FRAMEWORK FOR MATERNAL & CHILD 1.

HEALTH PROMOTION,
NURSING 2. HEALTH MAINTENANCE,
3. HEALTH RESTORATION, AND
OBSTETRICS
4. HEALTH REHABILITATION.
 The care of women during childbirth, is
derived from the Greek word obstare,
which means “to keep watch”
 A branch of medical science that deals
with pregnancy, childbirth, and the
postpartum period.
 Combined with GYNECOLOGY under the
discipline known as OBSTETRICS &
GYNECOLOGY (OB-GYN) which is a
surgical field.
PEDIATRICS
 A word derived from the Greek word pais, NURSING THEORISTS
meaning “child”.
 Branch of medicine concerned with the 1. Florence Nightingale – Environmental
development, care, diseases & Theory –
development of babies & children. This theory is based on five points, which
she believed to be essential to obtain a
GOALS AND PHILOSOPHIES OF MATERNAL healthy home, such as clean water and
AND CHILD HEALTH NURSING air, basic sanitation cleanliness, and light,
 The primary goal of both maternal and as she believed that a healthy
child health nursing is the promotion and environment was fundamental in healing.
maintenance of optimal family health.
Maternal and child health nursing extends 2. Hildegard Peplau – Psychodynamic
from preconception to menopause with an Nursing –
expansive array of health issues and This theory offers nurses an
healthcare providers. understanding of how personality is
 Scope of practice include: dynamic; instead of being fixed, it is a
1. Preconception health care constant state of friction and change
2. Care of women during three trimesters of which has implications for a person’s
pregnancy and the puerperium (the 6 wellbeing:
weeks after childbirth, sometimes termed
the fourth trimester of pregnancy) 3. Virginia Henderson – 14 Components of
3. Care of infants during the perinatal period Basic Nursing Care –
(the time span beginning at 20 weeks of  Breath normally
pregnancy to 4 weeks [28 days] after  Eat and drink adequately
birth)  Eliminate body waste
4. Care of children from birth through late  Move and maintain desirable posture
adolescent  Sleep and rest
5. Care in a variety of hospital and home  Select suitable clothes: dress and
care settings undress
 Maintain body temperature within the
FRAMEWORK FOR MCHN normal range by adjusting clothes and
 Maternal and child health nursing can be modifying the environment.
visualized within a framework in which  Keep the body clean and well
nurses use NURSING PROCESS, groomed and protect the integument.
NURSING THEORIES, NURSING  Avoid dangers in the environment and
RESEARCH and QUALITY AND SAFETY injuring others.
EDUCATION FOR NURSES(QSEN)
 Communicate with others in
competencies to care for families during
expressing emotions, needs, fears or
the childbearing and childrearing years
opinion.
through the FOUR PHASES of health care
 Worship according to one’s faith.
which are:
  Work in such a way that there is a Sees the person as a biopsychosocial
sense of accomplishment. being in continuous interaction with a
 Play or participate in various forms of changing environment.
recreation.
 Learn, discover, or satisfy the curiosity 11. Jean Watson – Philosophy of Science
that leads to normal development and and Caring –
health and use the available health This theory addresses how nurses
facility. express care to their patient.

4. Joyce Travelbee – Human-to-Human 12. Madeleine Leiniger – transcultural

Relationship model – Nursing –
In this theory, nursing is an interpersonal Means being sensitive to cultural
process whereby the nurse assists a differences as you focus on individual
patient/family to prevent or cope with patients, their needs and their
experience or illness and suffering and, if preferences.
necessary, to find meaning in these
experiences. 13. Patricia Benner – Excellence and Power
in Clinical Nursing Practice –
5. Betty Neuman – System Model – Five expertise level:
Views the client as an open system that a. Novice
responds to stressors in the environment. - Student nurse
- Working to acquire nursing
6. Dorothy Johnson – Behavioral System knowledge & skill
Model – b. Advanced beginner
This theory is useful in practice because it - Newly qualified nurse
allows junior medical personnel to provide - Months experience
not only physical but also psychological - Reliance on protocol and oversight
support to the patient, as well as inhibit on colleagues
inadequate behavior caused by this or that c. Competent
reason. - 2 years’ experience
- Able to provide independent care
7. Imogene King – Goal Attainment Theory - Assumes greater responsibility
– d. Proficient
This theory places the patient at the - 3+ years’ experience
center of focus with the nurse facilitating - Able to recognize and responds to
and supporting people in maintaining and rapidly changing clinical situations
caring for themselves. e.g., unstable patients
e. Master
8. Dorothea Orem – Selfcare Deficit Theory - Expert nurse
– - 5+ years’ experience
Focuses on each “individual’s ability to - Intuitive management of complex
perform self-care, defines as the practice cases
of activities that individuals initiate and - Patient advocate
perform on their own behalf in maintaining
life, health, and well-being. NURSING RESEARCH
 The controlled investigation of problems
9. Faye Abdellah – Typology of 21 Nursing that have implications for nursing practice,
Problems – provides evidence for practice and
This is a conceptual model mainly justification for implementing activities for
concerned with patient’s needs and outcome achievement, ultimately resulting
nurses’ roles in problem identification in improved and cost-effective patient
using a problem. care.

10. Sr. Callista Ray – Adaptation Model – QSEN: Quality and Safety Education for
Nurses
 Six competencies for quality care:
  Patient-centered care  A challenging role for nurses and a major
 Teamwork and collaboration factor in keeping families well and optimally
 Quality improvement functioning
 Informatics
 Evidenced-based practice A maternal and child health nurse:
 Safety  Considers the family as a whole and as a
partner in care when planning or
implementing or evaluating the effectiveness
of care.
FOUR PHASES OF HEALTH CARE  Serves as an advocate to protect the rights of
 Health Promotion all family members, including the fetus.
 Health Maintenance  Demonstrates a high degree of independent
 Health Restoration nursing functions because teaching and
 Health Rehabilitation counselling are major interventions.
 Promotes health and disease prevention
Measuring maternal and child health nursing because these protect the health of the next
population: statistical terms generation.
 Serves as an important resource for families
 Birth rate: the number of births per 1,000 during childbearing and childrearing as these
population can be extremely stressful times in a life
 Fertility rate: the number of pregnancies per cycle.
1,000 women of childbearing age  Respects personal, cultural, and spiritual
 Neonatal death rate: the number of deaths attitudes and beliefs as these so strongly
per 1,000 live births occurring at birth or in the influence the meaning and impact of
first 28 days of life childbearing and childrearing.
 Perinatal death rate: the number of deaths  Encourages developmental stimulation during
during the perinatal time period (beginning both health and illness so children can reach
when a fetus reaches 500 grams, about week their ultimate capacity in adult life.
20 of pregnancy, and ending about 4 to 6  Assesses families for strengths as well as
weeks after birth),it is the sum of the fetal and specific needs or challenges.
neonatal rates  Encourages family bonding through rooming-
 Maternal mortality rate: the number of in and family visiting in maternal and child
maternal deaths per 100,000 live births that health care settings.
occur as a direct result of the reproductive  Encourages early hospital discharge options
process to reunite families as soon as possible in
 Infant mortality rate: the number of deaths order to create a seamless, helpful transition
per 1,000 live births occurring at birth or in the process.
1st 12 months of life (the most meaningful and  Encourages families to reach out to their
important measure of maternal and child community so the family can develop a wealth
health) of support people they can call on in a time of
 Childhood mortality rate: the number of family crisis.
deaths per 1,000 population in children aged
1 to 14 years MATERNAL AND CHILD HEALTH GOALS &
STANDARD
Major philosophies on maternal and child  NATIONAL HEALTH GOALS ARE;
health nursing: 1. To increase quality and years of healthy life.
 Maternal and child health nursing is: 2. To eliminate health disparities
 Family-centered  A new objective was added in 2010 which
 Community centered recommended that 100% of pre-licensure
 Evidenced-based practice (is the programs in nursing include core content on
conscientious, explicit, and judicious use of counseling for lesbian, gay, bisexual, and
current best evidence to make decisions transgender (LGBT) populations, evaluation of
about the care of the patients obtained from health sciences literature, environmental
randomized controlled trials to move health, public health systems and global
healthcare actions from ‘’just tradition’’ to a health. *
more solid and safer, scientific basis)
ROLES & RESPONSIBILITIES OF MATERNAL Diversity and maternal and child health
AND CHILD HEALTH NURSE nursing
 Clinical Nurse Specialist  Diversity means there is a mixture or variety
 Case manager of sociodemographic groups, experiences,
 Nurse Practitioner and beliefs in the population.
 Women’s Health Nurse Practitioner  Culture is a view of the world and a set of
 Pediatric Nurse Practitioner traditions a specific social group uses and
 Neonatal Nurse Practitioner transmits to the next generation.
 Family Nurse Practitioner  Transcultural nursing is care guided by
 Certified Nurse-Midwife cultural aspects and respects individual
differences.
Legal considerations of maternal-child  Cultural values are preferred ways of acting
practice based on cultural traditions.
 Nurses are legally responsible for protecting Understanding cultural diversity in maternal
the rights of their patients, including and child health nursing
confidentiality, and are accountable for the Cultural aspects that are important to assess are :
quality of their individual nursing care and that  COMMUNICATION PATTERN;
of other health care team members.  USE OF CONVERSATIONAL SPACE;
 Reproductive healthcare rights and laws are  RESPONSE TO PAIN;
complex and vary from each country.  TIME ORIENTATION;
 New technologies (assisted reproduction,  WORK AND SCHOOL ORIENTATION;
surrogate motherhood, umbilical cord  FAMILY ORIENTATION
sampling, safety of new medicines to children)  MALE & FEMALE ROLES
can lead to legal actions, especially if patients  RELIGION
are uninformed about the reason or medical  HEALTH BELIEFS
necessity.  NUTRITION PRACTICES
 Understanding the scope of practice and care
based on a state or country can help nurses Maternal-child health nursing care and the
practice within appropriate legal parameters. community
 Documentation is essential for justifying  A community is a group of individuals
actions. interacting within a limited geographical area
 Nurses need to be conscientious about  Knowing the individual aspects of a
obtaining informed consent for invasive community helps us understand why some
procedures. people reach the illness level they do before
 ‘’Wrongful birth’ ’wrongful life’ ’wrongful they seek health care, example: a woman
conception’’ living in a rural area has no transportation to
 A nurse is legally responsible for reporting prenatal care until her partner comes home
inappropriate or neglect or breach of duty of from work, a 5-year old child develops
another practitioner. measles because there are no free
immunization services in his community.
Ethical considerations of practice  The health of individuals and their families are
 Conception issues (in vitro fertilization, influenced by the health of their community. It
embryo transfer, ownership of frozen oocytes is important to become acquainted with the
or sperm and surrogate motherhood) community in which a nurse practice or where
 Pregnancy termination a patient lives.
 Fetal rights versus rights of the mother
 Stem cell research
 Resuscitation and length of its continuation
 Number of procedures or degree of pain a
child should be asked to endure to achieve a
degree of better health
 Balance between modern technology and
quality of life
 Difficulty maintaining confidentiality of records
when there are multiple caregivers
INTRODUCTION TO MOTHER AND CHILD facilities that provide emergency obstetric
HEALTH NURSING care for every 125,000 population and which
are located strategically.
 Maternal and Child Health refer to Philo-  Improves the quality of prenatal and postnatal
mother and child relationship to one another care.
and consideration of the entire family as well  Reduce women’s exposure to health risks
as the culture and socio-economic through the institutionalization of responsible
environment as framework of the patient. parenthood and provision of appropriate
 It involves the care of the woman and family health care package to all women of
throughout pregnancy and childbirth and the reproductive age especially those who are
health promotion and illness care for the less than 18 years old and over 35 years of
children and families. age, women with low education and financial
resources, women with unmanaged chronic
Goal of MCH illness and women who had just given birth in
 To ensure that every expectant and nursing the last 18 months
mother maintains good health, learns the art  LGUs and NGOs and other stakeholders must
of child care, has normal delivery and bears advocate for health through resource
healthy child. generation and allocation for health services
 That every child, wherever possible lives and to be provided for the mother and the unborn.
grows up in a family unit with love and
security, in healthy surroundings, receives Maternal Neonatal and Child Health and
adequate nourishment, health supervision and Nutrition Strategy (MNCHN)
efficient medical attention, and is taught the
elements of healthy living (Reyala, 2000).  It applies specific policies and actions for
 Promotion and maintenance of optimum local health systems to systematically
health of the women and newborn. address health risks that lead to maternal
and especially neonatal deaths which
Philosophy of MCN comprise half of the reported infant
 Is community-centered mortalities.
 Is research-centered
 Is based on nursing theory BeMONC- Basic Emergency Obstetrics and
 Protects the rights of all family members Newborn Care
 Uses a high degree of independent It refers to lifesaving services for emergency
functioning maternal and newborn conditions/complications
being provided by a health facility or professional
 Places importance on the promotion of health
to include the following services:
 Is based on the belief that pregnancies or
 Administration of parenteral oxytocic drugs.
childhood illnesses are stressful because they
are crises.  Administration of dose of parenteral
anticonvulsants
 Is a challenging role for the nurse and is a
major factor in promoting high-level wellness  Administration of parenteral antibiotics
in families.  Administration of maternal steroids for
 Pregnancy, labor and delivery, and the preterm labor
puerperium are part of the continuum of the  Performance of assisted vaginal deliveries
total life cycle.  Removal of retained placental products
 Personal, cultural, and religious attitudes and
beliefs influence the meaning of pregnancy for  Manual removal of retained placenta
individuals and make each experience unique.
It also includes neonatal interventions which
 Maternal-child nursing is family centered. The
include at the minimum:
father of the child is as important as the
mother  Newborn resuscitation

Strategic thrusts (2005-2010)  Provision of warmth

 Launch and implement the Basic Emergency  Referral
Obstetric Care strategy in coordination with
the DOH. It entails the establishments of  Blood transfusion
 BeMONC facility shall consist of the core possible, for continuing care or
district hospital. consultation. Second choice will be
followed carefully by the rural health unit,
 For geographically isolated/disadvantaged city health clinic or puericulture center.
areas/ densely populated areas, the  All RHUs and BHS should have a master
designated BeMONC facilities are the list of pregnant women in their respective
following: Rural Health Unit, Barangay Health catchment center.
Station, Lying-in Clinics and Birthing Homes.
 The Home-Based Mother’s Record
 Accessibility within 1 hour from residence or (HBMR) shall be used when rendering
referring facility within the ILHZ (Inter-local prenatal care as a guide in in the
Health Zones) identification of risk factors, danger signs
and to be able to do appropriate
 Shall operate within 24 hours with 6 signal measures.
obstetric function.  There should be at least 3 prenatal visits
following the prescribed timing:
 Shall have access to communication and
o First prenatal visits should be
transportation facilities to mobilize referrals.
made as early in pregnancy as
 Staff composition: (1) Medical Doctor, (1) possible, during the first trimester.
Registered Nurse, (1) Registered Midwife. o Second during the second
trimester
o Third and subsequent visits during
CeMONC – Comprehensive Emergency the third trimester.
Obstetrics and Newborn Care facility o More frequent visits should be
done for those at risk or with
Refers to lifesaving services for complications.
emergency maternal and newborn conditions/
complications as in Basic Emergency Obstetric Tetanus Toxoid Immunization
and Newborn Care plus the provision of surgical
delivery and blood bank services and other  Neonatal tetanus is one of the public
specialized obstetric interventions. health concerns, that is why it is important
for pregnant women and child bearing age
Essential Health Services available in the women to get a tetanus toxoid
Health Care Facilities immunization in order to protect them from
this deadly disease.
 A series of 2 doses of TT vaccination must
A. Antenatal Registration/ Prenatal Care be received by woman one month before
delivery to protect baby from neonatal
OBJECTIVE: to reach all pregnant women, to tetanus.
give sufficient care to ensure a healthy pregnancy
 And the three booster dose shots to
and the birth of a full-term healthy baby.
complete the five doses following the
 Normal Patients- following the initial recommended schedule provides full
evaluation they will be given healthy protection. The mother is then called as a
instructions and counseling. This will “Fully Immunized Mother” (FIM).
include advice for prompt prenatal care
examination.
 Patients with mild complications- a Micronutrient Supplementation
thorough evaluation of the needs of
It is necessary to prevent anemia, vitamin
patients with mild complications will
A deficiency and other nutritional disorders.
determine the frequency of follow-up of
these cases by the rural health unit, city Vitamin A
health clinic or puericulture center
 Patients with potentially serious  Dose: 10,000 IU
complications- these patients shall be  Given a week starting on the 4th month of
referred to the most skilled source of pregnancy.
medical and hospital care. As a first
choice they will be referred, if at all
  Do not give it before the 4th month of and supervised by personnel of the nearest
pregnancy because it might cause BHS/RHU trained on Maternal Care.
congenital problems in the baby.
The following are qualified for home delivery:

 Full term
Iron  Less than 5 pregnancies
 Cephalic position
 Dose: 60mg/400 ug tablet
 Without existing diseases such as
 Schedule: Daily
diabetes, bronchial asthma, heart disease,
hypertension, goiter, tuberculosis, and
severe anemia.
Clean and Safe Delivery  No history of complications like
hemorrhage during previous deliveries.
 No history of difficult delivery and
A. Check for Emergency signs prolonged labor (more than 24 hours for
 Unconsciousness primi and more than 12 hours for
 Vaginal bleeding multigravida)
 Severe abdominal bleeding  No previous cesarean sections
 Looks very ill  Imminent deliveries (those who are about
 Severe headache with visual disturbance to deliver and can
 Severe breathing difficulty  no longer reach the nearest facility in time
 Fever for delivery)
 Severe vomiting  No premature rupture of membranes
 Adequate pelvis
B. Made woman comfortable  Abdominal enlargement is appropriate for
age of gestation.
C. Assess the woman in labor
 Home delivery kit must at least contain
 LMP two pairs of clamps, a pair of scissors,
 Number of pregnancies antiseptic (may use 70% Povidone/Iodine)
 Start of labor pains soap and hand brush, clean towel/piece of
 Age/height cloth, flashlight, sphygmomanometer,
 Danger signs of pregnancy stethoscope.
 Clean hands, clean surfaces, and clean
D. Determine the stage of labor cord must be strictly followed to prevent
E. Decide of the woman can safely deliver infection
F. Give supportive care throughout labor Guide for home delivery:
G. Monitor and manage labor
H. Monitor closely after delivery For registered patient: time when regular
I. Continue care for at least two hours pains started, whether bag of water ruptured or
postpartum not, presence of absence of vaginal discharges,
bleeding, etc., whether mother moved her bowels
and has urinated, fetal movement felt by the
Home Delivery mother or not, unusual symptoms such as
bleeding, headache, spots before eyes.
It is for normal pregnancies attended by
licensed health personnel. Trained hilots may be For unregistered patients: get same
allowed to attend home deliveries only in the information as for those registered patients and
following circumstances: get medical and obstetric history.

 Areas where there are no health

personnel on maternal care. Delivery in Healthy Facility
 When, at the time of delivery, such
personnel are not available.  At lying-in clinics, Birthing Homes or within
the BHSs/RHUs.
Actively practicing but untrained birth
attendants (hilots) should be identified, trained
  Normal pregnancies and with labor of this, treatment can be given early to prevent
progressing normally must be encourage consequences of untreated conditions.
to deliver in this facility.
Timing:
It is ideally done on the 48th-72nd hours of
life. However, it may also be done after 24 hours
from birth.
Delivery in Hospitals
Procedure:
Risk pregnancies should be advised to
deliver in the hospital are the following:  A few drops are taken from the baby’s heel,
blotted on a special absorbent filter card and
 Pregnancy more the 4 then sent to the Newborn Screening Center
 Previous CS (NSC). The blood samples for Newborn
 History of postpartum hemorrhage Screening (NBS) may be collected by any of
 History of medical illness such as heart the following: physician, nurse, medical
disease, goiter, tuberculosis, diabetes, technologies or trained midwife. The
severe anemia, hypertension, bronchial procedure costs P550. The DOH advisory
asthma Committee on Newborn Screening has
 Antepartum hemorrhage approved a maximum allowable fee of P50 for
 Hypertensive disorders of pregnancy and the collection of the sample. Newborn
Eclampsia Screening is now included in the Phil health
 Cephalo-pelvic disproportion Newborn Care Package. It is widely available
 Placenta previa and abruption placenta in hospitals, Lying- ins, Rural Health Unit,
 Multifetal pregnancy Health Centers, and some private clinics. If
 Post term and preterm pregnancies babies are delivered at home, babies may be
 Previous uterine surgery such as brought to the nearest institution offering
myomectomy newborn screening.
 Results can be claimed from the health facility
where NBS was availed. Normal NBS results
APGAR Scoring are available by 7-14 working days from the
time samples are received at the NSC.
It provides a valuable index for evaluation of
Positive NBS results are relayed to the
the infants at birth. It is based on five signs
parents immediately by the health facility. A
ranked in order of importance as follows: Heart
NEGATIVE SCREEN MEANS THAT THE
Rate, Respiratory Effort, Muscle Tone, Reflex
NBS IS NORMAL.
Irritability, and Color. In general, they made 1
 A positive screen means that the newborn
minute of life and 5 minutes. Each sign is
must be brought back to his/her health
evaluated according to the degree to which it is
practitioner for further testing. Babies with
present and is given a score of 0, 1, and 2. The
positive results may be referred at once to a
scores of each sign are added together to give a
specialist for confirmatory testing and further
total score (10 is the maximum).
management.
Newborn Screening
It is a public health program aimed at the
Disorders detected in Newborn Screening
early identification of infants who are affected by
certain genetic/metabolic/infectious conditions.
Early identification and intervention can lead to
significant reduction of morbidity, mortality and 1. Phenylketonuria
associated disabilities in affected infant  it is the inability to metabolize the amino
acid phenylamine, which is a common
Significance: component such a milk.
 Excessive accumulation of phenylalanine
Most babies with metabolic disorders look
in the blood causes brain damage. The
“normal” at birth. By doing NBS, metabolic
babies may look like “albino” with musty
disorders may be detected even before clinical
odor of the skin, hair, sweat and urine.
signs and symptoms are present. And as a result
PKU is treated with a special low-
 phenylalanine diet which the amount of A. The Rooming-in and Breastfeeding Act of
amino acid is carefully regulated. 1992
2. Congenital Hypothyroidism
 To encourage, protect and support the
 most common causes of mental
practice of breastfeeding. It shall
retardation. Most affected infants may look
create an environment where the basic
normal at birth; however, they may have
physical, emotional and psychological
large fontanels and tongues, big tummies
needs of mothers and infants are
and prolonged yellowish discoloration of
fulfilled.
the skin and eyes. Infants are treated with
thyroid hormones and it continues
throughout life. If the disorder is not
detected and hormone replacement is not
initiated within two weeks, the baby with B. Milk Code of 1986
CH may suffer from mental and growth
retardation.  The aim of this code is to contribute to
3. Galactosemia the provision of safe and adequate
 it is the absence of enzymes necessary nutrition for infants by the protection
for conversion of the milk sugar galactose and promotion of breastfeeding and by
to glucose. Affected infants present with ensuring the proper use of breast milk
difficulty in feeding, vomiting and diarrhea, substitutes and breastmilk
yellowish skin and eyes, weakness, white supplements when these are
eyes (cat’s eyes) and bleeding after blood necessary, on the basis of adequate
extraction. Accumulation of excessive information and through appropriate
galactose in the body may cause liver marketing and distribution.
damage, brain damage, and cataracts.
Treatment may include the elimination of
milk from the diet and the use of milk Family Planning Counseling
substitutes.
4. Glucose 6 phosphate dehydrogenase Proper counseling of couples on the
deficiency (G6PD deficiency) importance of family planning will help them
 the body lacks the enzyme called G6PD inform on the right choices of family planning
that may cause hemolytic anemia when methods, proper spacing of birth and addressing
the body is exposed to oxidative the right number of children. Birth spacing of
substances found in certain drugs, foods three to five years interval will help completely
and chemicals. Children become pale, develop the health of a mother from previous
with yellow skin and eye, tea colored urine pregnancy and childbirth. The risk of
and fast breathing. It may lead to heart complications increases after the second birth.
failure.
5. Congenital Adrenal Hyperplasia
 refers to a group of disorders with an
enzyme defect that prevents adequate
adrenal corticosteroid and aldosterone
production an increases production of
androgens. It manifested by poor feeding,
vomiting and diarrhea and weak cry. It
also causes short stature, early puberty
excessive hair growth and infertility.
Treatment of corticosteroids for the rest of
child’s life.

Support to Breastfeeding
Motivate, mothers to practice breastfeeding
 REPRODUCTIVE & SEXUAL HEALTH  Fetishism
is characterized by a distressing and
HUMAN PROCREATION
persistent pattern of sexual arousal involving
It is a biological process that enables the the use of nonliving objects or specific, non-
birth of another human being. It implies sexual genital body parts.
reproduction since the genetic information of the  Transvestism
offspring includes contributions from the two is the practice of dressing in a manner
parents through the fusion of the gametes. traditionally associated with the opposite sex
 Voyeurism
SEXUALITY & SEXUAL IDENTITY the practice of gaining sexual pleasure
 Gender identity is a person’s sense of his or from watching others when they are naked or
her masculinity or femininity. engaged in sexual activity.
 Gender roles are composed of behaviors,  Sadomasochism
attributes and attitudes an individual conveys can be defined as the taking of pleasure,
about being male or female. often sexual in nature, from the inflicting or
 Biologic gender is the term used to denote suffering of pain, hardship
chromosomal sexual development: male –XY  Exhibitionism
or female- XX involves exposing the genitals to become
 Sexual orientation refers to a person’s sexually excited or having a strong desire to
preference for heterosexual, homosexual, or be observed by other people during sexual
bisexual relationship. activity
 Sexual expression refers to the activities that  Making obscene telephone calls
the individual chooses to give and receive Making obscene telephone calls for sexual
physical love or gratification. arousal or other sexual pleasure is known
as telephone scatologia and is considered a
TYPES OF SEXUAL ORIENTATION form of exhibitionism
 Bestiality
 A heterosexual is a person who finds sexual sexual intercourse between a person and
fulfillment with a member of the opposite an animal
gender.  Pedophilia
 A homosexual is a person who finds sexual is characterized by recurring, intense
fulfillment with a member of his or her own sexually arousing fantasies, urges, or
sex; gay, lesbian, men who have sex with behavior involving children (usually 13 years
men, women who have sex with women. old or young
 Bisexual are said to achieve sexual
satisfaction from both homosexual and
heterosexual relationships. HUMAN SEXUAL RESPONSE
 A transsexual or transgender person is an
individual who, although of one biologic  Excitement occurs with physical &
gender, feels as if he or she is the opposite psychological stimulation that causes
gender. parasympathetic nerve stimulation which
leads to arterial dilation and venous
constriction in the genital area.
TYPES OF SEXUAL EXPRESSION
 Plateau stage is reached before orgasm.
 Sexual abstinence
the practice of refraining from some or all  Orgasm occurs when stimulation proceeds
aspects of sexual activity for medical, through the plateau stage to a point at which
psychological, legal, social, financial, the body suddenly discharges accumulated
philosophical, moral, or religious reasons. sexual tension. In men, muscle contractions
 Masturbation surrounding the seminal vessels and prostate
stimulation of the genitals with the hand project semen into the proximal urethra.
for sexual pleasure.
 Resolution is a 30-minute period during which
 Erotic stimulation
the external and internal organs return to an
is any stimulus (including bodily contact)
unaroused state.
that leads to, enhances and maintains sexual
arousal, and may lead to orgasm.
 FEMALE REPRODUCTIVE SYSTEM
DISORDERS OF SEXUAL FUNCTIONING
EXTERNAL STRUCTURES
 Inhibited sexual desire
(ISD) refers to a low level of sexual
interest
 Failure to achieve orgasm
The inability to ejaculate is called
anejaculation. Being unable to reach a
climax (orgasm) is called anorgasmia.
 Erectile Dysfunction

 The mons pubis is a mound of fatty tissue

over the symphysis pubis that cushions ad
protects the bone.
 The labia majora are longitudinal skin
folds between the labia majora.
 The clitoris is erectile tissue located at the
upper end of the labia minora. It is the
primary site of sexual arousal.
 The urethral meatus or orifice is small
opening of the urethra. It is located
between the clitoris and the vaginal orifice
also known as impotence, is for the purpose of urination.
defined by difficulty getting and keeping  Skene or paraurethral glands are small
an erection mucus-secreting glands that open into
 Premature ejaculation posterior wall of the urinary meatus and
occurs in men when semen leave lubricate the vagina.
the body (ejaculate) sooner than wanted  The vestibule is an almond-shaped area
during sex between the labia minora containing the
 Persistent sexual arousal syndrome vaginal introitus, hymen and Bartholin
(PGAD) is a rare condition that glands.
involves experiencing unwanted  The vaginal introitus is the external
sensations of arousal in your genitals that opening of the vagina.
don't resolve with one or more orgasms.  The hymen is a membranous tissue
Pain disorders: ringing the introitus.
 Vaginismus  Bartholin or vulvovaginal glands are
is the body's automatic reaction to mucus-secreting glands located on either
the fear of some or all types of vaginal side of the vaginal orifice.
penetration  The perineal body is composed of
 Dyspareunia muscles and fascia that support pelvic
defined as persistent or recurrent structures.
genital pain that occurs just before, during  The perineum is the area of tissue
or after sex between the anus and vagina, an
 vestibulitis episiotomy is performed here.
is characterized by a stinging or
burning-like pain at the vaginal introitus
that is provoked by sexual intercourse and
the insertion of objects such as a tampon
or speculum into the vagina.
FEMALE INTERNAL REPRODUCTIVE  The pelvis is a bony ring in the lower portion
of the trunk. It consists of three parts (ilium,
ischium and pubis) and four bones (two
innominate bones or hipbones, sacrum and
coccyx. The pelvic bones are held together by
four joints-symphisis pubis, two sacroiliac, and
sacrococcygeal.
 Types of pelvis: gynecoid (NORMAL
FEMALE PELVIS), android,
anthropoid, platypelloid
 Pelvimetry: the process of measuring
the internal or external pelvis is
performed with radiography or by
ORGANS internal examination.
 Internal pelvic inlet measurement
 The vagina is the female organ of copulation measures the diagonal conjugate, which is
and also serves as the birth canal. It is a the lower margin of the symphisis pubis to
tubular Musculo membranous organ that lies the promontory of the sacrum; it is
between the rectum and the urethra and normally 11.5 cm or more.
bladder.  Internal midpelvic outlet measurement
 The uterus is a hollow, muscular organ with measures the distance between ischial
three muscle layers (perimetrium, spines and prominence or bluntness of
myometrium, and endometrium). It is located spines; it is normally 10.5 cm.
between the bladder and rectum, and consists  Internal pelvic outlet measurement is an
of the fundus, body(corpus), and cervix. estimation of the angle of the pubic arch,
Uterine function include: mobility of the coccyx, intertuberous
 Menstruation, the sloughing away of diameter 11 cm, and posterior sagittal
spongy layers of endometrium with
bleeding from torn vessels.
 Environment for pregnancy; the
embryo and fetus develop in the
uterus after fertilization.
 Labor, consisting of powerful
contractions of the muscular uterine
wall that result in expulsion of the
fetus.
 Uterine ligaments include:
 Broad and round ligaments that
provide upper support for the uterus
 Cardinal, pub cervical, and uterosacral
ligaments that are suspensory and diameter 7.5 cm.
provide middle support.
 Pelvic muscular floor ligaments that
provide lower support. FEMALE BREASTS
 The fallopian tubes extend from the upper  The female breasts (mammary glands) are
outer angles of the uterus and end near the specialized sebaceous glands that produce
ovary. These tubes serve as the passageway milk after childbirth(lactation)
for the ovum to travel from the ovary to the  Internal breast include:
uterus and for the sperm to travel from the  Glandular tissue (parenchyma is
uterus to the ovary. composed of acini milk-producing) cells
 The ovaries are female sex glands located on that cluster in groups of 15 to 20 to form
each side of the uterus. The two functions of the lobes of the breast.
the ovaries are  Lactiferous ducts or sinuses, which form
 Ovulation (release of ovum) passageways from the lobes to the nipple.
 Secretion of hormones (estrogen and
progesterone)
  Fibrous tissue, also called Cooper  Menstruation is the periodic shedding of
ligaments, which provide support to the blood, mucus, and epithelial cells from the
mammary glands. uterus; average blood loss is 30 to 80 ml.
 Adipose and fibrous tissues, which  The ovaries produce mature gametes and
provide the relative size and consistency secrete the following hormones:
of the breast.  Estrogen which contributes to female
 External structure include: characteristics.
 The nipple, a raised, pigmented area of  Progesterone(hormone of
the breast. pregnancy),which decreases the
 The areola, pigmented skin around the contractility of the uterus.
nipple.  Prostaglandins, which regulate the
 Montgomery tubercles, sebaceous glands reproductive process by stimulating
of the areola the contractility of uterine and other
 The breasts change in size and nodularity in smooth muscle.
response to cyclic ovarian hormonal changes,
including;
 Estrogen stimulation
 Progesterone CENTRAL NERVOUS SYSTEM (CNS)
 Physical changes in the breast size and RESPONSE
activity are at a minimum 5 to 7 days after  The hypothalamus stimulates the anterior
menstruation stops; this is the best time to pituitary gland by secreting gonadotropin-
detect pathologic changes through breast self- releasing hormone(GnRH). The anterior
exam. pituitary secretes two gonadotropins-follicle-
stimulating hormones (FSH) and luteinizing
hormone (LH).
 FSH prompts the ovary to develop ovarian
follicles; the developing follicles secrete
estrogen, which feeds back to the anterior
pituitary to suppress FSH and trigger a surge
of LH.
 LH acts with FSH to cause ovulation and
enhance corpus luteum formation.

OVARIAN RESPONSE
 An oocyte grows within the primordial follicle
THE MENSTRUAL CYCLE in two phases-follicular and luteal.
 In the follicular phase, days 1 to 14, the follicle
matures as a result of FSH.
 In the luteal phase, days 15 to 22, the corpus
luteum develops from a ruptured follicle.

ENDOMETRIAL RESPONSE
 In the menstrual phase, days 1 to 5, the
estrogen level is low and cervical mucus is
scanty.
 In the proliferative (follicular)phase, days 6 to
14, the estrogen level is high, the
endometrium and myometrium thicken, and
MENSTRUATION & HORMONES changes in cervical mucosa occur. On
 Menarche, onset of menstruation, typically average, ovulation occurs on day 14 of a 28-
occurs between 9 and 17 years of age, with day cycle.
average age of onset at 12 or 13 years.  In the secretory phase, days 14 to 26, after
 The menstrual cycle is a monthly pattern of release of the ovum, the estrogen level drops,
ovulation and menstruation. the progesterone level is high, increased
 Ovulation is the discharge of a mature ovum uterine vascularity occurs, and tissue
from the ovary. glycogen levels increase.
 In the ischemic phase, days 27 to 28,  The ejaculatory duct is the canal formed by
estrogen and progesterone levels recede. the union of the vas deferens and the
Arterial vessels constrict, the endometrium excretory duct of the seminal vesicle. It enters
prepares to shed, the blood vessels rupture, the urethra at the prostate gland.
and menstruation begins.  The urethra is the passageway for urine and
semen that extends from the bladder to the
CERVIX AND CERVICAL MUCUS RESPONSE urethral meatus.
 Before ovulation, estrogen levels rise, causing
cervical dilation, abundant liquid mucus, high
spinnbarkeit, and excellent sperm penetration.
 After ovulation, progesterone levels rise,
resulting in cervical constriction, scant viscous
mucus, low spinnbarket, no ferning, and poor
sperm penetration.
 During pregnancy, cervical circulation (blood
supply) increases, and a protective mucus
plug form.

CLIMACTIC PERIOD & MENOPAUSE

 The climacteric is a transitional period during
SEMEN
which ovarian function and hormonal
 Semen is a thick, whitish fluid ejaculated by
production decline.
the man during orgasm. It contains
 Menopause refers to a woman’s last
spermatozoa and fructose-rich nutrients.
menstrual period; the average age of
During ejaculation, semen receives
menopause is 51 with an age range of 40 to
contributions of fluid from the seminal vesicles
55 years.
and the prostate gland.
 The earlier the age of menarche the earlier
 Semen is alkaline (average pH 7.5) and the
menopause tends to occur
average amount of semen released during
ejaculation is 2.5 ml to 3.5 ml.
MALE REPRODUCTIVE SYSTEM
MALE BREASTS
 Male mammary tissue remains dormant
throughout life, but the breasts are a site of
sexual excitation and arousal.
 Although rare, male breast cancer occurs
frequently enough to warrant routine
inspection of the breasts for dimpling,
discharge or nipple inversion.

Neurohormonal control of the male

reproductive system

 At puberty, the hypothalamus stimulates the

INTERNAL STRUCTURES
pituitary gland to produce FSH and LH.
 The testes are two solid, ovoid organs 4 to 5
 FSH stimulates germ cells within the
cm long, divided into lobes containing
testes to manufacture sperm.
seminiferous tubules. The two functions of the
 LH stimulates the production of
testis’s reproduction and spermatogenesis
testosterone in the testes. Although LH
(sperm production)
stimulates the Leydig cells to produce
 The epididymis is a tubular sac located next to
testosterone from cholesterol,
each testis that is a reservoir for sperm
testosterone inhibits the secretion of LH
storage and maturation.
by the anterior pituitary.
 The vas deferens is a duct extending from the
 Testosterone, one of several androgens (and
epididymis to the ejaculatory duct, which
the most potent) produced in the testes, is
provides a passageway for sperm.
 responsible for the development of secondary
sex characteristics at puberty.
 Testosterone production occurs in the
interstitial Leydig cells in the seminiferous
tubules. Leydig cells are abundant in the
newborn and the pubescent boy, and
testosterone is abundant during these
periods.
 Testosterone production slows after 40
years of age; by 80 years of age,
production is only about one-fifth peak
level.

SPERMATOGENESIS

 Spermatogenesis occurs continually after

puberty, providing large numbers of sperm for
unlimited ejaculations during the mature life
span.
 Spermatozoa are released from the
epithelial wall of the seminiferous tubules.
Meiosis occurs during the process, and
the number of chromosomes in each cell
is reduced by one-half (haploid number).
 Spermatogenesis is a heat-sensitive
process; the 2 degrees to 3-degree
difference between scrotal and abdominal
temperature allows spermatogenesis to
proceed in the cooler environment.
 The entire period of spermatogenesis,
from germinal cell to mature sperm, takes
about 75 days.
 THE CHILDBEARING & CHILD REARING  Family of procreation (a family one
FAMILY establishes; or oneself, spouse or
significant other, and children, if any)
FAMILY-CENTERED MATERNAL-NEWBORN
NURSING CLASSIFICATION OF FAMILY STRUCTURE
Family-centered maternal-newborn Based on Descent:
nursing is the term used to describe the provision  • Patrilineal- affiliates a person with a
of safe, quality care that recognizes, focuses on, group of relatives through his or her
and adapts to the physical and psychosocial father.
needs of the pregnant woman, her family, and the  • Matrilineal- affiliates a person with a
newborn. group of relatives through his or her
mother.
PRINCIPLES OF FAMILY-CENTERED  • Bilateral- affiliates a person with a group
MATERNAL & CHILD HEALTH NURSING of relatives related through both his or her
 Pregnancy and childbirth are usually parents.
normal health events within the family. Based on Authority:
 Childbirth affects the entire family and  Patriarchal- authority is vested on the
marks the beginning of a new set of oldest male in the family, often the father.
important relationships.  Matriarchal- authority is vested in the
 Families are able to make decisions about mother or mother’s kin.
care if given the proper information.  Matricentric- prolonged absence of the
 A maternal-newborn nurse serves as an father gives the mother a dominant
advocate for the rights of all family position in the family, although the father
members, including the fetus. may also share with the mother in
 Personal, cultural and religious attitudes decision making.
influence the meaning of pregnancy and Based on Place of Residence
birth within the family.  Patrilocal- requires the newly wed to
reside near the groom’s parents.
THE FAMILY  Matrilocal- near the bride’s parents.
  The FAMILY is the basic social institution  Bilocal- provides the couple the choice to
and the primary group in society. reside on either parent.
 According dg to Murdok, family is a social  Neolocal- permits the couple to reside
group characterized by common independently of their parents.
residence, economic cooperation and  Avunculocal- prescribes the newlywed
reproduction. couple to reside with or near the maternal
 According dg to Burges and Locke, family uncle of the groom.
is a group of persons united by ties of Based on Internal Organization or
marriage, blood or adoption, constituting a Membership
single household, interacting and  Childfree or Childless Family
communicating with each other in their Childfree is the term used
respective social roles of husband and generally for those who have chosen not
wife, mother and father, son and daughter, to have kids while Childless is for those
brother and sister, and creating and who would love them but can't have them
maintaining a common culture.  Cohabitation Family
 According and to Murray and Zentner is a   is an arrangement where people
social system and primary reference who are not married, usually couples, live
group made up of two or more persons together.
living together who are related by blood,  Nuclear Family
marriage or adoption or who are living refers to the core members of a
together by arrangement over a period of family, usually parents and children
time.  Extended or Multigenerational Family
a house where adults of two or
FAMILY TYPES more generations live under the same roof
 Family of orientation (the family one is  Single-Parent Family
born into; or oneself, parents, and siblings,  Blended Family
if any)
 or stepfamily forms when you and  Promote child safety related to home and
your partner make a life together with the automobiles.
children from one or both of your previous  Encourage socialization experiences
relationships. outside the home such as sports
 LGBT Family participation, music lessons, or hobby
 Foster Family activities.
a person temporarily serving as a Encourage a meaningful school experience to
parent for a child who has lost or been make learning a lifetime concern, not one of
removed from a parent's care and who is merely 12 years
not the person's own biological child  STAGE 5: THE FAMILY WITH AN
 Adoptive Family ADOLESCENT
 is a family who has welcomed a  Loosen ties enough to allow an
child born to another into their family and adolescent more freedom while still
legally adopted that child as their own remaining safe.
 Begin to prepare adolescents for life on
FAMILY TASKS their own.
 Physical maintenance STAGE 6: THE FAMILY WITH A LATE
 Socialization of family members ADOLESCENT
 Allocation of resources (THE LAUNCHING STAGE)
 Maintenance of order  Change their role from mother or father to
 Division of labor once removed support persons or
 Reproduction, recruitment, and release of guideposts.
family members  Encourage independent thinking and
 Placement of members into the larger adult-level decision skills in their child.
society STAGE 7:THE FAMILY OF MIDDLE-AGED
 Maintenance of motivation and morale PARENTS
 Adjust to “empty nest” syndrome by
DEVELOPMENTAL STAGES OF FAMILY reawakening their relationship with their
supportive partner.
STAGE 1: MARRIAGE  Prepare for retirement so when they
 Establish a mutually satisfying reach that stage they will not be
relationship. unprepared socially or financially
 Learn to relate well to their families of STAGE 8: THE FAMILY IN RETIREMENT OR
orientation. OLDER AGE
 Engage in reproductive life planning, if  Maintain heath by preventive care in light
applicable. of aging.
STAGE 2: THE EARLY CHILDBEARING  Participate in social, political, and
FAMILY neighborhood activities to keep active and
 Integrate the new member into the family. enjoy this stage of life.
 Make whatever financial and social
adjustments are necessary to meet the
needs of the new member while TRENDS & ISSUES
continuing to meet the meets of the  Increase divorce rate
parents.  Decrease/increase family size
STAGE 3: THE FAMILY WITH A PRE-SCHOOL  Increased dual-parent
CHILD employment/unemployment
 Prevent unintentional injuries (accidents)  Household violence
such as poisoning or falls.
 Begin socialization through play dates,
child care, or nursery school settings.
STAGE 4: THE FAMILY WITH A SCHOOL-
AGED CHILD
 Promote children’s health through
immunizations, dental care, and routine
health assessments.