with a small with PMS may vary from just slightly noticeable to all the
opening way too intense
➢ No real medical purpose for the hymen but some - Treatment and lifestyle adjustment can help reduce or
think it may have evolved to help protect the manage the sign and symptoms of premenstrual
vagina from infection syndrome
- Most girls have small crescent or donut-shaped opening
in the hymen. This opening allows for access to the vagina
Signs and Symptoms: ○ Insufficient serotonin levels may contribute to
● Physical s/s: premenstrual depression, fatigue, food cravings,
○ Abdominal bloating and sleep problems
○ Pelvic fullness ● Depression
○ Breast tenderness ○ Some women with severe premenstrual syndrome
○ Weight gain → due to fluid retention have undiagnosed depression
○ Joint muscle pain ○ Depression alone does not cause all symptoms
○ Headache
○ Fatigue Treatment:
○ Acne flares ● Advise women to have regular exercise and enough sleep
○ Constipation ● Avoid smoking, limit sugar salt, alcohol and caffeine
○ Diarrhea ● Yoga, acupuncture, hypnosis, massage
○ Alcohol intolerance ● Stress reduction techniques → can decrease s/s
● Emotional and behavioral s/s: ● NSAIDs
○ Tension or anxiety
○ Depression MENOPAUSAL SYNDROME
○ Crying spells - The stage of life after you have not had a period for 12
○ Irritability months or longer
■ Mood swings - This is the time that marks the end of the menstrual cycle
■ Anger - It is diagnosed after 12 months without a menstrual
○ Panic attacks period
○ Premenstrual cravings (appetite changes_ - This can happen in women in their 40s or 50s, but the
○ Insomnia average age is 51.
○ Social withdrawal - A natural, biological process but the physical symptoms
○ Poor concentration (e.g. hot flashes) and emotional symptoms of menopause
○ Change in libido may disrupt sleep, lower energy, or affect emotional
● For some physical pain and emotional stress are severe health
enough to affect their daily lives
● Regardless of the severity of the s/s, generally, these will ETIOLOGY:
disappear within 4 days after the start of menstruation ● Decline of hormones
● A small number of women with premenstrual syndrome ● Hysterectomy
have disabling symptoms. This form of PMS is called ● Chemotherapy &
Premenstrual Dysphoric Disorder (PMDD) → significant Radiation
physical and behavioral symptoms that interfere with ● Primary ovarian
daily living insufficiency →
○ S/S: genetic
■ Irritability or anger that may affect other
people With the declining level of
■ Feeling of sadness or despair estrogen, progesterone,
■ Thoughts of suicide, feeling out of control testosterone, or hormones
■ Feeling of tension or anxiety, panic attacks, in women, this can lead to the different s/s of premenopausal
mood swings or crying often syndrome.
■ Often lack of interest in daily activities and
relationships In months and years leading to menopause, there is a period
■ Trouble thinking or focusing called premenopausal wherein women might experience the
■ Tiredness or low energy ff. signs and symptoms:
■ Food craving or binge eating ● Irregular periods
■ Insomnia ○ Vary among women
■ Physical symptoms: bloating, breast ○ Most likely, a woman may experience some
tenderness, headache, and joint or muscle irregularity in the periods before they end
pain ○ Skipping periods during premenopause is common
and expected.
Etiology: unknown, but there are some factors that may ■ Often menstrual periods will skip a 1 month
contribute and will return or will skip a several months
● Cyclic change in hormones or hormonal fluctuation and then their monthly cycle starts again for
○ Disappear with pregnancy and menopause a few months
● Chemical change in the brain ○ Pregnancy is still possible
○ Neurotransmitter: serotonin. This is thought to ■ Consider a pregnancy test if the woman has
play a crucial role in mood state. skipped a period and is not sure if they are
○ With the fluctuation of serotonin, this could trigger in transition towards menopause
PMS symptoms. ● Vaginal Dryness
● Hot flashes

● Chills Prostate gland is located beneath the bladder. The tube that
● Night sweats transports urine from the bladder out of the penis and passes
● Sleep problems through the center of the prostate (the tube is called the
● Mood changes urethra).
● Weight gain and slowed metabolism
● Thinning hair & dry skin When the prostate enlarges, it begins to block the urine flow.
● Loss of breast fullness Most men have continued prostate growth throughout life, and
with enlarged prostate, this can cause urinary symptoms or
Complications: significant blocked urine.
● Osteoporosis
○ Due to loss of estrogen in the body The one with the yellow picture is the normal prostate and
○ Will lose up to 25% of our bone density following there is no obstruction in the urethra.
menopause up to the age of 60
○ Makes a woman susceptible to bone fractures, On the other hand, the enlarged prostate presses against the
particularly in the hips, spine, and wrists urethra causing blockage. There is little amount of urine passed
● Cardiovascular disease through the urethra because of the increased size of the
● Obesity → due to slowed metabolism prostate. The compressed urethra causes the possibility of
● Vaginal dryness stasis of urine in the bladder.
● Urinary incontinence
Signs and Symptoms: severity will vary but they tend to
TTT: worsen overtime
● Hormone therapy → replacement of declined hormones ● Frequent or urgent need to urinate
● Gabapentin ● Increased frequency of urination at night (nocturia)
○ For hot flashes ● Difficulty starting urination
○ Is said to be an anticonvulsant drug but it is used ● Weak urine stream or a stream that stops & starts
to treat vasomotor symptoms in premenstrual ● Dribbling at the end of urination
women with contraindications to hormonal ● Inability to completely empty the bladder
therapy ● Less common:
● Vitamin D and calcium supplements → prevent ○ UTI
osteoporosis ○ Inability to urinate
○ Blood in the urine
Nursing Consideration: key focus is more on a symptomatic ● The size of the prostate doesn’t necessarily determine
approach the severity of the symptoms
● Dress lightly → to counter the effects of hot flashes ○ Some men with only slightly enlarged prostate
● Increase cold fluids. Minimize hot beverage, spicy foods, can have significant symptoms, while other men
caffeine, smoking, alcohol, stress, hot weather and warm with very large prostate can only have minor
room urinary symptoms.
● Use water-based vaginal lubricants → for vaginal dryness ○ Symptoms eventually stabilize and might even
● Sleep and exercise improve over time
● Kegel exercise → for the muscle tone in the lower pelvic
area
ADULT MEN
BENIGN PROSTATIC HYPERPLASIA
- Also called prostate gland enlargement
- Common condition in men as they get older
- An enlarged prostate gland can cause uncomfortable Complications:
urinary symptoms such as blocking the flow of urine out ● Urinary retention
of the bladder. ○ Sudden inability to urinate
➢ Blockage causes statis, urinary tract and kidney ○ The need to have a catheter inserted into the
problems bladder to drain the urine
○ In some men with larger prostate, they need
Risk Factors: surgery to relieve the retention
● Aging (60 y.o and ● UTI (urinary tract infection)
above) ○ The inability to fully empty the bladder can
● Family history of BPH increase the risk of infection in the urinary tract
● Diabetes and heart ○ If UTI occurs frequently, there is a need for
disease (due to the surgery to remove part of the prostate
use of beta blockers) ● Bladder stones
● Obesity ○ Generally caused by an inability to completely
empty the bladder

○ Bladder stones can cause infection, bladder ○ Transurethral Resection of the Prostate (TURP)
irritation, blood in the urine, and obstruction of ■ Done using a lighted scope inserted into
urine the urethra, then the surgeon removes all
● Damaged bladder but the outer part of the prostate
○ A bladder that hasn’t emptied completely can ■ Generally, relieves symptoms quickly and
stretch and weaken over time. most men have a strong urine flow soon
○ As a result, the muscular wall of the bladder no after the procedure.
longer contracts properly and makes it hard to ■ After TURP, a catheter is inserted
fully empty the bladder temporarily to drain the bladder
● Kidney damage ○ Transurethral Incision of the Prostate (TUIP)
○ Pressure in the kidney from urinary retention can ■ Same with TURP; a lighted scope into the
directly damage the kidneys and allow bladder urethra and the surgeon makes one or two
infection to reach the kidney or ascending small cuts in the prostate gland, making it
infection easier for urine to pass through the urethra
■ This surgery might be an option if the man
Diagnosis: has a small to moderate enlarged prostate
● Direct Rectal Exam (DRE) gland, especially if the man has health
○ This is when the doctor inserts a finger into the problems that make other surgeries too
rectum to check the prostate for enlargement risky
● Prostate Specific Antigen (PSA) Test ○ Transurethral Microwave Thermotherapy (TUMT)
○ Blood test ■ The doctor inserts special electrodes
○ A substance produced in the prostate through the urethra into the prostate area.
○ An increased level of which is seen in enlarged ■ The microwave energy from the electrodes
prostate. destroy the inner portion of the enlarged
○ However, elevated PSA level can also be due to: prostate gland, shrinking it, and easing the
■ Recent procedure urine flow
■ Infection ■ Only partly relieves symptoms and it might
■ Surgery take some time before a man notices the
■ Prostate cancer result
● Ultrasound (UTZ)
○ Transrectal ultrasound Nursing Consideration:
○ An ultrasound probe is inserted into the rectum ● Instruct the patient to spread the fluid intake
to measure and evaluate the prostate throughout the day
● Biopsy (Bx) ● Limit beverages at night → to prevent nocturia
○ Prostate biopsy is an examination wherein a ● Avoid caffeine & alcohol → these increases the need to
tissue sample is taken to help the doctor diagnose urinate
and rule out prostate gland cancer ● Bladder care
○ A transrectal ultrasound guides the needle and ○ Take plenty of time to urinate and try to relax
takes tissue samples for biopsies ○ Read or think of other things while urinating
● Cystoscopy ○ For dribbling problems, wash penis daily to avoid
○ Wherein an instrument called a cystoscopy is skin irritation and infection
inserted into the urethra, allowing the doctor to ● Healthy diet, minimize obesity
see the inside of
the urethra and
the bladder
○ A local
anesthesia is
given before the
test
TTT: either be minimally invasive therapy (e.g. drug therapy)

or surgery
● Drug therapy (most common tx for mild to moderate
symptoms):
○ Alpha-blockers (Tamsulosin, Alfuzosin, Doxazosin)
→ relaxes the bladder neck muscles and muscle
fiber in the prostate, making urination easier
○ 5-alpha reductase inhibitors (Finasteride,
Dutasteride) → shrinks the prostate by preventing
hormonal changes that cause prostate growth
● Surgical management:

NURSING CARE OF A FAMILY WITH AN ILL CHILD Stage 2: ● Symbolic thinker
OUTLINE: Preoperational ● Learn to use words and pictures to
stage (2 to 7 years represent them
I. Introduction old) ● Egocentric and struggles to see things
II. The Meaning of Illness to Children from the perspective of others.
III. Care of the Ill Child and Family in the Hospital
IV. Nursing Care of the Child Undergoing Medication Stage 3: Concrete ● Think logically about concrete events
Operational Stage ● Understand the concept of conservation
Administration and Intravenous Therapy
(7 to 11 years old) that the amount of liquid in a short wide
V. Nursing Considerations in Administering cap is equal to that in a tall, skinny glass.
Intravenous Therapy in Pediatric Clients ● Egocentrism begins to disappear as they
become better at thinking about how
other people view a situation.
REFERENCE: Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal
& child health nursing: Care of the Childbearing & Stage 4: Formal ● Begins to think abstractly
Childrearing Family (Eight ed., Vol. 1.) operational stage ● Hypothetical reasoning
(12 years old and ● Abstract thoughts emerge at this point
above) ● Think more about moral, philosophical,
INTRODUCTION ethical, social, and political issues that
The quality of life of an individual is closely related to the require theoretical and abstract
quality of life to those surrounding them like if one of the family reasoning.
members gets sick, the rest or wide variety of the aspect of the ● Deductive logic or reasoning from a
family member’s life can be affected also, including: general principle to specific information.
➢ Emotional ● Increase in logic & abstract ideas.
➢ Financial
➢ Family relationship EARLY SCHOOL AGE CHILDREN
➢ Education and work ‒ Generally know quite a bit about the working of their
➢ Leisure time major body parts
➢ Social activities ‒ Able to name the function of heart, lungs, and stomach
- Many of these are linked to one another including: ‒ Not able to see the body as a system until the age of 10
➢ Financial impact to 11 years
➢ Social impact
YOUNGER CHILDREN
➢ Emotional impact
‒ May think the cause of illness is magical/ a consequence
- There are some positive aspect were alsos identified from
of breaking a rule. They think they get well after following
the literature, this includes family relationships growing
another set of rules
stronger.
‒ Children may see a passive role for themselves in getting
- Helping a child and family prepare and adjust to the
well like being susceptible to chickenpox because they did
experience is a fundamental nursing role. This role goes
not get the vaccine
well beyond just providing information on what to expect
‒ By 4th grade — generally aware of the role of germs play
throughout the illness.
in illness
‒ By 8th grade — able to voice an understanding that
THE MEANING OF ILLNESS TO CHILDREN
illness can occur from several causes
- Depends on:
➢ Cognitive ability DIFFERENCES IN RESPONSE OF CHILDREN & ADULTS TO
➢ Past experiences ILLNESS
➢ Level of knowledge/understanding ‒ Knowing how children of each age view illness affects the
- All of these can relate to Piaget’s Cognitive development planning of nursing care and influences how it should be
wherein the focus of this theory is more on understanding worded:
children acquired knowledge and also understanding ‒ Examples:
their nature of intelligence. ➢ Stick for a blood work → this can be misinterpreted
- Piaget’s Cognitive Development by children as putting an actual stick on the arm.
➢ Receiving a die → the child may misinterpret it as
Stages Characterized by: the he/she will die during the procedure.
‒ Need to be very careful in using words with double
Stage 1: ● Infant uses senses and motor skills meaning
Sensorimotor ● Know items by its use ‒ Explain further to the child what it really means and how
stage (birth to 2 ● Object prominence the procedure is being done.
years old)

INABILITY TO COMMUNICATE ➢ Example: When a child has pneumonia, supposed to
‒ Very young children be the presenting symptoms if pneumonia is cough,
➢ Do not have the vocabulary to describe symptoms but children will be admitted because of the
like when they have headache or they are dizzy or accompanying systemic symptoms
nauseated ‒ Systemic reactions can delay diagnosis and therapy and
➢ They cannot expressed what they are feeling can cause increased fluid and nutrient loss
because of lack of vocabulary
➢ They may minimize or intensify symptoms. AGE-SPECIFIC DISEASES
‒ School age ‒ Most adults have achieved immunity to common
➢ most can describe symptoms with accuracy infectious diseases
‒ Children are susceptible to illness such as measles,
INABILITY TO MONITOR OWN CARE AND MANAGE FEAR mumps, and chicken pox
‒ Because of their growth requirements and immaturity
‒ Adults
they are susceptible to diseases that does not affect
➢ Often ask questions about medications and
adults like rickets and it may lead to skeletal deformities
procedures
➢ If the nurse will give late medication, the adults will CARE OF THE ILL CHILD AND FAMILY IN THE HOSPITAL
follow up
‒ The parents of children admitted in ICU are predicted to
‒ School age and younger children cannot monitor their
have high degree of stress during their child
own care
hospitalization both because of the severity of child’s
➢ They may not know which medicine or procedures
illness and hitech setting of the ICU
they are to receive. If they do know, they may be
‒ Parents requires patience because they will have
confused about time
difficulty understanding under stress
‒ Children have fears:
➢ 8-9 months — fear of separation (if taken away THE EFFECT OF HOSPITAL SEPARATION AND CHILDREN:
from mother or primary caregivers) DECREASING SEPARATION ANXIETY
➢ Toddler and preschoolers — fear of separation, ‒ Infants (5-9 months old): attached to parents and
the dark, intrusive procedures, and mutilation of caregivers
body parts
➢ To reduce separation anxiety - establish a
➢ School age child and adolescent — fear of loss of primary nurse
body parts, loss of life, and loss of friends ➢ Primary nurse - the nurse who will care for
them the entire course of their
NUTRITIONAL NEEDS hospitalization. Establish trust to the child
- According to CDC (2015a) and reduce sepanx.
➢ Children have greater metabolic demand ‒ Toddlers and preschoolers — effects of separation
➢ Children breathe in more air per pound of body become especially intense in young children before they
weight understand time. Also need to establish primary nurse
➢ Higher surface to body mass ratio ‒ School-age children and adolescent — react better than
➢ Children need more nutrients like calories, younger children to the serpation
proteins, minerals, or protein per pound of body
weight PREPARING THE ILL CHILD & FAMILY FOR
➢ Intake must not only be encouraged for tissue HOSPITALIZATION
repair but also enough to allow for growth ‒ Depending on the age of the child (2-7 years old) and
➢ Infant: needs 120 kcal/kg individual experience
➢ Adult: 30-35 kcal/kg of body weight per day ‒ No matter the child's age the parents should encourage
to convey a good positive attitude towards
FLUID AND ELECTROLYTE BALANCE hospitalizations
‒ Children between 2 and 7 years of age should be told
‒ Adults: extracellular water represents approximately 23%
about the scheduled ambulatory or in-patient
of total body wt.
hospitalizations. Examples:
‒ Newborn: extracellular water is close to 40%
➢ 2 year-old — 2 days before hospitalization
➢ Means that an infant doesn't have much water
stored in their cells than the adult does and is more ➢ 4 year-old — 4 days before
likely to lose a devastating amount of body water ‒ Children older than 7 years of age can be told as soon as
with diarrhea and vomiting. There’s no such thing, the parents are aware of it
only diarrhea or simple diarrhea in a child younger
than 1 year old. ADMITTING THE ILL CHILD AND FAMILY
Assessment on Admission:
SYSTEMIC RESPONSE TO ILLNESS ● Chief concern - determine what the parents
‒ Because children have immature body, young children understanding on the patient's condition or what is the
tend to respond to disease systemically rather than reason for the admission
locally
● Family profile - obtain for the profile and include if there ➢ For ill toddler and preschooler — promote both
are any educational level, primary caregiver, or if the autonomy in toddlers and initiative in preschoolers
parents are divorced and who is authorized to sign for ● Urge the parents to encourage the children
medical admission to make choices on their care
● Past experience with illness or separation - include: ➢ For ill school-age children — need to work on a
➔ How the child feels on previous hospitalization sense of industry or learning more about how and
➔ Any recent hospitalization in the family, consider why things are done
bad outcomes if there is any
➔ If the child is away overnight PROMOTING NUTRITIONAL HEALTH OF THE ILL
➔ Does the child taking medication - As nurses, it is part of our responsibility to monitor and
➔ Is the child able to swallow a pill or any allergies maintain optimal nutritional status of children in the
and this needs to be documented by exacts hospital facing illness or treatment that interferes
symptoms and happening with adequate intake. To correct nutritional
● Daily routines include: deficiency, we need to help and aid children and
➔ Any bedtime sleep routines or nap rituals families to follow nutritional care plans
➔ Does the child needs help in tooth brushing or
combing the hair Areas of Concern when planning Nutrition for Ill Children
● Meaning of food → in children, early in their life, like
➔ Can the child do the daily routine independently
infancy, they learn to associate eating as being held and
● Developmental survey
being loved like in breastfeeding
➔ If the child can feed herself ● Opportunity for socialization → meal time is often the
➔ Use spoon or cups time of the day children socialize in the family. In the
➔ Can dress herself hospital, they might feel lonely eating alone
➔ What grade is the child ● Level of stress → can cause loss of appetite; experience
● Special information the need to snack frequently, they should not be hungry
➔ What the parents think would make the child and the snacks should be nutritious
more comfortable in the hospital ● Custom and culture → some children wants their food to
be separate and not mixed up; in hospital setting ask
PROMOTING A POSITIVE HOSPITAL STAY parent to bring favorite food to stimulate appetite
‒ Important for the health of both children and their ● Environment → hunger is associated with sight and smell
families of food.
‒ Providing continuity of care (primary nursing) - this
ensures that children are exposed to a few substitute care Encourage Fluid Intake
people as possible to maintain consistency and quality of ● Offer small, full glasses frequently rather than larger
care. Nursing assignments should be made and one nurse half-full glasses
gives a smooth care to the same child ● Determine the child’s favorite fluid and then offer it, if
‒ Providing adequate play facilities appropriate
➢ Therapeutic play ● Popsicles and Jell-O count as fluids
‒ Setting limits on behavior ● Children can drink more of clear fluid than a thicker fluid
● Suggest soothing beverages such as milk or Pedialyte
DISCHARGE PLANNING popsicles for children with mouth lesions
‒ Discharge planning is not only an important link between ● Ice melts one half of its volume
the hospital and the home, but it is also a final way to ● Encourage breastfeeding whenever possible
create a satisfying hospital experience ● Introduce a game
‒ As part of the discharge plan, we need to include
information like tantrums or nightmares after returning Encourage Food Intake
home from hospital stay, as school-age children may ● Calorie counting → record all the food that a child eats
manifest these behaviors to lesser extent. during each 24-hour period
‒ Assure the parents that these behaviors are part of the ● Include snacks, candy, or gum
child's normal response to hospitalizations because of the ● A dietitian then will analyse the list and determine the
experience that was too intense for the child to handle. calorie intake
PROMOTING GROWTH & DEVELOPMENT OF THE ILL PROMOTING SAFETY FOR THE ILL CHILD
CHILD Nursing consideration:
‒ Children often fall behind in the growth and ‒ Keep the child safe during illness care
development because of their illness. ‒ Always be sure of the location of all children in you care
‒ Nursing diagnosis: Risk for delayed growth and ‒ Ensure that doors or gates are provided near stairways or
development related to the effects of illness elevators
‒ Need to promote growth and development ‒ Ensure that doors of healthcare facilities have working
alarms to prevent children from going out and to prevent
➢ For ill infants — maintain their at home schedule
strangers from coming in
when possible

‒ Be sure windows are covered by screens or guards so - A child may suddenly wake up because of a disturbed
children cannot climb up on sills and fall out frightening dream.
‒ Check that the side rails of beds are in good conditions
raised appropriate, and locked SLEEP DEPRIVATION
‒ Test crib rail after it is raised to ensure the lock is caught ‒ Children who do receive enough sleep can suffer from
‒ Push bedside tables or stands away from cribs so as child sleep deprivation, just like adults do.
cannot climb over the railing and use the stand as a step ‒ Infants are dependent on sleep to promote brain
down development.
‒ Be careful of the placement of television/call cords or ‒ If sleep loss is mainly REM deprivation, children show
window blind cords so they cannot lead to strangulations symptoms of irritability and difficulty concentrating
‒ Never leave a child alone in the bathtub (because even a ‒ If stage IV NREM sleep is lacking, tends to cause apathy
small amt. of water can drown a child) physical fatigue, and depression and can slow recovery
‒ Adhere to all fire precaution measures ➢ Sleep is very important for ill children
‒ Closely follow standard infection precautions ➢ Provide atmosphere conducive for sleep
➢ Provide interesting activity during the day
PROMOTING ADEQUATE SLEEP FOR THE ILL CHILD increases their night time sleep
‒ Children needs adequate sleep so that their body and
tissue can effectively use nutrients for repair and normal PROMOTING ADEQUATE STIMULATION FOR THE ILL
growth to continue CHILD
‒ Children may not sleep well when they are ill because of ‒ Sensory Deprivation → the condition of being deprived
the discomfort, pain, administration of the medication, or of, or lacking adequate sensory, social, physical or
intensified symptoms of chronic sleep problems. cognitive stimulation
‒ Another factor is the strange hospital setting. ‒ Sensory Overload → occurs when children receive more
‒ Also the procedure that he shall undergo. This has to do stimulation than they can tolerate or process. Provide eye
with deprivation of nap and rest as much during the day cover or earplugs to lessen stimulation
as compared to their usual.
‒ Encourage parents to stay with these children for support PROMOTING PLAY FOR THE ILL CHILD
and comfort.
● Assessing child through play
● Providing play in ambulatory settings
SLEEP PATTERNS
● Providing play in the hospital
‒ Influenced by: ● Providing play for children on bed rest
➢ Apprehension level ● Safety with play
➢ State of health ● Child support programs
➢ Habit ● Therapeutic play
➢ Medication
➢ Environment at the time of sleep THERAPEUTIC PLAY
‒ Pattern of normal sleep is described in this Four Stages of 3 types:
Sleep in Children: ● Energy release — pounding, hitting, running, punching,
➢ Non-rapid eye movement (NREM) stage I — occur and shouting
up to 80% of the sleep time; a feeling of drifting or ● Dramatic play — acting out on an anxiety producing
falling; often described as "twilight sleep"; can be situation
aroused easily from slightest noise or even the ● Creative play — e.g. drawing
silent presence of the person in the room
● To promote sleep: reduce noise level during NURSING CARE OF THE CHILD UNDERGOING MEDICATION
this stage ADMINISTRATION & INTRAVENOUS THERAPY
➢ NREM stage II — sleep deepens temperature and ‒ Medication in children are given by a variety of routes:
HR decrease slightly more; more difficult to awake ➢ Orally
the child from sleep when this point has been ➢ Intranasally
reached ➢ Transdermally
➢ NREM stage III — sleep deepens still further. Temp ➢ Topically
and HR decrease further; very difficult to awake ➢ Rectally
the child
➢ Via injection or by inhalation
➢ NREM stage IV — approx. 20-30 minutes after ‒ Safe medication administration is a priority in child health
beginning to fall asleep; respiration is slow, nursing
temperature and HR rate is even more slow and BP ‒ Particularly to pedia, prior to giving medication, we need
decreases to obtain the weight and the age of the baby so that we
➢ Rapid eye movement (REM) — eye move in rapid, will give the right dose for the children
involuntary motions where respiration are ‒ Each dose of drug must be calculated individually because
irregulars; the child is confused and unable to there are rarely a standard for pediatric dose of a
orient himself; lasts 10-30 minutes particular drugs

‒ It is important to have each drug, each dose, and each
child must be carefully and individually evaluated prior to AT HOME
giving the medication. ‒ Medication should be kept in a locked medicine cabinet
above the height their child could reach
PHARMACOKINETICS IN CHILDREN ‒ Remind parents that most childhood poisoning occurs
‒ Pharmacokinetics: How the drug is being absorbed by the when a family is under stress. During stress, we tend to
body forget procedures such as locking away the drug.
‒ The four basic processes: ‒ Tell parents they should never take medicine in front of
➢ Absorption - transfer of the drug from its point of children, (because they can imitate the action of taking
entry into the bloodstream. Influenced by the the medication) or pour or prepare medicine in the dark
route of administration (because almost all of the medicine bottles look the same
➢ Distribution - movement of the drug through the and feel the same).
bloodstream to a specific site of action. This
binding action limits the amount of free drug in the SAFE ADMINISTRATION OF DRUGS
circulation ‒ Administering drugs to children requires ro determine
➢ Metabolism - involves the conversion of drugs into giving the right drug to the right child, in the right dosage
an active/ inactive form. Because a child's basal and by the right route, at the right time.
metabolic rate is faster than that of an adult, the ‒ Ensure parents and children the right of information on
drugs are metabolized more rapidly in children. In the medication they are taking. In giving this medication
rapid metabolism, drugs must be administered we always remember the golden rule of drug
more frequently. administration.
➢ Excretion - elimination of raw drug or drug
metabolites. It's either through the kidney or bile. ORAL ADMINISTRATION
‒ Determines the intensity and duration of a drug action. ‒ Children younger than 9 years old often have difficulty
‒ The immaturity of body systems in children play a major swallowing tablets
role in drug action throughout each of these processes. ‒ Most oral medication is furnished in liquid form
‒ In infants:
ADVERSE DRUG EFFECTS IN CHILDREN ➢ Oral mediation can be given with a medicine
‒ Children respond to a drug in the same way as adults do. dropper or a unit dose syringe (without needle)
‒ Children may experience unique or exaggerate side ➢ Gently restrain the child’s arm and head
effects because of their immature liver function and their ➢ Never give medicine with the child lying
rapid metabolism during periods of rapid growth. completely flat for the risk of aspiration
‒ Newborns may suffer from adverse effects from drugs ‒ A crying child is already opening his or her mouth for you;
taken by the mother prenatally or from drugs taken or gently open the mouth by pressing on the child’s chin
during breastfeeding mother. ‒ The end of the syringe or dropper should rest on the side
on the mouth to help prevent aspiration
SAFE STORAGE OF DRUGS ‒ May also be given fluid from a small glass or spoon
‒ This is very important to prevent incidents like overdosing ‒ Allow the fluid to flow, a little at time so a child can
or poisoning of children. swallow small sips
‒ Adolescents can deliberately take extra doses of drugs ‒ Because firm pressure was used to give the medicine to
such as steroids or pain medication, hoping for an added the infant, he or she may be frightened, so take time to
effect. Thus, leading to overdosing of the drug. sit and comfort
‒ Children, like adults, may hoard drugs and then use them ‒ Preschoolers and Early School-age
in a suicide attempt. ➢ Responds well to rewards each time they take
‒ Store drugs away from the reach of children. their medicine (e.g. giving of stickers so that they
can paste it to the book each time they take
IN HOSPITALS medicine)
‒ Always be certain that medicines are stored in a safe ‒ Older children
place ➢ Hand them a glass of medicine as if they are
‒ In the nursing unit, there's a particular unit for medication expected to take it
wherein only the medication nurse can enter and prepare ➢ Offer a “chaser” if necessary and not
and store all the medication. contraindicated
‒ On a children’s unit, leaving a car in the hallway is ● Chaser like oranges or any juice available and
inappropriate. accessible
‒ As medication nurses, we should always look after the ‒ If a child is having difficulty in swallowing tablets, they can
medication that is prepared. This is to prevent tampering, be crushed and added to a teaspoonful of applesauce or
switching or even stealing of medication. a flavoured syrup
‒ Never leave medicine on a bedside table for a child to ‒ Let the child practice on small bits of ice before teaching
take later. As soon as you enter the room, always offer them to swallow tablets
water and make sure that the medicine is taken by the ‒ Another technique to help a child swallow pills is to push
child right away before leaving the room. them into teaspoonful of ice cream or pudding

➢ The intent is not to hide the pill but to help the ➢ If the eye is pus-filled, apply from the medial
child learn to swallow medicine aspect to the outer one. This is to prevent
➢ With ice cream or pudding, it has a slippery texture transferring infected mucus from one eye to
that can easily slide and helps the child swallow the another. Eye medicine should be prescribed and
medicine as they take them. not used by other children because if the tip of the
dropper or tube touches conjunctival sac, it is
INTRANASAL ADMINISTRATION considered contaminated with body fluids.
‒ Place the child on his or her back
‒ Extend the head over the side of OTIC ADMINISTRATION
the bed ‒ Refers to administering medicine into the ear canal
‒ Preschoolers are too frightened ‒ Remind the child that ear drops can feel funny
by this strange position. Place a ‒ Ear drops must always be used at room temperature or
pillow under their shoulders warmed slightly. Because cold fluids such as medications
instead taken from the refrigerator thus cause pain and may also
‒ An infant may need to be restrained in a mummy restraint cause severe vertigo as it touches the tympanic
(mummy restraint: where you wrap the baby from the membrane.
neck down to the feet, where the feet, hands, and body ‒ Place the child on the back in mummy restraint if
cannot move to have an easy administration of the dug) necessary
‒ Instill the appropriate number of drops into one nostril ‒ Turn the head to one side to expose the ear
‒ Turn the child’s head to the sides. To the left, after the ‒ A child younger than 3, straighten the ear canal by pulling
left nostril and right after the right nostril so that the the pinna down and back
medicine stays on the nose longer. ‒ A child older than 3 years, pull the pinna of the ear up and
‒ If child is preschool or older: Ask the child to sniff the back
medicine ‒ Instill the specified number of drops into the ear canal
‒ Have the child remain in a head flat position for at least 1 ‒ Hold the child’s head in the sideways position for at least
minute to let the medicine come in contact with the 1 minute to ensure that the medication fills the entire ear
mucus membrane of the nose. canal
‒ Give the child high praise even if he or she did not ‒ Praise the child for his or her cooperation after the
cooperate at all. procedure.
‒ If using spray bottles, let the patient stand or sit upright,
hold the spray bottle upright with the tip just inside the RECTAL ADMINISTRATION
nose, and gently squeeze the spray bottle. ‒ This allows the medication
to be absorbed across the
OPHTHALMIC ADMINISTRATION mucous membrane of the
‒ Eye medications → most often intestine
dripped into the conjunctival sac of ‒ Medications are given by
the eye rectal suppository or by
‒ Infants and preschoolers must be retention enema
restrained in a mummy restraint ‒ Suppositories are supplied
➢ Place the child on the back already lubricated. If not, add a drop of water-based
➢ Open the eyes of infants and lubricant to the tip
preschoolers gently by firmly ‒ Use a glove and insert the suppository gently but quickly
pressing on the lower lid with beyond the rectal sphincters
the thumb and on the upper lid ➢ Approximately ½ inch or as far as the first knuckle
with the index finger of the little finger for infants, and 1 inch or as far as
‒ You may need to rest a hand on the eyelid to keep the eye the first knuckle of the index finger for older
open long enough and allow the eyelid to close after children
‒ Avoid placing the drops directly on the cornea because ‒ Withdraw your finger & press the buttocks together
this can be painful and to prevent conjunctival from firmly until the child urge to evacuate the suppository
drying passes
‒ Do not hold the eyelids apart of any longer than necessary
‒ After the child has blinked two or three times, allow the TRANSDERMAL / TOPICAL ADMINISTRATION
child to get up ‒ Children who have skin medication or need medicine to
‒ Praise the child for his or her cooperation. Even if relieve itching or dryness may have topical creams or
cooperation was not evident, he or she has accomplished lotions prescribed.
a major by allowing touch and invading the eye. ‒ Most children accept this type of application well because
‒ To instill ophthalmic ointment: the medicine brings most immediate relief
➢ Apply a fine line of the ointment along the inside ‒ In applying the medication:
rim of the conjunctival sac, working from the inner ➢ Be certain the child’s skin is dry and intact at the
to the outer eye canthus. site

➢ Apply patches over trunk or major muscle, not on ➢ To produce therapeutic levels of drugs in the body
distal extremities, for best absorption quickly - IV is directly to the bloodstream so its
➢ Assess and change the site every time a new efficacy and action is quick
patch is applied ➢ To provide rehydration and nutritional support
➢ Put clothes son the young child immediately so ‒ IV fluid may be infused into a peripheral vein, a central
that the patch is out of the site venous access device, or a peripherally inserted central
➢ Be certain patches applied to children wearing venous catheter (all are the same but differs on the site
diapers are not placed where a leaking diaper of insertion)
could wet the patch ‒ The amount, type and rate of IV fluids for children are
prescribed carefully
INTRAMUSCULAR & SUBCUTANEOUS ADMINISTRATION ‒ IV solutions and blood products
‒ Intramuscular (IM) injections are rarely prescribed for
children, because children do not have sufficient muscle DETERMINING FLUID & CALORIC NEEDS OF THE CHILD
mass for easy deposition of medication. ‒ IV fluids administered to the children and infants must be
➢ For infants, the mandatory site is the vastus isotonic
lateralis muscle of the anterior thigh (Isotonic: no change in the size of the cell; the solution and the
■ Use the lateral aspect rather than the cell have an equal component; will not draw water or absorb
medial portion water unlike other solution; Hypotonic: cause cell swelling;
■ Using the gluteal muscle in children Hypertonic: cell shrinkage)
younger than 1 year is extremely
hazardous
CONTINUOUS SUBCUTANEOUS PUMP INFUSION

‒ The constant infusion of a medication
into the subcutaneous tissue using a
medication pump
‒ The disadvantage: The child must be
‒ E.g of Isotonic: Lactated ringer’s and 0.9% normal saline
careful to protect the pump from
‒ E.g of hypotonic: Normal saline 0.45%
damage
‒ E.g of hypertonic: Dextrose 10% in 0.9% NaCl
‒ Site chosen: the abdomen
‒ Insulin and heparin are two drugs often
OBTAINING VENOUS ACCESS
prescribed for use with infusion pumps
‒ The syringe is filled with medicine and a small tube with ‒ The needle size for IV therapy varies depending on the
the needle attached at the distal end is attached to hub solution and the rate at which it will be administered
of the syringe ‒ Commonly used catheter sizes:
‒ The syringe is then ➢ 22-gauge
clamped into the pump ➢ 24-gauge
and the skin is cleaned ➢ 25-gauge (in newborns)
with alcohol and the ‒ Isotonic, hypotonic and hypertonic solution can use any
needle inserted at 45- gauge
degree angle ‒ For blood products, a bigger lumen is required (18-gauge)
to prevent hemolysis and not destroy the lumen of rbcs.
Nursing Considerations: ‒ “Butterfly” needles or “Scalp Vein Needles” are metal
‒ The insertion site is change every 1-2 days needles with a flange of plastic added on both sides of the
‒ If the child is not toilet trained, it is important to keep needle hub.
pump and insertion site away from an area that can be ➢ Usually use this on the scalp because it can’t be easily
soiled with urine or stool moved. Consideration for this type of needle is secure
‒ With small children, cover the pump with clothing so the needle won’t infiltrate the area.
‒ ‒ A length of narrow tubing leads from the needle to the
NURSING CONSIDERATIONS IN ADMINISTERING fluid administration tubing
INTRAVENOUS THERAPY TO PEDIATRIC CLIENTS ➢ This tubing must be flushed with IV solution before
INTRAVENOUS THERAPY the needle is inserted to avoid air embolism.
‒ The quickest and most effective (Solution should cover the entire length up to the
means of administering fluid or tip of the needle to prevent introducing air in the
medicine because it goes tube or air embolus)
directly into the bloodstream.
‒ Used to:
➢ Maintain fluid and
electrolyte balance

‒ Minidropper → device that reduces the size of the drop
in the control chamber to 60 drops per mL
‒ Keeping a careful record of both rate and amount of fluid
into the drip chamber
➢ Signs of fluid overload are those of congestive
heart failure (dyspnea: sign of congestive heart
failure);
➢ Nursing consideration: Time to time, always check
the I&O. Do not overshoot to avoid putting harm
to patients.
‒ It is difficult for children to lie still and wait for an infusion
to finish.
‒ Infants and preschoolers may need to have their other
arms restrained. (Ask permission before restraining the
child)
‒ Be sure that parents understand the importance of IV
therapy.
‒ Common sites: the veins on the dorsal surface of the INTRAVENOUS MEDICATION ADMINISTRATION
hand or on the flexor surface of the wrist ‒ Medications may be added to an IV line as small, one-time
‒ Leg and foot veins may also be used administration (bolus) or piggyback for longer infusions
‒ Scalp vein over the temporal area → ultimately causes ‒ Ensure that the drug to be injected is compatible with an
the least discomfort for their child because needles do IV fluid being infused
not infiltrate readily. Lesser option unless none of the ‒ To administer medicine by a bolus technique (when you
peripheral sites are accessible give more fluids than the usual IV
‒ Children who have IV infusions for long periods may medication; 10-20 cc syringe is
require the placement of an Intracath (a slim, pliable used)
catheter threaded into a vein) ‒ Students are not allowed to give
➢ Advantage: it can’t be dislodged as easily as it is IVTT medication to a patient. 30
sutured in skin; minor surgery; needs sterile days extension
equipments
‒ IV infusions must be secured in place with at least a small ‒ For piggyback infusion of
armboard. medicine: (run for a longer
time)
➢ Clean the medicine
port on the IV line, and
insert the piggyback
system into the port
➢ Lower the level of the
main infusion bag and
adjust the flow rate
➢ Elevate the
DETERMINING RATE & AMOUNT OF FLUID
maintenance bag of
ADMINISTRATION
fluid again and regulate
‒ IV fluids must be infused at a slower rate than adults
at proper rate
‒ Automatic rate-flow infusion pumps are useful when
giving potent medications (quick-effect; e.g potassium).
USING INTERMITTENT INFUSION DEVICES
Should be mandatory for small children. This will give a
‒ Heparin Locks → devices that maintain open venous
slow and accurate rate of flow.
access for medicine administration while allowing
children to be free out of bed
‒ Scalp vein tubing → is used and capped at the end with a
specially designed rubber stopper or commercial trap
‒ Always remember all the spaces are filled with fluid so
that no air can enter into the vein causing air embolus.
‒ Fluid chambers (SoluSet) → devices that

allow only 50-100 ml of fluid into the drip
chamber at a time

‒ The tubing and stopper must be firmly secured to the dressing is required. It allows a full range of
wrist and an armboard taped in place and remind the activities like showering and swimming.
child to protect the site from trauma to avoid reinsertion ➢ Needs skin puncture unlike CV
of needle.
‒ Uses:
● For hospitalized or receiving home care for a long time
● Can also be used if frequent venous blood samples are
required
USING CENTRAL VENOUS ACCESS CATHETERS & DEVICES

‒ Venous access for long-term IV therapy
➢ Obtained using a catheter inserted into the vena
cava just outside the right atrium
- Peripherally Inserted Central Catheters (PICC lines)

➢ Advantage: Can remain in place for up to 4
months without being changed
➢ These catheters are inserted into an arm vein
(usually at the antecubital space into the median,
cephalic or basilic vein) and advanced until the tip
rests in the superior vena cava
➢ All central venous access systems have the
potential to cause thromboses because they
- Typical catheters → These catheters can be used to partially occlude a vein (thromboses can cause
administer bolus or continuous infusions of medications cardiac arrest)
and fluid: ➢ Dressing must be changed using strict aseptic
➢ Broviac techniques to prevent infection.
➢ Hickman
INTRAOSSEOUS INFUSION ADMINISTRATION
➢ Groshong catheters
‒ Minor surgery (sterile technique)
‒ Infusion of fluid into the bone marrow, usually the distal
ADVANTAGE DISADVANTAGE or proximal tibia, the distal femur, or the iliac crest
‒ Fluid reaches the bloodstream quickly as if it were
- Discomfort from further - Catheter could become snagged administered IV
skin punctures is on something and accidentally be
‒ Is used in an emergency when it is difficult to establish
avoided pulled out
usual IV access
- Patients are not allowed to swim
or take showers to avoid ‒ It is temporary measure until a usual route of
infection, unless there is a administration
waterproof dressing ‒ It must be initiated with sterile technique, and if
continued for an extended time, the infusion point is
rotated about 2-3 days.
- Vascular Access Ports (VAPs) ‒ Tubing must be change every 48 hours and the dressing
➢ Are small plastic devices that are implanted under over the site must be changed every 24 hours (You need
the skin, usually on the anterior chest just under to change every day using proper asepsis)
the clavicle, for long term fluid or medication ‒ Assess for distal pulse and adequate temperature and
administration via bolus or continuous color of the leg every hour throughout the infusion
administration
SUBCUTANEOUS (HYPODERMOCLYSIS) INFUSION
ADMINISTRATION
‒ Using a butterfly needle (bolus type)
‒ Used for children with blood disorders who receive
medication to remove stored iron from their body
‒ Sites used for hypodermoclysis generally include:
➢ Pectoral region
➢ Common brands: ➢ Back
● Port-A-Cath ➢ Anterolateral aspects of the thigh
● Infus-a-Port ‒ 45-degree angle subcutaneous
● Groshong Venous Port
➢ After cleansing, blood samples can be removed or
medication can be injected by a puncture, but no ‒ Fluid reaches the bloodstream quickly as if it were
administered IV

‒ Is used in an emergency when it is difficult to establish
usual IV access
‒ It is temporary measure until a usual route of
administration
‒ It must be initiated with sterile technique, and if
continued for an extended time, the infusion point is
rotated about 2-3 days.
‒ Tubing must be changed every 48 hours and the dressing
over the site must be changed every 24 hours (You need
to change every day using proper asepsis)
‒ Assess for distal pulse and adequate temperature and
color of the leg every hour throughout the infusion

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MCHN 2 - LECTURE 4th

Factors: FEMALES (35%)

INFERTILITY (SUBFERTILITY) Environmental ➢ exposure to radiation and chemicals

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 2 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 3 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 4 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 5 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 6 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 8 .

Signs and Symptoms:

➢ Failure of urethra to close; ➢ The opening of the urethra

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 10 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 11 .

Signs and Symptoms:

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 15 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 16 .

TTT: either be minimally invasive therapy (e.g. drug therapy)

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 17 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 18 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 20 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 21 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 22 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 23 .

CONTINUOUS SUBCUTANEOUS PUMP INFUSION

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 24 .

‒ Fluid chambers (SoluSet) → devices that

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 25 .

USING CENTRAL VENOUS ACCESS CATHETERS & DEVICES

- Peripherally Inserted Central Catheters (PICC lines)

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 26 .

KUAN, PADILLO, PEPITO, RELAMPAGOS, SEVILLA, TABOR 27 .

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