 Using conscientious assessment to be certain the

COVERAGE: symptoms of illness are identified and intervention are

begun to return patient to wellness rapidly
 Identify the symptoms of the disease to return to
2. Reproductive and Sexual Health normal state
3. Responsible Parenthood
4. Health Rehabilitation
 Preventing further complications from an illness,
helping an ill client back to an optimal state of
wellness or helping a client to accept inevitable death.
Week 1: FRAMEWORK FOR MATERNAL AND
CHILD HEALTH NURSING
STANDARDS OF CARE AND MEASURES OF QUALITY
MATERNAL AND CHILD HEALTH NURSING (WHO)
Maternal and Child Health Nursing follows the
family from the pregnancy period, through labor, STANDARD 1: Every woman and newborn receives
routine, evidence-based care and management of
delivery, and the post-partal period; it then
complications during labor, childbirth and the early
follows the child in the family from birth
through adolescence. postnatal period, according to WHO guidelines.
 Women are assessed routinely on admission and
1. Nursing Process – is a scientific form of problem during labour and childbirth and are given timely,
solving serves as the basis for assessing, making a appropriate care.
a. Newborns receive routine care immediately after
nursing diagnosis, planning, implementing, and
birth.
evaluating care.
2. Nursing Theory (GUIDELINES) – designed to b. Mothers and newborns receive routine postnatal care.
offer helpful ways to view patients so nursing  Women with pre-eclampsia or eclampsia promptly
activities can be receive appropriate interventions, according to WHO
created to best meet guidelines.
 Women with postpartum haemorrhage promptly
patient needs
receive appropriate interventions, according to WHO
3. Evidenced – based
Practice – is a guidelines.
combination of research,
clinical expertise, and STANDARD 2: The health information system enables
patient preference or use of data to ensure early, appropriate action
 Every woman and newborn has a complete, accurate,
values.
standardized medical record during labour, childbirth
4. Nursing Research –
is the systematic and the early postnatal period.
investigation of  Every health facility has a mechanism for data
problems that have collection, analysis and feedback as part of its
implications for nursing activities for monitoring and improving performance
around the time of childbirth.to improve the care of
practice usually carried
every woman and newborn.
out by nurses.

I. STANDARDS OF MATERNAL AND CHILD STANDARD 3: Every woman and newborn with
HEALTH NURSING PRACTICE condition(s) that cannot be dealt with effectively with the
available resources is appropriately referred.
 Every woman and newborn is appropriately assessed
1. Health Promotion
on admission, during labour and in the early postnatal
 Educating clients to be
aware of good health period to determine whether referral is required,
through teaching and and the decision to refer is made without delay.
role modeling.  For every woman and newborn who requires referral,
the referral follows a pre-established plan that can be
implemented without delay at any time.
2. Health Maintenance
 For every woman and newborn referred within or
 Intervening to maintain health when risk of
illness is present between health facilities, there is appropriate
information exchange and feedback to relevant
health care staff.
3. Health Restoration
 Promptly diagnosing
STANDARD 4: Communication with women and their
and treating illness
using interventions that families is effective and responds to their needs and
will return client to preferences.
wellness most rapidly.  All women and their families receive information about
the care and have effective interactions with staff.

1
 All women and their families experience II. ADVANCED-PRACTICE ROLES FOR NURSES IN
coordinated care, with clear, accurate MATERNAL AND CHILD HEALTH
information exchange between relevant health CLINICAL NURSE SPECIALIST
and social care professionals. are nurses prepared at the master’s or doctorate
degree level who are capable of acting as consultants in
STANDARD 5: Women and newborns receive care their area of expertise, as well as serving as role models,
with respect and preservation of their dignity. researchers, and teachers of quality nursing care.
 All women and newborns have privacy around a. Neonatal Nurse Specialists - manage the care of
the time of labour and childbirth, and their infants at birth and in intensive care settings; they
confidentiality is respected provide home follow-up care to ensure the newborn
 No woman or newborn is subjected to remains well. Childbirth educators teach families
mistreatment, such as physical, sexual or about normal birth and how to prepare for labor and
verbal abuse, discrimination, neglect, birth.
detainment, extortion or denial of services. b. Childbirth Educators - teach families about normal
 All women have informed choices in the birth and how to prepare for labor and birth.
services they receive, and the reasons for c. Lactation Consultants - educate women about
interventions or outcomes are clearly explained. breastfeeding and support them while they learn
how to do this.
STANDARD 6: Every woman and her family are d. Genetic Nurse Counselors - consult with families
provided with emotional support that is sensitive to about patterns of inheritance and offer support to
their needs and strengthens the woman’s capability. families with a child who has inherited a genetic
 Every woman is offered the option to disorder.
experience labor and childbirth with the e. Case Manager – a graduate-level nurse who
companion of her choice. supervises a group of patients from the time they
 Every woman receives support to strengthen enter a health care setting until they are discharged
her capability during childbirth. from the setting.
STANDARD 7: For every woman and newborn, NURSE PRACTITIONERS
competent, motivated staff are consistently available are nurses educated at the master’s or doctoral level.
to provide routine care and manage complications. Recent advances in technology, research, and
 Every woman and child has access at all times knowledge have amplified the need for longer and more
to at least one skilled birth attendant and in-depth education for nurse practitioners as they play
support staff for routine care and management pivotal roles in today’s health care system.
of complications.
 The skilled birth attendants and support staff a. Pediatric Nurse Practitioner (PNP)
have appropriate competence and skills mix with extensive skills in physical assessment,
to meet the requirements of labour, childbirth interviewing, and well-child counseling and care.
and the early postnatal period.  Determines common illnesss – (Iron deficiency
 Every health facility has managerial and clinical anemia) they can orders the necessary laboratory
leadership that is collectively responsible for tests and prescribes appropriate drugs for therapy.
developing and implementing appropriate  Determines Major illness - Congenital subluxated hip,
policies and fosters an environment that kidney disease, heart disease, consults with an
supports facility staff in continuous quality associated pediatrician.
improvement.
b. Neonatal Nurse Practitioner
STANDARD 8: The health facility has an is an advanced-practice role for nurses who are
appropriate physical environment, with adequate skilled in the care of newborns, both well and ill.
water, sanitation and energy supplies, medicines, • Level 1 – Healthy babies
supplies and equipment for routine maternal and • Level 2 – infants with moderate health problems
newborn care and management of complications. • Level 3 – Neonatal ICU
 Water, energy, sanitation, hand hygiene and • Newborn nurseries, neonatal follow-up clinics, or
waste disposal facilities are functional, reliable, physician groups.
safe and sufficient to meet the needs of staff,
women and their families. c. Family Nurse Practitioner (FNP)
 Areas for labor, childbirth and postnatal care are • an advanced-practice that provides health
designed, organized and maintained so that care to women and children and
every woman and newborn can be cared for to the family as a whole.
according to their needs in private, to facilitate • FNP can provide prenatal care for a
the continuity of care. woman with an uncomplicated pregnancy
 An adequate stock of medicines, supplies and
equipment is available for routine care and
management of complications

2
d. Certified Nurse-Midwife 5. Adolescents who support themselves or who are
is an individual educated in the two disciplines of pregnant are termed “emancipated minors” or
nursing and midwifery and licensed. “mature minors” and have the right to sign for their
▪ plays an important role in assisting women with own health care.
pregnancy and childbearing either independently
or in association with a physician IV. ETHICAL CONSIDERATIONS OF PRACTICE
▪ Nurse-midwife assumes full responsibility for the
care and management of women with  Some of the most difficult ethical quandaries in health
uncomplicated pregnancies. care today are those that involve children and their
families
III. LEGAL CONSIDERATIONS OF ▪ Ethics – concerned with determining what is good or
MATERNAL-CHILD PRACTICE valuable for individuals, groups, and society.
▪ acts that are ethical reflects a commitment to
• MCHN carries some legal concerns that extend standards that individuals, professionals,
above and beyond other areas of nursing, because societies strive to meet.
care is often given to an “unseen client”—the ▪ Difficult Ethical quandaries in Health care
fetus—or to clients who are not of legal age for involves children and their families
giving consent for medical procedures. Examples are:
• In addition, labor and birth of a neonate are 1. Conception issues -related to in-vitro fertilization,
considered “normal” events, so the risks for a embryo transfer, ownership of frozen oocytes or
lawsuit are greater when problems arise (O’Grady sperm, cloning, stem cell research, and surrogate
et al., 2007) mothers
2. Abortion, particularly Partial-birth abortions
1. Nurses are legally responsible for protecting the 3. Fetal rights versus rights of the mother
rights of their clients, including confidentiality and 4. Use of Fetal tissue for research
are accountable for the quality of their individual 5. Neonatal Resuscitation (for how long should it be
nursing care and that of other health care team continued?)
members. 6. Number of procedures or degree of pain that a child
▪ Confidentiality – protection of patients' personal should be asked to endure to achieve a degree of better
health information. health
▪ Accountability – ability to answer for one’s 7. Balance between modern technology and quality of life
professional actions.
V. NURSING THEORY
2. Understanding the scope of practice and
standards of care can help nurses practice within One of the requirements of a profession (together with
appropriate legal parameters. other critical determinants, such as member-set standards,
monitoring of practice quality, and participation in research)
3. Documentation is essential for protecting a is that the concentration of a discipline’s knowledge flows
nurse and justifying his or her actions. from a base of established theory.
Documentation – is a nursing action that produces Nursing theorists offer helpful ways to view clients so
a written account of patient data, nursing clinical that nursing activities can best meet client needs—for
decisions, and intervention and patient response example, by seeing a pregnant woman not simply as a
physical form but as a dynamic force with important
4. Nurses need to be conscientious about psychosocial needs, or by viewing children as extensions
obtaining informed consent for invasive or active members of a family as well as independent
procedures and determining that pregnant beings. Only with this broad theoretical focus can nurses
women are aware of any risk to the fetus appreciate the significant effect on a family of a child’s
associated with a illness or of the introduction of a new member.
procedure or test. Another issue most nursing theorist’s address is how
nurses should be viewed or what the goals of nursing care
Amniocentesis should be. Extensive changes in the scope of maternal
Informed Consent – and child health nursing have occurred as health
process of obtaining promotion, or keeping parents and children well, has
permission from a become a greater priority.
patient to perform a With health promotion as a major nursing goal, teaching,
specific test or counseling, supporting, and advocacy are also common
procedure after roles (Vonderheid et al., 2007). Nurses care for clients who
describing are more critically ill than ever before. Because care of
all risks, side effects, women during pregnancy and of children during their
and benefits. developing years helps protect not only current health but
also the health of the next generation, maternal-child
health nurses fill these expanded roles to a unique and
special degree.
3
  Maternal Mortality Rate: Philippines maternal
VI. PHILOSOPHY OF MATERNAL AND CHILD mortality ratio was at level of 121 deaths per
HEALTH NURSING
100,000 live births in 2017, down from 124 deaths per
1. Family – Centered 100,000 live births previous year, this is a change of
• assessment must include both family and 2.42%.
individual assessment data
2. Community – Centered VII. GOALS OF MATERNAL AND CHILD
▪ the health of families depends on the influences HEALTH NURSING
the health of communities
3. Evidenced – Based Practice The primary goal of maternal and child health nursing
▪ this is the means whereby critical knowledge care can be stated simply as the promotion and
increases maintenance of optimal family health to ensure cycles
4. MCH nurse serves as an advocate to protect the of optimal child- bearing and childrearing.
rights of all family members, including the fetus The goals of Maternal and Child Health Nursing care
5. MCH Nursing includes a high degree of are necessarily broad because the scope of practice.
independent nursing functions, because teaching
and counselling are major interventions The range of practice includes:
6. Promoting health and disease prevention are a. Preconceptual health care
important nursing roles because these to protect
the health of the next generation
7. MCH Nurse serve as an important resources for
family during childbearing and childbearing
8. Personal, cultural, and religious attitudes and
beliefs influence the meaning and impact of
childbearing and childbearing on families
9. Circumstances such as illness or pregnancy are
meaningful only in the context of a total life.
10. Maternal and child health nursing is a
challenging role for nurses and a major factor in
keeping families well and optimally functioning.
b. Care of women during three trimesters of pregnancy
STATISTICAL TERMS USED TO REPORT and the puerperium. (6 wks. After childbirth), sometimes
MATERNAL AND CHILD HEALTH termed the fourth trimester of pregnancy
 Birth Rate: Number of births per 1000 c. Care of infants during the perinatal period (6 weeks
population. before conception to 6 weeks after birth)
 Fertility rate: Number of pregnancies per 1000 d. Care of children from birth through young adolescence
women of childbearing age. e. Care in settings as varied as the birthing room, the
 Fetal Death Rate: Number of fetal deaths pediatric intensive care unit, and the home
(weighing more 500 g) per 1000 live births.
 Neonatal Death Rate: Number of deaths per VIII. WORLD HEALTH ORGANIZATION’S
1000 live births occurring at birth or in the first 17 SUSTAINABLE DEVELOPMENT GOALS
28 days of life.
 Perinatal Death Rate: Number of deaths of
fetuses weighing more than 500 g and within
the first 28 days of life per 1000 live births.
 Maternal Mortality Rate: Number of maternal
deaths per 100,000 live births that occur as a
direct result of the reproductive process.
 Infant Mortality Rate: Number of deaths per
1000 live births occurring at birth or in the first
12 months of life.
 Childhood Mortality Rate: Number of deaths
per 1000 population in children, 1 to 14 years of
age
 Infant Mortality Rate: The infant mortality rate
for Philippines in 2019 was19.239deaths per TERMINOLOGIES:
1000 live births, a2.16% decline from 2018. • Infant Mortality rate - is the number of deaths among
 The top three leading causes of infant mortality infants from birth to 1 year of age per 1000 live births.
were Pneumonia (3,146; 14.3%); Bacterial • Maternal Mortality Rate - is the number of resident
sepsis of newborn (2,731; 12.4%); and maternal deaths within 42 days of pregnancy termination
Respiratory distress of newborn (2,347; 10.7%). due to complications of pregnancy, childbirth, and the
puerperium in a specified geographic area.
4
• Maternity Nursing – involves direct personal care feels as if he or she is of the opposite gender (Jain &
to maternity patients and their newborn infants or to Bradbeer, 2007). Such people may have sex change
related activities on their behalf during the various operations so that they appear cosmetically as the
phases of the child bearing experience gender they feel that they are.

Week 2: REPRODUCTIVE AND SEXUAL HEALTH TYPES OF SEXUAL EXPRESSION

SEXUALITY AND SEXUAL IDENTITY 1. Sexual abstinence (celibacy) is separation from
Sexuality is a multidimensional phenomenon sexual activity (Ott, Labbett, & Gold, 2007). It is the
that includes feelings, attitudes, and actions. It has avowed state of certain religious orders. It is also a
both biologic and cultural components. It way of life for many adults and one that is becoming
encompasses and gives direction to a person’s fashionable among a growing number of young adults.
physical, emotional, social, and intellectual It is the main point of many high school sex education
responses throughout life. classes.
Biologic gender is the term used to denote a 2. Masturbation is self-stimulation for erotic pleasure; it
person’s chromosomal sex: male (XY) or female can also be a mutually enjoyable activity for sexual
(XX). Gender identity or sexual identity is the partners. It offers sexual release, which may be
inner sense a person has of being male or female, interpreted by the person as overall tension or anxiety
which may be the same as or different from biologic relief. Masters (1998) reported that women may find
gender. Gender role is the male or female behavior masturbation to orgasm the most satisfying sexual
a person exhibits, which, again, may or may not be expression and use it more commonly than men.
the same as biologic gender or gender identity. Children between 2 and 6 years of age discover
masturbation as an enjoyable activity as they explore
COMPONENTS OF SEXUALITY their bodies.
a. Reproductive Sexuality 3. Erotic stimulation is the use of visual materials such
- involves the biological aspects of conception & as magazines or photographs for sexual arousal.
procreation. It also includes the sexual response Although this is thought to be mostly a male
b. Gender Sexuality phenomenon, there is increasing interest in centerfold
- deals w/ the social & emotional aspects of being a photographs in magazines marketed primarily to
man or a woman. women. Some parents of adolescents may need to be
c. Erotic Sexuality assured that an interest in this type of material is
- refers to sexual love and arousing sexual desires developmental and normal.
4. Fetishism is sexual arousal resulting from the use of
TYPES OF SEXUAL ORIENTATION certain objects or situations. Leather, rubber, shoes,
Sexual gratification is experienced in several and feet are frequently perceived to have erotic
ways. What is considered normal varies greatly qualities. The object of stimulation does not just
among cultures, although general components of enhance the experience; rather, it becomes a focus of
accepted sexual activity are that it is an activity of arousal and a person may come to require the object
adults and privacy, consent, and lack of force are or situation for stimulation.
included. 5. Transvestite is an individual who dresses in the
1. Heterosexual is a person who finds sexual clothes of the opposite sex. Transvestites can be
fulfillment with a member of the opposite heterosexual, homosexual, or bisexual. Many are
gender. married. Some transvestites, particularly married
2. Homosexual is a person who finds sexual heterosexuals, may be under a great deal of strain to
fulfillment with a member of his or her own sex. keep their lifestyle a secret from friends and
Many homosexual men prefer to use the term neighbors.
“gay.” “Lesbian” refers to a homosexual woman. 6. Sadomasochism involves inflicting pain (sadism) or
More recent terms are “men who have sex with receiving pain (masochism) to achieve sexual
men” (abbreviated as “MWM”) and “women who satisfaction. It is a practice generally considered to be
have sex with women” (WWW). Many young within the limits of normal sexual expression as long
adults are worried about the stigma of being as the pain involved is minimal and the experience is
labeled homosexual and therefore keep their satisfying to both sexual partners.
identity secret from heterosexual 7. Voyeurism – sexual arousal by looking at another’s
acquaintances. body. Almost all children and adolescents pass
3. Bisexuality - people are said to be bisexual if through a stage when voyeurism is appealing.
they achieve sexual satisfaction from both 8. Exhibitionism – revealing one’s genitals in public.
homosexual and heterosexual relationships. 9. Pedophiles – interested in sexual encounters with
Like men who have sex with men, bisexual children.
men may be at greater risk for HIV and STIs
than are others. Female partners of bisexual HUMAN SEXUAL RESPONSE
men need to be aware that they are also at Sexuality has always been a part of human life, but it is
increased risk for HIV and other STIs. only in the past few decades that it has been studied
4. Transsexual or transgender person is an scientifically. One common finding of researchers has
individual who, although of one biologic gender, been that feelings and attitudes about sex vary widely: the
5
sexual experience is unique to each individual, but
sexual physiology (i.e., how the body responds to
sexual arousal) has common features.

EXCITEMENT
 Occurs with physical and psychological
stimulation (i.e., sight, sound, emotion, or
thought) that causes parasympathetic nerve
stimulation. This leads to arterial dilation and
venous constriction in the genital area. The
resulting increased blood supply
DISORDERS OF SEXUAL FUNCTIONING
leads to vasocongestion and increasing 1. Inhibited Sexual Desire
muscular tension.  Lessened interest in sexual relations is normal in
 In women, this vasocongestion causes the some circumstances, such as after the death of a
clitoris to increase in size and mucoid fluid to family member, a divorce, or a stressful job change.
appear on vaginal walls as lubrication. The The support of a caring sexual partner or relief of the
vagina widens in diameter and increases in tension causing the stress allows a return to sexual
length. The nipples become erect. interest.
 In men, penile erection occurs, as well as  Decreased sexual desire can also be a side effect of
scrotal thickening and elevation of the testes. In many medicines. Chronic diseases, such as peptic
both sexes, there is an increase in heart and ulcers or chronic pulmonary disorders, that cause
respiratory rates and blood pressure. frequent pain or discomfort may interfere with a man’s
PLATEAU or a woman’s overall well-being and interest in sexual
 The plateau stage is reached just before activity.
orgasm. In the woman, the clitoris is drawn  Some women experience a decrease in sexual desire
forward and retracts under the clitoral prepuce; during perimenopause. Administration of androgen
the lower part of the vagina becomes extremely (testosterone) to women may be helpful at that time,
congested (formation of because it can improve interest in sexual activity.
the orgasmic platform), and there is increased 2. Failure to Achieve Orgasm
nipple elevation.  The failure of a woman to achieve orgasm can be a
 In men, the vasocongestion leads to distention result of poor sexual technique, concentrating too
of the penis. Heart rate increases to 100 to 175 hard on achievement, or negative attitudes toward
beats per minute and respiratory rate to sexual relationships.Treatment is aimed at relieving
approximately 40 respirations per minute. the underlying cause. It may include instruction and
ORGASM counseling for the couple about sexual feelings and
 Orgasm occurs when stimulation proceeds needs.
through the plateau stage to a point at which the 3. Erectile Dysfunction
body suddenly discharges accumulated sexual  Erectile dysfunction (ED), formerly referred to as
tension. impotence, is the inability of a man to produce or
 A vigorous contraction of muscles in the pelvic maintain an erection long enough for vaginal
area expels or dissipates blood and fluid from penetration or partner satisfaction (Wessells et al.,
the area of congestion. The average number of 2007). Most causes of ED are physical, such as aging,
contractions for a woman is 8 to 15 contractions atherosclerosis, or diabetes, which limit blood supply.
at intervals of 1 every 0.8 seconds. It may also occur as a side effect of certain drugs.
 In men, muscle contractions surrounding the  Examples of drugs prescribed today for ED are
seminal vessels and prostate project semen into sildenafil (Viagra), tadalafil (Cialis), and vardenafil
the proximal urethra. These contractions are (Levitra), which are taken up to once a day to
followed immediately by three to seven stimulate penile erection.
propulsive ejaculatory contractions, occurring at  a surgical implant to aid erection by the use of
the same time interval as in the woman, which vacuum pressure is a possible alternative (Hossein,
force semen from the penis. 2007). Testosterone injections may be helpful in some
RESOLUTION men.
 Resolution is a 30-minute period during which 4. Premature Ejaculation
the external and internal genital organs return to  Premature ejaculation is ejaculation before
an unaroused state. penile–vaginal contact (Docherty, 2007). The term
 For the male, a refractory period occurs during also is often used to mean ejaculation before the
which further orgasm is impossible. sexual partner’s satisfaction has been achieved.
 Women do not go through this refractory period, Premature ejaculation can be unsatisfactory and
so it is possible for women who are interested frustrating for both partners.
and properly stimulated to have additional
orgasms immediately after the first.

6
 The cause, like that of ED, can be psychological. gonadotropin-releasing hormone (GnRH), which in
Masturbating to orgasm (in which orgasm is turn triggers the anterior pituitary to begin the release
achieved quickly because of lack of time) may of follicle-stimulating hormone (FSH) and luteinizing
play a role. Other reasons suggested are doubt hormone (LH). FSH and LH initiate the production of
about masculinity and fear of impregnating a androgen and estrogen, which in turn initiate
partner, which prevent the man from sustaining secondary sex characteristics, the visible signs of
an erection. Sexual counseling for both partners maturity.
to reduce stress, as well as serotonergic  Puberty is when the body starts to change, like
antidepressants such as Mirtazapine, may be growing hair and developing curves or muscles, and
helpful in alleviating the problem. these changes happen because a part in the brain
5. Persistent Sexual Arousal Syndrome (PSAS) releases signals that tell the body to make hormones,
 is excessive and unrelenting sexual arousal in which then lead to these visible signs of growing up.
the absence of desire (Mahoney & Zarate,  GnRH is a signal from the brain that starts the
2007). It may be triggered by medications or production of reproductive hormones.
psychological factors. When assessing  FSH is a hormone that helps make eggs and sperm.
someone with the disorder, be certain to ask if  LH is a hormone that triggers the release of eggs and
the person is taking any herbal remedies such the production of testosterone.
as Ginkgo biloba because some of these can  Role of Androgen - Androgenic hormones are the
have arousal effects. hormones responsible for muscular development,
6. Vaginismus physical growth, and the increase in sebaceous gland
 is involuntary contraction of the muscles at the secretions that causes typical acne in both boys and
outlet of the vagina when coitus is attempted girls. In males, androgenic hormones are produced by
that prohibits penile penetration (Engman, the adrenal cortex and the testes; in females, by the
Wijma, & Wijma, 2007). adrenal cortex and the ovaries.
 Vaginismus may occur in women who have  Androgen hormones help muscles grow, bodies get
been raped. Other causes are unknown, but it bigger, and skin glands make more oil that can lead to
could also be the result of early learning acne, and they are made in boys by testes and
patterns in which sexual relations were viewed adrenal cortex, and in girls by ovaries and adrenal
as bad or sinful. As cortex.
with other sexual problems, sexual or  Role of Estrogen – When triggered at puberty by
psychological counseling to reduce this FSH, ovarian follicles in females begin to excrete a
response may be necessary. high level of the hormone estrogen.This hormone is
7. Dyspareunia and Vestibulitis actually not one substance but three compounds
 Dyspareunia is pain during coitus. This can (estrone [E1], estradiol [E2], and estriol [E3]).
occur because of endometriosis (abnormal  Estrogen, released when growing up, makes girls'
placement of endometrial tissue), vestibulitis bodies change and start making eggs, and it's actually
(inflammation of the vestibule), vaginal infection, three different things: estrone, estradiol, and estriol.
or hormonal changes such as those that occur  Estrone is one type of the estrogen hormones that
with menopause and cause vaginal drying. A helps girls' bodies change during puberty.
psychological component may be present.  Estradiol is another type of estrogen that also plays a
 Treatment is aimed at the underlying cause. role in girls' body changes as they grow up.
Encouraging open communication between  Estriol is the third type of estrogen hormone,
sexual partners can be instrumental in resolving contributing to the changes that happen in girls'
the problem. bodies during puberty.

ANATOMY OF THE MALE AND FEMALE SECONDARY SEX CHARACTERISTICS

REPRODUCTIVE SYSTEM Adolescent sexual development is categorized into
REPRODUCTIVE DEVELOPMENT stages (Tanner, 1990). There is wide variation in the time
 Intrauterine Development - The sex of an required for adolescents to move through these
individual is determined at the moment of developmental stages; however, the sequential order is
conception by the chromosome information fairly constant. In girls, pubertal changes typically are
supplied by the particular ovum and sperm that manifest as:
joined to create the new life. 1. Growth spurt
 During intrauterine development, the sex of a 2. Increase in the
person is decided when an egg cell and a transverse diameter of
sperm cell come together during conception, the pelvis
carrying the chromosome information that 3. Breast development
determines whether the individual will be male 4. Growth of pubic hair
or female. 5. Onset of menstruation
 Pubertal Development - Puberty is the stage 6. Growth of axillary hair
of life at which secondary sex changes begin. 7. Vaginal secretions
These changes are stimulated when the
hypothalamus synthesizes and releases
7
In boys, usually occur in the order of: pregnancy, many male preterm infants are born with
1. Increase in weight undescended testes.
2. Growth of testes  In most males, one testis is slightly larger than the
3. Growth of face, other and is suspended slightly lower in the scrotum
axillary, and pubic hair than the other (usually the left one). Because of this,
4. Voice changes testes tend to slide past each other more readily on
5. Penile growth sitting or muscular activity, and there is less possibility
6. Increase in height of trauma to them.
7. Spermatogenesis  Spermatozoa do not survive at a temperature as high
(production of sperm) as that of the body, however, so the location of the
testes outside the body, where the temperature is
ANATOMY AND PHYSIOLOGY OF THE approximately 1° F lower than body temperature,
REPRODUCTIVE SYSTEM provides protection for sperm survival (McCance &
I. MALE REPRODUCTIVE SYSTEM Huether, 2007).
The major function of the reproductive system
is to ensure survival of the species. An 3. Penis - is composed of three cylindrical masses of
individual may live a long, healthy, and happy erectile tissue in the penis shaft: two termed the
life without producing offspring, but if the corpus cavernosa, and a third termed the corpus
species is to continue, at least some spongiosum. The urethra passes through these layers
individuals must produce offspring. of erectile tissue, making the penis serve as the outlet
 Within the context of producing offspring, the for both the urinary and the reproductive tracts in
reproductive system has four functions: men.
 To produce egg and sperm cells  At the distal end of the organ is a bulging, sensitive
 To transport and sustain these cells ridge of tissue, the glans. A retractable casing of skin,
 To nurture the developing offspring the prepuce, protects the nerve-sensitive glans at
 To produce hormones birth.
 Reproductive development
 Gonad is a body organ that produces sex cells
(the ovary in females and the testis in males)
 Mesonephric ducts develops in males
 Paramesonephric ducts develops in females

PHYSIOLOGY OF ONSET
 Puberty is initiated by hypothalamicpituitary –
gonad complex.
 Puberty usually starts in Girls at 10-13 years old
and Boys starts at 12-14 years old.

A. EXTERNAL STRUCTURES
1. Scrotum - is a rugated, skin-covered,
muscular pouch suspended from the perineum. GLANS
Its functions are to support the testes and to The distal end of the organ is bulging sensitive ridge of
help regulate the temperature of sperm. tissue which has the external urinary meatus at its tip.
 The scrotum is a wrinkled, skin-covered pouch CORONA
below the body that holds the testes and helps The proximal margin of the glans.
them stay at the right temperature for making PREPUCE
sperm, pulling them closer in cold weather and  Also called the foreskin.
letting them hang away in hot weather or fever.  Loose skin attached to the shaft, allowing for
expansion during erection.
2. Testes - are two ovoid glands, 2 to 3 cm wide,  Retractable casing of skin that protects the nerve
that lie in the scrotum. Each testis is encased by sensitive glans at birth.Frenulum
a protective white fibrous capsule and is  Ventral fold of tissue attaches the skin to the glans.
composed of several lobules, with each lobule  Contains the urethra as well as 3 erectile bodies:
containing interstitial cells (Leydig’s cells)  2 dorsal erectile tissues known as the corpora
and a seminiferous tubule. cavernosa
 Seminiferous tubules produce spermatozoa.  1 midventral tissue known as the corpus spongiosum
 Leydig’s cells are responsible for the production  Surrounds penile urethra
of testosterone.  Expands distally to form the glans penis
 Testes in a fetus first form in the pelvic cavity.
They descend, late in intrauterine life (about the
34th to 38th week), into the scrotal sac.
Because this descent occurs so late in

8
  These glands secrete a viscous alkaline liquid that
has a high sugar, protein, and prostaglandin content.
Sperm become increasingly motile with this added
fluid, because it surrounds them with nutrients and a
more favorable pH.
 Seminal vesicles are two pouches near the bladder
that connect to the urethra through small tubes and
release fluids during ejaculation. Seminal vesicles are
pouches near the bladder that release a thick fluid
into the tube where urine comes out, helping sperm
move better by giving them nutrients and a good pH.
B. INTERNAL STRUCTURES 4. Ejaculatory Ducts - The two ejaculatory ducts pass
1. Epididymis - the seminiferous tubule of each through the prostate gland and join the seminal
testis leads to a tightly coiled tube, the vesicles to the urethra.
epididymis, which is responsible for conducting 5. Prostate Gland - is a chestnut-sized gland that lies
sperm from the tubule to the vas deferens, the just below the bladder. The urethra passes through
next step in the passage to the outside. the center of it, like the hole in a doughnut.
 Because each epididymis is so tightly coiled, its  The prostate gland secretes a thin, alkaline fluid.
length is extremely deceptive: it is actually over When added to the secretion from the seminal
20 ft long. vesicles and the accompanying sperm from the
 Some sperm are stored in the epididymis, and a epididymis, this alkaline fluid further protects sperm
portion of the alkaline fluid that will surround from being immobilized by the naturally low pH level
sperm at maturity (semen, or seminal fluid that of the urethra.
contains a basic sugar and mucin, a form of  The prostate gland is a small gland near the bladder
protein) is produced by the cells lining the with a hole in the middle, and it makes a liquid that
epididymis. helps sperm move and survive in the body.
 Sperm are immobile and incapable of 6. Bulbourethral Glands - two bulbourethral or
fertilization as they pass or are stored at the Cowper’s glands lie beside the prostate gland and
epididymis level. empty via short ducts into the urethra. Like the
 It takes at least 12 to 20 days for them to travel prostate gland and seminal vesicles, they secrete an
the length of the epididymis and a total of 64 alkaline fluid that helps counteract the acid secretion
days for them to reach maturity. of the urethra and ensure the safe passage of
 This is one reason that aspermia (absence of spermatozoa.
sperm) and oligospermia (20 million sperm/mL)  The bulbourethral glands are two glands near the
are problems that do not appear to respond prostate that release a fluid into the urethra, like the
immediately to therapy but rather only 2 prostate and seminal vesicles, to balance the urethral
months. acid and help sperm move safely.
 It is a coiled tube connected to each testis that 7. Urethra - is a hollow tube leading from the base of the
carries sperm from the testis to the vas bladder, which, after passing through the prostate
deferens. gland, continues to the outside through the shaft and
2. Vas Deferens (Ductus Deferens) - is an glans of the penis. It is approximately 8 in (18 to 20
additional hollow tube surrounded by arteries cm) long.
and veins and protected by a thick fibrous
coating. It carries sperm from the epididymis
through the inguinal canal into the abdominal
cavity, where it ens. ds at the seminal vesicles
and the ejaculatory ducts. Sperm mature as
they pass through the vas deferens.
 Vasectomy (severing of the vas deferens to
prevent passage of sperm) is a popular means
of male birth control (Cook et al., 2009).
 It is a tube that carries sperm from the testicles
to other parts of the body and helps sperm get
ready for fertilization as they travel through it.
3. Seminal Vesicles - are two convoluted
pouches that lie along the lower portion of the
posterior surface of the bladder and empty into
the urethra by way of the ejaculatory ducts.
after

9
II. FEMALE REPRODUCTIVE SYSTEM  Skene's glands, found on each side near the pee hole,
 It produces the female egg cells necessary for have ducts that open into the urethra.
reproduction, called the ova or oocytes. 7. Bartholin’s glands (vulvovaginal glands) are
 It is designed to transport the ova to the site of located just lateral to the vaginal opening on both
fertilization. sides. Their ducts open into the distal vagina.
 If fertilization does not take place, the system is  Bartholin's glands are found on each side of the
designed to menstruate. vaginal opening, and their tubes connect to the lower
 It produces female sex hormone that maintain part of the vagina.
the reproductive cycle.  Secretions from both of these glands help to lubricate
the external genitalia during coitus.
A. EXTERNAL STRUCTURES  The alkaline pH of their secretions helps to improve
1. Mons Veneris - is a pad of adipose tissue sperm survival in the vagina.
located over the symphysis pubis, the pubic 8. Fourchette is the ridge of tissue formed by the
bone joint. It is covered by a triangle of coarse, posterior joining of the two labia minora and the labia
curly hairs. The purpose of the mons veneris is majora. This is the structure that is sometimes cut
to protect the junction of the pubic bone from (episiotomy) during childbirth to enlarge the vaginal
trauma. opening.
 The mons veneris is a fatty pad above the pubic  The fourchette is a tissue ridge where the back parts
bone covered with hair that protects the pubic of the inner and outer vaginal lips meet, and it might
bone joint from harm. be cut during childbirth to make the vaginal opening
2. Labia Minora - just posterior to the mons bigger.
veneris spread two hairless folds of connective 9. Hymen is a tough but elastic semicircle of tissue that
tissue, the labia minora. Before menarche, covers the opening to the vagina in childhood. It is
these folds are fairly small; by childbearing age, often torn during the time of first sexual intercourse.
they are firm and full; after menopause, they However, because of the use of tampons and active
atrophy and again become much smaller. sports participation, many girls who have not had
 Behind the pubic mound, there are two smooth sexual relations do not have intact hymens at the time
folds of tissue called the labia minora, which are of their first pelvic examination.
small before a girl's first period, become larger  The hymen is a stretchy piece of tissue that partly
during adulthood and pregnancy, and get covers the vagina's opening in the beginning, and it
smaller again after menopause. usually breaks during the first time someone has sex;
3. Labia Majora - are two folds of adipose tissue but sometimes, due to activities like using tampons or
covered by loose connective tissue and playing sports, the hymen can be broken before
epithelium that are positioned lateral to the labia having sex.
minora. Covered by pubic hair, the labia majora
serve as protection for the external genitalia and
the distal urethra and vagina.
 The labia majora are two soft folds of skin with
fat underneath that are on the sides of the
smaller labia, and they have hair on them; they
help protect the
private parts and the openings of the urethra
and vagina.
4. Vestibule - is the flattened, smooth surface
inside the labia. The openings to the bladder
(the urethra) and the uterus (the vagina) both
arise from the vestibule
 The vestibule is a flat, smooth area between the
labia, where the openings to the bladder
(urethra) and the uterus (vagina) are located.
B. INTERNAL STRUCTURES
5. Clitoris - is a small (approximately 1 to 2 cm),
1. Ovaries - are approximately 4 cm long by 2 cm in
rounded organ of erectile tissue at the forward
diameter and approximately 1.5 cm thick, or the size
junction of the labia minora. It is covered by a
and shape of almonds. They are grayish white and
fold of skin, the prepuce.The clitoris is sensitive
appear pitted, or with minute indentations on the
to touch and temperature and is the center of
surface.
sexual arousal and orgasm in a woman.
 Ovaries are the two small organs in a girl's body that
 The clitoris is a small, sensitive organ located at
make eggs and release hormones important for her
the front of the vaginal opening, covered by a
growth and development.
piece of skin; it plays a big role in women's
 The function of the two ovaries (the female gonads) is
sexual feelings and pleasure.
to produce, mature, and discharge ova (the egg cells).
6. Skene’s glands (paraurethral glands) are
In the process, the ovaries produce estrogen and
located just lateral to the urinary meatus, one on
progesterone and initiate and regulate menstrual
each side. Their ducts open into the urethra.
cycles.
10
 Ovarian function, therefore, is necessary for  Isthmus
maturation and maintenance of secondary sex  next distal portion
characteristics in females.  2 cm in length
 At birth, each ovary contains approximately 2  this portion is cut and sealed in
million immature ova (oocytes), which were  ubal ligation
formed during the first 5 months of intrauterine  Ampulla
life.  Longest portion
 By age 7 years, only approximately 500,000 are  5 cm length
present in each ovary; by 22 years, there are  Fertilization of ovum occurs4
approximately 300,000; and by menopause,  Infundibular
none are left (all have either matured or  Most distal segment
atrophied).  2 cm in length
 Ovaries have three principal divisions:  Funnel shape
 Protective layer of surface epithelium  The rim of the funnel is covered by fimbriae or small
 Cortex, where the immature (primordial) hairs that
oocytes mature into ova and large amounts of  Help to guide the ovum into the fallopian tube .
estrogen and progesterone are produced
 Central medulla, which contains the nerves, The wall of the fallopian tube is made up of
blood vessels, lymphatic tissue, and some 4 layers :
smooth muscle tissue Peritoneal (serous) – covers the tubes.
2. Fallopian Tubes - arise from each upper corner Subserous ( adventitial ) – contains the blood and nerve
of the uterine body and extend outward and supply
backward until each opens at its distal end, next Muscular - responsible for the peristaltic movement of the
to an ovary. Fallopian tubes are approximately tube.
10 cm long in a mature woman. Their function is Mucosal – composed of ciliated and unciliated cells with
to convey the ovum from the ovaries to the the number of ciliated cells more abundant at the fimbria.
uterus and to provide a place for fertilization of
the ovum by sperm. The most proximal division, 3. Uterus - is a hollow, muscular, pear-shaped organ
the interstitial portion, is that part of the tube that located in the lower pelvis, posterior to the bladder
lies within the uterine wall. This portion is only and anterior to the rectum. During childhood, it is
about 1 cm in length; the lumen of the tube is approximately the size of an olive. An adolescent is
only 1 mm in diameter at this point. The isthmus closer to 17 years old before the uterus reaches its
is the next distal portion. It is approximately 2 adult size. With maturity, a uterus is approximately 5
cm in length and like the interstitial tube, is to 7 cm long, 5 cm wide, and, in its widest upper part,
extremely narrow. This is the portion of the tube 2.5 cm deep. In a nonpregnant state, it weighs
that is cut or sealed in a tubal ligation, or tubal approximately 60 g.
sterilization procedure. The ampulla is the third  The function of the uterus is to receive the ovum from
and also the longest portion of the tube. It is the fallopian tube; provide a place for implantation
approximately 5 cm in length. It is in this portion and nourishment; furnish protection to a growing fetus;
that fertilization of an ovum usually occurs. The and, at maturity of the fetus, expel it from a woman’s
infundibular portion is the most distal segment body.
of the tube. It is approximately 2 cm long and is  Anatomically, the uterus consists of three divisions:
funnel shaped. The rim of the funnel is covered a. The body of the uterus is the uppermost part and
by fimbria (small hairs) that help to guide the forms the bulk of the organ. During pregnancy, the
ovum into the fallopian tube body of the uterus is the portion of the structure that
 Fallopian tubes are like pathways that come expands to contain the growing fetus. The portion of
from the upper corners of the uterus, and they the uterus between the points of attachment of the
carry eggs from the ovaries to the uterus, where fallopian tubes is termed the fundus.
fertilization can happen; they have different b. The isthmus of the uterus is a short segment
parts, and the one closest to the uterus is very between the body and the cervix. In the nonpregnant
tiny, while the one where fertilization usually uterus, it is only 1 to 2 mm in length. It is the portion of
happens is longer, and the end is shaped like a the uterus that is most commonly cut when a fetus is
funnel with little hairs that help guide the egg born by a cesarean birth.
inside. c. The cervix is the lowest portion of the uterus. It
represents approximately one third of the total uterus
PARTS OF THE FALLOPIAN TUBE size and is approximately 2 to 5 cm long. The opening
 Interstital portion of the canal at the junction of the cervix and isthmus is
 lies within the uterine wall the internal cervical os; the distal opening to the
 approximately 1 cm in length lumen is 1 mm in vagina is the external cervical os. The level of the
the diameter external os is at the level of the ischial spines (an
important relationship in estimating the level of the
fetus in the birth canal).

11
 LAYERS OF THE UTERUS nipples is darkly pigmented out to approximately 4 cm
 Perimetrium – a part of visceral peritoneum and is termed the areola. The area appears rough on
 Myometrium – bulk of uterus – three layers of the surface because it contains many sebaceous
muscle that contract under influence of oxytocin glands, called Montgomery’s tubercles.
during labor.  Breasts start forming before birth, but they really grow
 Endometrium – highly vascular mucosa bigger during puberty because of hormones like
 Stratum functionalis – shed during estrogen, and they're important for feeding babies.
menstruation They have milk glands that make milk in small
 Stratum basalis – deeper, permanent layer, sections, and the nipple can get bigger and send
gives rise to new stratum functionalis messages to release milk when a baby sucks. The
darker skin around the nipple is called the areola and
has tiny bumps called Montgomery's tubercles.

GYNECOMASTIA

 Increase in male breast size

 Most evident in obese boys
C. BREASTS  Normal change of puberty
The mammary glands, or breasts, form from
ectodermic tissue early in utero. They then remain in PHYSIOLOGY OF MENSTRUATION ( HUMAN
a halted stage of development until a rise in estrogen REPRODUCTION, FERTILIZATION, IMPLANTATION)
at puberty produces a marked increase in their size. MENSTRUATION
The size increase occurs mainly because of an
monthly discharge of blood from the uterus occurring
increase of connective tissue plus deposition of fat.
form puberty to menopause wherein about 30-60 cc of
The glandular tissue of the breasts, necessary for
blood, epithelial cells and mucus are being discharged.
successful breastfeeding, remains undeveloped until
 The purpose of a menstrual cycle is to bring an ovum
a first pregnancy begins
to maturity and renew a uterine tissue bed that will be
 Milk glands of the breasts are divided by
responsible for the ova’s growth should it be fertilized.
connective tissue partitions into approximately
It is the process that allows for conception and
20 lobes. All of the glands in each lobe produce
implantation of a new life.
milk by acinar cells and deliver it to the nipple
 The length of menstrual cycles differs from woman to
via a lactiferous duct. The nipple has
woman, but the average length is 28 days (from the
approximately 20 small openings through which
beginning of one menstrual flow to the beginning of
milk is secreted. An ampulla portion of the duct,
the next).
located just posterior to the nipple, serves as a
 It is not unusual for cycles to be as short as 23 days or
reservoir for milk before breastfeeding.
as long as 35 days. The length of the average
 A nipple is composed of smooth muscle that is
menstrual flow (termed menses) is 4 to 6 days,
capable of erection on manual or sucking
although women may have periods as short as 2 days
stimulation. On stimulation, it transmits
or as long as 7 days
sensations to the posterior pituitary gland to
release oxytocin. Oxytocin acts to constrict milk
PHYSIOLOGY OF MENSTRUATION
gland cells and push milk forward into the ducts
Four body structures are involved in the physiology of
that lead to the nipple. The skin surrounding the
the menstrual cycle: the hypothalamus, the pituitary gland,
the ovaries, and the uterus
1. HYPOTHALAMUS
 The release of GnRH (also called luteinizing
hormone–releasing hormone, or LHRH) by the
hypothalamus initiates the menstrual cycle.
 GnRH is transmitted from the hypothalamus to the
anterior pituitary gland and signals the gland to begin
producing the gonadotropic hormones FSH and LH.
Because production of GnRH is cyclic, menstrual
periods also cycle.
12
2. PITUITARY GLAND 3. In view of the FSH, estrogen is now going to be
 Under the influence of GnRH, the anterior lobe produced in an increasing amount inside the follicle,
of the pituitary gland (the adenohypophysis) which is found in the ovary. Once estrogen is
produces two hormones that act on the ovaries present, the primordial follicle is now termed Graafian
to further influence the menstrual cycle: follicle. The GF is the structure therefore that
a. FSH, a hormone that is active early in the cycle contains high amounts of estrogen.
and is responsible for maturation of the ovum 4. Estrogen in the GF will cause the cells in the uterus to
b. LH, a hormone that becomes most active at the proliferate (grow rapidly); increasing its thickness to
midpoint of the cycle and is responsible for about eight fold. This is called Proliferative/follicular
ovulation, or release of the mature egg cell from phase.
the ovary, and growth of the uterine lining 5. On the 13th day of menstrual cycle, there is now a
during the second half of the menstrual cycle. very low level of progesterone in the blood. This
3. OVARY stimulates the hypothalamus to produce Luteinizing
c. As it grows, its cells produce a clear fluid Hormone releasing factor (LHRF).
(follicular fluid) that contains a high degree of 6. LHRF is responsible for stimulating the APG to
estrogen (mainly estradiol) and some produce LH.
progesterone. At this stage of maturation, the 7. The LH in turn, is responsible for stimulating the ovary
small ovum (barely visible to the naked eye, to produce progesterone. The increased amounts of
approximately the size of a printed period), with both estrogen and progesterone push the new mature
its surrounding follicle membrane and fluid, is ovum to the surface of the ovary until the following
termed a graafian follicle. day (14th) the GF ruptures and releases the mature
d. After an upsurge of LH from the pituitary, ovum.
prostaglandins are released and the graafian 8. Once ovulation has taken place, the GF which
follicle ruptures. The ovum is set free from the contains increased amount of progesterone will turn
surface of the ovary, a process termed ovulation. to Corpus Luteum which is yellow appearance.
It is swept into the open end of a fallopian tube 9. Progesterone causes the gland of the uterine
4. UTERUS endothelium to become corkscrew or twisted in
also illustrates uterine changes that occur appearance. This is the hormone of pregnancy
monthly as a result of stimulation from the hormones because it prevents uterine contractions. Once the
produced by the ovaries. fertilized ovum developed finger-like projections
called TROPHOBLAST around the blastocyst, the
EFFECTS OF ESTROGEN TO THE BODY trophoblasts are the ones that will implant high on the
anterior or posterior surface of the uterus.
 Inhibits production of FHS.  During the menstrual cycle, hormones like estrogen
 Causes hypertrophy and hyperplasia of and progesterone change in the body, causing
myometrium different phases: first, the follicle-stimulating hormone
 Stimulates the growth of ductile structures of the stimulates an egg to grow, making estrogen increase
breast and the uterus lining thicken. Then, luteinizing
 Increases quantity and pH of cervical mucus hormone triggers ovulation, releasing an egg from the
causing it to become watery and can be to a ovary. After ovulation, the remaining structure
distance of 10-13 cm. (Spinnbarkeit test of becomes the corpus luteum, which releases
dilation). progesterone to prepare the uterus for pregnancy.

EFFECTS OF PROGESTERONE IN THE BODY IMPORTANT

 Inhibits production of LH.  Despite the variability of a woman’s cycle (23-35
 Facilitates transport of fertilized ovum through days), ovulation occurs exactly 2 weeks before the
the fallopian tubes. next menstruation. The first 14 days of the cycle is
 Causes fluid retention variable. Thus, ovulation occurs not on the 14th day of
 Decreased hemoglobin and hematocrit levels the cycle but 14 days prior to the first day of the next
 Increased basal body temperature after menstrual cycle unless a pregnancy occurs.
ovulation because of the presence of  First day of the cycle is the first day of menstruation
progesterone. and one menstrual cycle is from the first day of the
menstrual period till the first day of the next cycle.
THE MENSTRUAL CYCLE
1. On the third day of the menstrual cycle, serum FERTILIZATION: THE BEGINNING OF PREGNANCY
estrogen level is at lowest which stimulates the Fertilization (also referred to as conception and
hypothalamus to produce follicle stimulating impregnation) is the union of an ovum and a
hormone releasing factor (FSHRF). spermatozoon. This usually occurs in the outer third of a
2. FSHRF is responsible for stimulating the fallopian tube, the ampullar portion (Crombleholme, 2009).
anterior pituitary gland (APG) to produce the  Usually only one of a woman’s ova will reach maturity
FSH which will act on one immature oocyte each month. Once the mature ovum is released,
inside. a primordial follicle, stimulating its fertilization must occur fairly quickly because an ovum
growth.
13
 is capable of fertilizationfor only 24 hours (48  If an X-carrying spermatozoon entered the ovum, the
hours at the most). resulting child will have two X chromosomes and will
 After that time, it atrophies and becomes be female (XX).
nonfunctional. Because the functional life of a  If a Y-carrying spermatozoon fertilized the ovum, the
spermatozoon is also about 48 hours, possibly resulting child will have an X and a Y chromosome
as long as 72 hours, the total critical time span and will be male (XY).
during which sexual relations must occur for  Fertilization happens when a sperm meets an egg,
fertilization to be successful is about 72 hours usually in a fallopian tube, within a specific timeframe,
(48 hours before ovulation plus 24 hours resulting in the formation of a new cell called a zygote,
afterward). which has 46 chromosomes and determines the
 As the ovum is extruded from the graafian baby's gender.
follicle of an ovary with ovulation, it is IMPLANTATION
surrounded by a ring of mucopolysaccharide  Once fertilization is complete, a zygote migrates over
fluid (the zona pellucida) and a circle of cells the next 3 to 4 days toward the body of the uterus,
(the corona radiata). aided by the currents initiated by the muscular
 The ovum and these surrounding cells (which contractions of the fallopian tubes. During this time,
increase the bulk of the ovum and serve as mitotic cell division, or cleavage, begins.
protective buffers against injury) are propelled  The first cleavage occurs at about 24 hours; cleavage
into a nearby fallopian tube by currents initiated divisions continue to occur at a rate of about one
by the fimbriae—the fine, hairlike structures that every 22 hours. By the time the zygote reaches the
line the openings of the fallopian tubes. A body of the uterus, it consists of 16 to 50 cells. At this
combination of peristaltic action of the tube and stage, because of its bumpy outward appearance, it is
movements of the tube cilia help propel the termed a morula (from the Latin word morus, meaning
ovum along the length of the tube. “mulberry”).
 At the time of ovulation, there is a reduction in  Large cells tend to collect at the periphery of the ball,
the viscosity (thickness) of the cervical mucus, leaving a fluid space surrounding an inner cell mass.
which makes it easy for spermatozoa to At this stage, the structure becomes a blastocyst. It is
penetrate it. Sperm transport is so efficient this structure that attaches to the uterine endometrium.
close to ovulation that spermatozoa deposited The cells in the outer ring are trophoblast cells.
in the vagina generally reach the cervix within  Implantation, or contact between the growing
90 seconds and the outer end of a fallopian tube structure and the uterine endometrium, occurs
within 5 minutes after deposition. approximately 8 to 10 days after fertilization.
 Spermatozoa move through the cervix and the  The structure brushes against the rich uterine
body of the uterus and into the fallopian tubes, endometrium (in the second [secretory] phase of the
toward the waiting ovum by the combination of menstrual cycle), a process termed apposition. It
movement by their flagella (tails) and uterine attaches to the surface of the endometrium (adhesion)
contractions. and settles down into its soft folds (invasion).
 Capacitation is a final process that sperm must  The blastocyst is able to invade the endometrium
undergo to be ready for fertilization. This because, as the trophoblast cells on the outside of the
process, which happens as the sperm move structure touch the endometrium, they produce
toward the ovum, consists of changes in the proteolytic enzymes that dissolve any tissue they
plasma membrane of the sperm head, which touch. This action allows the blastocyst to burrow
reveal the sperm-binding receptor sites. deeply into the endometrium and receive some basic
 Hyaluronidase (a proteolytic enzyme) is nourishment of glycogen and mucoprotein from the
released by the spermatozoa and dissolves the endometrial glands. As invasion continues, the
layer of cells protecting the ovum. One reason structure establishes an effective communication
that an ejaculation contains such a large network with the blood system of the endometrium.
number of sperm is probably to provide  After fertilization, the tiny zygote travels towards the
sufficient enzymes to dissolve the corona cells. uterus for a few days while dividing into more cells,
Under ordinary circumstances, only one forming a bumpy structure called a morula. As it
spermatozoon is able to penetrate the cell reaches the uterus, it becomes a blastocyst, attaching
membrane of the ovum. Once it penetrates the to the uterus' lining about 8 to 10 days later. It sticks to
cell, the cell membrane changes composition to the uterus, settles in, and grows by dissolving tissue
become impervious to other spermatozoa. with enzymes, connecting to the blood system for
 Immediately after penetration of the ovum, the nourishment.
chromosomal material of the ovum and
spermatozoon fuse to form a zygote. Amenorrhea – markedly diminished menstrual flow
 Because the spermatozoon and ovum each Menorrhagia – excessive bleeding during regular
carried 23 chromosomes (22 autosomes and 1 menstruation.
sex chromosome), the fertilized ovum has 46 Polymenorrhea – frequent menstruation occurring at
chromosomes. intervals of less than 3 weeks.
Dysmenorrhea – is the medical term for pain with
menstruation.

14
 OVARIAN CYCLE
1. The Follicular Phase: Days 1 through 13 • Change in vaginal mucus
• In response to follicle stimulating hormone (FSH) • Goodel’s sign
released from the pituitary gland in the brain, • Mood changes
ultimately one egg matures. • Breast tenderness
2. Ovulation: Day 14 • Increased levels of Progesterone
• At about day 14, in response to a surge of • Change in basal body temperature
luteinizing hormone, the egg is released from the
ovary.
• The egg travels through the fallopian tube toward ANTEPARTAL PERIOD
the uterus.
3. The Luteal Phase: Days 14 through 28 Ovum – from ovulation to fertilization
• The remains of the follicle become the corpus Zygote – from fertilization to
luteum which releases progesterone implantation
Embryo – from implantation to 5-8
UTERINE CYCLE weeks
Fetus – from 5-8 weeks until term
1. Proliferative Phase: Days 5 -14 Conceptus – Developing embryo or
• The uterine lining increases rapidly in thickness, fetus
and the uterine glands proliferate and grow. And placental structure throughout
2. Secretory Phase: Days 14 through 28 pregnancy
• When an egg is not fertilized, the corpus luteum
gradually disappears, estrogen and progesterone
levels drop, and the thickened uterine lining is shed.
This is menses (your period). PROCESS OF FERTILIZATION

• Fertilization ( Conception, Fecundation)

- is the union of an ovum and a spermatozoon. This
usually occurs in the outer third of fallopian tube.
• Usually only one of a woman’s ova will reach maturity
each month. Once the mature ovum is released,
fertilization must occur fairly quickly because an ovum is
capable of fertilization nfor only 24 hours (48 hours at the
most).
• After that time, it atrophies and becomes nonfunctional.
Because the functional life of a spermatozoon is also
about 48 hours, possibly as long as 72 hours, the total
critical time span during which sexual relations must occur
for fertilization to be successful is about 72 hours (48 hours
before ovulation plus 24 hours afterward)
• As the ovum is extruded from the graafian follicle of an
ovary with ovulation, it is surrounded by a ring of
mucopolysaccharide fluid (the zona pellucida) and a circle
of cells (the corona radiata).
• The ovum and these surrounding cells (which increase
the bulk of the ovum and serve as protective buffers
against injury) are propelled into a nearby fallopian tube
TIME OF OVULATION by currents initiated by the fimbriae—the fine, hairlike
structures that line the openings of the fallopian tubes. A
An easy way to approximate the time of ovulation combination of peristaltic action of the tube and
for women with regular cycles is to subtract 16 from movements of the tube cilia help propel the ovum along
the number of days in the cycle and then add 4. This the length of the tube.
will calculate the span of days in which ovulation is • At the time of ovulation, there is a reduction in the
most likely to occur. viscosity (thickness) of the cervical mucus, which makes it
easy for spermatozoa to penetrate it. Sperm transport is so
SIGNS & SYMPTOMS OF OVULATION efficient close to ovulation that spermatozoa deposited in
the vagina generally reach the cervix within 90 seconds
a. Mittlelschmerz – abdominal tenderness on and the outer end of a fallopian tube within 5 minutes after
left/right iliac regions,brought about by peritoneal deposition.
irritation due to blood coming out from the graafian • Spermatozoa move through the cervix and the body of
follicle. the uterus and into the fallopian tubes, toward the waiting
b. Spinnbarkeit – vaginal secretion is clear & ovum by the combination of movement by their flagella
transparent (tails) and uterine contractions.
15
• Capacitation is a final process that sperm must the structure touch the endometrium, they produce
undergo to be ready for fertilization. This process, proteolytic enzymes that dissolve any tissue they
which happens as the sperm move toward the ovum, touch. This action allows the blastocyst to burrow
consists of changes in the plasma membrane of the deeply into the endometrium and receive some basic
sperm head, which reveal the sperm-binding nourishment of glycogen and mucoprotein from the
receptor sites. endometrial glands. As invasion continues, the
• Hyaluronidase (a proteolytic enzyme) is released structure establishes an effective communication
by the spermatozoa and dissolves the layer of cells network with the blood system of the endometrium.
protecting the ovum. Under ordinary circumstances, • Implantation or contact between the growing structure
only one spermatozoon is able to penetrate the cell and the uterine endometrium occurs approximately 8 to 10
membrane of the ovum. Once it penetrates the cell, days after fertilization.
the cell membrane changes composition to become • Apposition – the blastocyst brushes against the rich
impervious to other spermatozoa. uterine endometrium
• Adhesion – it attaches to the surface of the endometrium
• Invasion – the blastocyst settles down into its soft folds.
***once the zygote
implanted it is an EMBRYO

IMPLANTATION

• Once fertilization is complete, a zygote migrates

over the next 3 to 4 days toward the body of the HUMAN GENETICS
uterus, aided by the currents initiated by the
muscular contractions of the fallopian tubes. During Genetics is the study of the ways such disorders occur.
this time, mitotic cell division, or cleavage, begins. Genetic Disorders are disorders resulting from a defect
• The first cleavage occurs at about 24 hours; in the structure or number of genes or chromosomes.
cleavage divisions continue to occur at a rate of
about one every 22 hours. By the time the zygote I. NATURE OF INHERITANCE
reaches the body of the uterus, it consists of 16 to 50 Genes are the basic units of hereditary that determine
cells. At this stage, because of its bumpy outward both the physical and cognitive characteristics of people.
appearance, it is termed a morula (from the Latin Composed of segments of DNA, they are woven into
word morus, meaning “mulberry”). strands in the nucleus of all body cells to form
• Large cells tend to collect at the periphery of the chromosomes.
ball, leaving a fluid space surrounding an inner cell  A person’s phenotype refers to his or her outward
mass. At this stage, the structure becomes a appearance or the expression of the genes.
blastocyst. It is this structure that attaches to the  A person’s genotype refers to his or her actual gene
uterine endometrium. The cells in the outer ring are composition.
trophoblast cells.  A person’s genome is the complete set of genes
• Implantation, or contact between the growing present which is about 50,000-100,000.
structure and the uterine endometrium, occurs
approximately 8 to 10 days after fertilization. II. INHERITANCE OF THE DISEASE
• The structure brushes against the rich uterine
endometrium (in the second [secretory] phase of the A. Autosomal Dominant Inheritance
menstrual cycle), a process termed apposition. It  With an autosomal dominant condition, either a
attaches to the surface of the endometrium person has two unhealthy genes or is heterozygous,
(adhesion) and settles down into its soft folds with the gene causing the disease stronger than the
(invasion). corresponding healthy recessive gene for the same
• The blastocyst is able to invade the endometrium trait.
because, as the trophoblast cells on the outside of
16
 Examples of autosomal dominant disorders are 1. Both parents of a child with the disorder are clinically
Huntington’s disease, Facioscapulohumeral free of the disorder
muscular dystrophy, a form of Osteogenesis 2. The sex of the affected individual is unimportant in
imperfecta and Marfan syndrome terms of inheritance
In assessing family genograms for the incidence of 3. The family history for the disorder is negative – that is
inherited disorders, a number of common findings no one can identify anyone else who had it (a
are usually discovered when a dominantly inherited horizontal transmission pattern)
pattern is present in the family: 4. A known common ancestor between the parents
1. One of the parents of a child with the disorder sometimes exists. This explains how both
also will have the disorder (a vertical male and female came to possess a like gene for the
transmission picture) disorder.
2. The sex of the affected individual is unimportant
in terms of inheritance C. X-Linked Dominant Inheritance
3. There is usually a history of the disorder in other  There are about 300 known X-linked disorders. If
family members the gene is dominant, only ne X chromosome with the
trait need be present for symptoms of the disorder
to be manifested.
Family characteristics seen with this type of inheritance
include the following:
1. All individuals with the gene are affected
2. All female children of affected men are affected; all
male children of affected men are unaffected
3. It appears in every generation
4. All children of homozygous affected women are
affected.50% of the children of heterozygous
affected women are affected.

B. Autosomal Recessive Inheritance

 More than 1,500 autosomal recessive disorders

have been identified. In contrast, to structural
disorders, these tend to be biochemical or
enzymatic.

D. X-Linked Recessive Inheritance

 The majority of X-linked inherited disorders are
recessive, and inheritance of the gene from both
parents is incompatible with life.
 Examples are Hemophilia A, color blindness,
Duchenne muscular dystrophy and fragile X
syndrome
When family genograms are assessed for inherited
disorders, the following findings usually are apparent if an
 Examples include cystic fibrosis, adrenogenital X-linked recessive inheritance disorder is present in the
syndrome, albinism, Tay-Sachs disease, family:
galactosemia, phenylketonuria, limb-girdle
muscular dystrophy and Rh-factor 1. Only males in the family will have the disorder
incompatibility. When family genograms are 2. A history of girls dying at birth for unknown reasons
assessed for the incidence of inherited disease, often exists (females who had the affected gene on
situations commonly discovered when a both X chromosomes
recessively inherited disease is present in the 3. Sons of an affected man are unaffected
family include the following: 4. The parents of affected children do not have the
disorder
17
 NURSING RESPONSIBILITIES
1. Alerting a couple to what procedures they can
expect to undergo
2. Explaining how different genetic screening tests are
done and when they are usually offered
3. Supporting a couple during the wait for test results
4. Assisting couples in various clarifications, planning,
and decision making base on test results

ASSESSMENT FOR GENETIC DISORDERS

1. History
2. Physical Assessment
3. Diagnostic Testing

 Karyotyping - A karyotype is a visual presentation

E. Y-Linked Inheritance of the chromosome pattern of an individual
Although genes responsible for features such as  Maternal Serum Screening - Alpha-fetoprotein is a
height and tooth size are found on the Y glycoprotein produced by the fetal liver that reaches a
chromosome, no known disease genes are inherited peak in maternal serum between the 13th and 32nd
by Y-chromosome transmission. week of pregnancy. The AFP level deviates from
normal if a chromosomal or a spinal cord disorder is
GENETIC COUNSELING present.
 Anyone concerned about the possibility of  Chorionic Villi Sampling - A diagnostic technique
transmitting a disease to his or her children that involves the retrieval and analysis of chorionic villi
should have access to genetic counseling for for chromosome or DNA analysis
advice on the inheritance of the disease.  Amniocentesis - The withdrawal of amniotic fluid
Purposes: through the abdominal wall for analysis at the 14th to
1. Provide concrete, accurate information about 16th week of pregnancy
inherited disorders  Percutaneous Umbilical Blood Sampling. (PUBS)
2. Reassure people who are concerned that their or Cordocentesis is the removal of blood from the fetal
child may inherit a particular disorder that the umbilical cord at about 17th week of pregnancy using
disorder will not occur an amniocentesis techni
3. Allow people who are affected by inherited  Fetal Imaging - Computed tomography (CT),
disorders to make informed choices about Magnetic Resonance Imaging (MRI) and
future reproduction ultrasonography are all diagnostic tools used to
4. Educate people about inherited disorders and assess a fetus for general size and structural
the process of inheritance disorders of the internal organs, spine and limbs.
5. Offer support by skilled health care  Fetoscopy - Insertion of a fiberoptic fetoscope
professionals to people who are affected by through a small incision in the mother’s abdomen into
genetic disorders the uterus and membranes to visually inspect the
fetus for gross abnormalities.
The following are the couples most apt to benefit  Preimplantation Diagnosis - It may be possible in
from genetic counseling: the future for a fertilized ovum to be removed from the
1. A couple who has a child with a congenital uterus by lavage before implantation and biopsied for
disorder or an inborn error of metabolism DNA analysis
2. A couple whose close relatives have a child with a
genetic disorder including a congenital disorder or Legal Responsibilities on Genetic Testing, Counseling
inborn error of metabolism and Therapy
3. Any individual who is a known balanced
1. Participation by couples or individuals in genetic
translocation carrier
screening must be elective
4. Any individual who has an inborn error of
2. People desiring genetic screening must sign an
metabolism or chromosomal disorder
informed consent for the procedure
5. A consanguineous (closely related) couple
3. Results must be interpreted correctly yet provided to
6. Any woman older than 35 years of age and any
the individuals as quickly as possible
man older than 45 of age
4. The results must not be withheld from the individuals
7. Couples of ethnic backgrounds in which specific
and must be given only to those persons directly
illnesses are known to occur
involved
5. After genetic counseling, persons must not be
coerced to undergo procedures such as abortion or
sterilization.

18
Common Chromosomal Disorders Resulting In responsibility between parents to determine and achieve
Physical Or Cognitive Developmental Disorders the desired number and timing of their children according
to their own aspirations. (RA 10354 Section 4v).These
1. Trisomy 13 Syndrome - also called Patau principles are based on the four (4) pillars of Responsible
syndrome, is a chromosomal condition associated Parenthood, Respect for Life, Birth Spacing, and
with severe intellectual disability and physical Informed Choice. Health services, including
abnormalities in many parts of the body. Reproductive Health services, are devolved by the Local
2. Trisomy 18 Syndrome - also called Edwards Government Code to the local government units
syndrome, is a chromosomal condition associated (Philippine Commission on Women, 2021).
with abnormalities in many parts of the body. Reproductive life planning includes all the decisions
Individuals with trisomy 18 often have slow growth an individual or couple make about whether and when to
before birth (intrauterine growth retardation) and a have children, how many children to have, and how they
low birth weight. are spaced.
3. Cri-du-Chat Syndrome- also known as 5p- Health teaching is necessary because some couples
syndrome and cat cry syndrome - is a rare genetic want counseling about how to avoid conception. Others
condition that is caused by the deletion (a missing need information on increasing fertility and their ability to
piece) of genetic material on the small arm (the p conceive. Others need counseling because contraception
arm) of chromosome 5. has failed. It is important for the health of children that as
4. Turner Syndrome - is a chromosomal condition many pregnancies as possible be intended, because when
related to the X chromosome that alters a pregnancy is unintended or mistimed, both short-term
development in females, though it is not usually and long-term consequences can result such as a woman
inherited in families. being less likely to seek prenatal care, being less likely to
5. Klinefeiter Syndrome - also known as the XXY breastfeed, and possibly being less careful to protect her
condition, is a term used to describe males who have fetus from harmful substances.
an extra X chromosome in most of their cells. A disproportionate share of women who bear
6. Fragile X Syndrome (FXS) is a genetic disorder children whose conception was unintended are unmarried;
characterized by mild-to-moderate intellectual such women are less apt to complete high school or
disability. college and more likely to require public assistance and to
7. Down Syndrome- (sometimes referred to as live in poverty than are their peers who are not mothers.
"Down's syndrome") or trisomy 21 is a common The child of such a pregnancy is at greater risk of low
genetic disorder that occurs when a person has birth weight, dying in the first year, being abused, and not
three copies of chromosome 21. receiving sufficient resources for healthy development

Genetic disorders - can be caused by a mutation in METHODS OF CONTRACEPTION

one gene (monogenic disorder), by mutations in
multiple genes (multifactorial inheritance disorder), Individuals or couples should choose a contraceptive
by a combination of gene mutations and method carefully, considering the advantages,
environmental factors, or by damage to disadvantages, and side effects of the various options.
chromosomes (changes in the number or structure Important things to consider when doing this are:
of entire chromosomes, the structures that carry  Personal values
genes).  Ability to use a method correctly
 How the method will affect sexual enjoyment
RESPONSIBLE PARENTHOOD  Financial factors
 Status of a couple’s relationship
The Responsible Parenthood and  Prior experiences
Reproductive Health Act of 2012, known as the RH  Future plans
Law, is a groundbreaking law that guarantees  Nurses need to understand how different methods of
universal and free access to nearly all modern contraception work and their pros and cons so that
contraceptives for all citizens, including they can effectively educate couples on their options
impoverished communities, at government health and how to use them.
centers The law also mandates reproductive health  One positive outcome of contraception is that there
education in government schools and recognizes a are now fewer teenage pregnancies and fewer
woman’s right to post-abortion care as part of the elective abortions compared to before, as reported by
right to reproductive healthcare. the CDC in 2009.
It mandates the government to adequately  When nurses provide clients with information and help
address the needs of Filipinos on responsible them discuss their specific concerns about
parenthood and reproductive health. The law aims to contraception, it empowers clients to make informed
empower the Filipino people, especially women and decisions that are best for their individual needs.
youth, through informed choice and age and (Nettleman, Brewer, & Ayoola, 2007).
development- appropriate education.  An ideal contraceptive should be:
Responsible parenthood is the will and ability  Safe
of parent(s) to respond to the needs and aspirations  One hundred percent effective
of the family and children. It is the shared
19
 Compatible with religious and cultural beliefs  The calendar method requires a couple to abstain
and personal preferences of both the user and from coitus (sexual relations) on the days of a
sexual partner menstrual cycle when the woman is most likely to
 Free of side effects conceive (3 or 4 days before until 3 or 4 days after
 Convenient to use and easily obtainable ovulation).
 Affordable and needing few instructions for  To plan for this, the woman keeps a diary of six
effective use menstrual cycles. To calculate “safe” days, she
 Free of effects after discontinuation and on subtracts 18 from the shortest cycle documented.
future pregnancies. This number represents her first fertile day. She
subtracts 11 from her longest cycle. This represents
NATURAL FAMILY PLANNING AND her last fertile day.
FERTILITY AWARENESS  If she had six menstrual cycles ranging from 25 to 29
days, her fertile period would be from the 7th day (25
 Natural family planning, also known as periodic minus 18) to the 18th day (29 minus 11). To avoid
abstinence, is a way to prevent pregnancy pregnancy, she would avoid coitus during those days
without using birth control pills or devices. It
involves understanding when a woman is fertile BASAL BODY TEMPERATURE METHOD
and avoiding sexual intercourse during those
times. Some people choose this method for
religious reasons or because they prefer not to
use chemicals or devices. However, its
effectiveness varies widely, depending on how
well the couple can avoid sex during fertile
periods. Fertility awareness is a key part of this
method, as it helps identify when a woman is
fertile so they can abstain from sex during those
times.  To avoid getting pregnant, some couples use a
method called fertility awareness. They track a
ABSTINENCE woman's basal body temperature (BBT) to figure out
 Abstinence is when someone decides not to when she's most likely to ovulate (release an egg).
have sexual relations at all. It's the most Just before ovulation, the BBT goes up. So, they
effective way to prevent both unwanted avoid having sex for three days after this increase
pregnancies and sexually transmitted infections because that's how long an egg can survive. However,
(STIs) because there's no chance of sperm sperm can stay alive in the woman's body for about
meeting an egg or the transmission of four days. So, it's usually recommended to also use a
infections. calendar method and abstain from sex a few days
 However, it's not always easy for people, before expected ovulation. The calendar method
especially teenagers, to stay abstinent. Many alone has a failure rate of 9% in ideal conditions and
sex education classes only focus on abstinence 25% in typical situations.
and might not teach about other contraception  There are challenges with using BBT for fertility
methods. Without any contraception, there's an awareness. Many things, like taking certain
85% chance of pregnancy. medications or changing your daily routine (like
 So, when talking about abstinence as a way to starting an exercise program), can affect your BBT. If
prevent pregnancy and STIs, it's important to a woman works night shifts, she should take her
also provide information on how to make it work. temperature after her longer sleep, no matter what
This might include discussing ways to resist time of day it is, to get accurate readings.
peer pressure, setting boundaries, and making In simple terms, fertility awareness involves tracking a
informed decisions about when to engage in woman's body temperature to avoid getting pregnant, but
sexual activity. it's not always reliable because many factors can influence
temperature changes. So, some couples also use a
CALENDAR (RHYTHM) METHOD calendar method to be more sure about when to avoid
having sex.

CERVICAL MUCUS METHOD

20
 Cervical Mucus Changes: The cervix woman's urine. LH levels increase 12 to 24 hours before
produces mucus that changes throughout the ovulation.
menstrual cycle. Before ovulation, this mucus is These kits are really good at predicting ovulation, with
thick and doesn't stretch much when touched. an accuracy rate of 98% to 100%. While they can be a bit
 Ovulation Approaches: As ovulation gets pricey, they're a convenient alternative to other methods
closer, the amount of mucus increases. On the like checking cervical mucus. Many women prefer using
day of ovulation (peak day), the mucus these kits, and some even combine them with cervical
becomes abundant, thin, watery, and clear. It mucus checks to improve accuracy. Overall, it's a popular
feels slippery and can stretch at least an inch choice for couples practicing natural family planning to
before breaking (called spinnbarkeit). help them know when it's more or less likely for the woman
 Fertile Days: Any day with abundant cervical to get pregnant.
mucus and for at least one day afterward is
considered fertile. To prevent pregnancy, a LACTATION AMENORRHEA METHOD
woman should avoid having sex on these days.  When a woman is
 Consistency Matters: This method requires breastfeeding her
careful monitoring of daily vaginal secretions. baby, her body
It's not reliable to rely on how the mucus feels naturally reduces
after sex because seminal fluid can be similar to the chances of
ovulatory mucus. releasing an egg
(ovulation), which
SYMPTOTHERMAL METHOD can make it less
 The symptothermal method of birth control likely for her to get
combines the cervical mucus and BBT methods. pregnant again
The woman takes her temperature daily, soon after giving
watching for the rise in temperature that marks birth. However, it's important to know that even
ovulation. She also analyzes her cervical mucus though she might not have her regular monthly period
every day and observes for other signs of while breastfeeding, she can still become fertile (able
ovulation such as mittelschmertz (midcycle to have a baby) because her body may release an
abdominal pain). The couple must abstain from egg without her noticing it.
intercourse until 3 days after the rise in  If the baby is also getting other types of food or is not
temperature or the fourth day after the peak of breastfeeding very often, the effectiveness of
mucus change, because these are the woman’s breastfeeding as a birth control method becomes
fertile days. The symptothermal method is more uncertain. In such cases, it's important for the woman
effective than either the BBT or the cervical to consider using another form of birth control if she
mucus method alone (ideal failure rate, about wants to prevent pregnancy.
2%).  As a rule, after 3 months of breastfeeding, the woman
 Basal Body Temperature (BBT): The woman should be advised to choose another method of
takes her temperature every morning to notice a contraception (Burkman, 2007).
slight increase, which indicates ovulation (when
an egg is released). COITUS INTERRUPTUS
 Cervical Mucus: She also observes changes in  Coitus interruptus is an old method of contraception
the mucus from her cervix. As she gets closer to where a couple has sexual intercourse, but the man
ovulation, the mucus becomes clear, slippery, pulls out before ejaculation to prevent sperm from
and stretchy. entering the woman's vagina. However, this method is
By using both methods together, the couple can not very reliable because sometimes ejaculation
determine their fertile days, which are the days when happens too quickly or small amounts of sperm can
pregnancy is most likely. To prevent pregnancy, they be present in pre-ejaculation fluid, leading to a risk of
should avoid having intercourse on these fertile days pregnancy. It's only about 75% effective in preventing
and wait until a few days after the temperature rise or pregnancy.
the peak in cervical mucus changes.
POSTCOITAL DOUCHING
OVULATION DETECTION Douching after sex, using any type of solution, is not an
This method effective way to prevent pregnancy. This is because sperm
uses an can reach the cervix (the entrance to the uterus) very
over-the-counter quickly, sometimes as fast as 90 seconds after ejaculation.
kit to help predict Douching won't remove the sperm fast enough to
when a woman is prevent pregnancy, so it's not a reliable method of
most likely to contraception. If someone wants to prevent pregnancy,
ovulate (release they should use a more proven and effective contraceptive
an egg from her method, like condoms or birth control pills, as advised by a
ovaries). The kit healthcare professional.
detects a
hormone called luteinizing hormone (LH) in a
21
 HORMONAL CONTRACEPTION Beginning pills as soon as they are prescribed this
Hormonal contraceptives are medications that way (a Quick Start system) rather than have to wait
contain hormones. These hormones are designed to for a set day may increase compliance.
prevent a woman from releasing an egg (ovulation)  After childbirth, a woman should start the
during her menstrual cycle. When you don't release contraceptive on the Sunday closest to 2 weeks after
an egg, it's much harder to get pregnant. These birth; after an elective termination of pregnancy, she
contraceptives can be taken in different forms, like should start on the first Sunday after the procedure.
pills, patches, vaginal rings, implants under the skin, Because COCs are not effective for the first 7 days,
or injections. They all work by controlling the advise women to use a second form of contraception
hormones in your body to stop ovulation and help during the initial 7 days on which they take pills.
prevent pregnancy  A woman prescribed a 21-day cycle brand takes a pill
at the same time every day for 21 days. Pill taking by
ORAL ROUTE this regimen will end on a Saturday. The woman
 Oral contraceptives, commonly known as the would then not take any pills for 1 week. She would
pill, OCs (for oral contraceptive), or COCs (for restart a new month’s supply of pills on the Sunday 1
combination oral contraceptives), are composed week after she stopped. A menstrual flow will begin
of varying amounts of synthetic estrogen about 4 days after the woman finishes a cycle of pills.
combined with a small amount of synthetic  To eliminate having to count days between pill cycles,
progesterone (progestin). most brands of OCs are packaged with 28 pills—21
 The estrogen acts to suppress follicle active pills and 7 placebo pills. With these brands, a
stimulating hormone (FSH) and LH, thereby woman starts a second dispenser of pills the day after
suppressing ovulation. The progesterone action finishing the first dispenser. There is no need to skip
complements that of estrogen by causing a days because of the placebo tablets. Menstrual flow
decrease in the permeability of cervical mucus, will begin during the 7 days on which she is taking the
thereby limiting sperm motility and access to placebo tablets.
ova. Progesterone also interferes with tubal  For ovulation suppressants to be effective, women
transport and endometrial proliferation to such must take them consistently and conscientiously.
degrees that the possibility of implantation is Women who have difficulty remembering to take a
significantly decreased. contraceptive in the morning may find it easier to take
 COCs must be prescribed by a physician, nurse a daily pill at bedtime or with a meal (the time of day
practitioner, or nurse-midwife after a pelvic makes no difference; it is the consistency that is
examination and a Papanicolaou (Pap) smear. important) (Box 6.5). Also, some women find that
When used correctly, they are 99.7% effective taking pills at bedtime rather than in the morning
in preventing conception. Women who forget to eliminates any nausea they otherwise experience.
take them as scheduled, however, experience a
failure rate of 95%. SIDE EFFECTS AND CONTRAINDICATIONS
 Oral contraceptives have non-contraceptive  Nausea
benefits such as decreased incidences of:  Weight gain
 Dysmenorrhea, because of lack of ovulation  Headache
 Premenstrual dysphoric syndrome and acne,  Breast tenderness
because of the increased progesterone levels  Breakthrough bleeding (spotting outside the
 Iron deficiency anemia, because of the reduced menstrual period)
amount of menstrual flow  Monilial vaginal infections
 Acute pelvic inflammatory disease (PID) and the  Mild hypertension
resulting tubal scarring  Depression
 Endometrial and ovarian cancer, ovarian cysts,  COCs are not routinely prescribed for women with a
and ectopic pregnancies history of thromboembolic disease or a family history
 Fibrocystic breast disease of cerebral or cardiovascular accident, who are over
 Possibly osteoporosis, endometriosis, uterine 40 years of age, or who smoke because of the
myomata (fibroid uterine tumors), and increased tendency toward clotting as an effect of
progression of rheumatoid arthritis increased estrogen.
 Colon cancer  COCs can interfere with glucose metabolism. For this
 COCs are reason, women with diabetes mellitus or a history of
packaged with liver disease, including hepatitis, are evaluated
21 or 28 pills individually before COCs are prescribed.
in a convenient  COCs may interact with several drugs such as
dispenser. It is acetaminophen, anticoagulants, and some
generally anticonvulsants, reducing their therapeutic effect so
recommended women may be advised to temporarily change their
that the first pill method of birth control while prescribed these drugs.
be taken on a Sunday (the first Sunday after
the beginning of a menstrual flow), although a
woman may choose to begin on any day.
22
 MINI-PILLS patch falls off, take it off and put on a new one right
 Mini-pills are a away. If it was off for less than 24 hours, you don't
type of birth need extra birth control..
control pill that
contains only a VAGINAL INSERTION
hormone called  The NuvaRing is a small
progestin. They silicone ring that a woman
work by inserts into her vagina. It
thickening the releases two hormones,
mucus in the estrogen and
cervix, which progesterone, slowly over
makes it harder for sperm to reach the uterus. three weeks. After three
While it's possible for ovulation to happen with weeks, she takes it out for
mini-pills, they also prevent the uterine lining one week. This is when she has her period. The
from fully developing, so a fertilized egg can't hormones are absorbed through the vaginal lining. It's
implant and result in pregnancy. a birth control method that helps prevent pregnancy.
 However, mini-pills have a drawback of causing  Fertility returns immediately after discontinuing using
more irregular bleeding than combination pills, the ring. Women may need to make out a calendar
which contain both progestin and estrogen. You that they post conspicuously to remind themselves to
have to take mini-pills every day, even during remove and replace the ring. Implantation
your period. The good thing is that they don't  Five subdermal implants, rods the size of pencil lead
interfere with breastfeeding, so you can use are embedded just under the skin on the inside of the
them if you're nursing your baby. upper arm.
 These rod-shaped implants contain a hormone called
EFFECT ON PREGNANCY etonogestrel, which is related to another hormone
If a woman is taking a birth control pill that called desogestrel used in the NuvaRing. When these
contains both estrogen and progestin and she thinks implants are put under the skin, they slowly release
she might be pregnant but wants to continue the this hormone over 3 to 5 years. This hormone
pregnancy, she should stop taking the pills. This is prevents pregnancy by stopping the release of eggs,
because having too much estrogen or progestin in thickening the cervical mucus, and making it hard for
the body during early pregnancy could potentially a fertilized egg to attach to the uterus.
harm the developing baby. So, it's a good idea to  The implants are inserted with some numbing
stop the pills if she plans to have the baby. medicine. It's done either during a woman's period or
within the first week of her menstrual cycle to make
TRANSDERMAL ROUTE sure she's not already pregnant. They can also be put
 Transdermal in shortly after an abortion or six weeks after giving
contraception is a birth. They are very effective, with a failure rate of less
birth control than 1%.
method that uses  One big advantage of these implants is that they
patches to slowly eliminate the need to remember to take a daily birth
release hormones control pill. They are also a good option for women
(estrogen and who can't use birth control methods with estrogen, as
progesterone) into they don't contain estrogen. Unlike some other birth
the body. These control methods, they don't interfere with sexual
patches are applied to the skin once a week for enjoyment, and they can even be used while
three weeks. Then, during the fourth week, no breastfeeding without affecting milk production.
patch is used, and this is when a woman  A disadvantage of the implant method is its cost ($500
typically has her period. After the patch-free on average) and side effects such as:
week, the cycle starts again with three weeks of  Weight gain
patch use followed by one week without a patch.  Irregular menstrual cycle such as spotting,
This method is as effective as birth control pills breakthrough bleeding, amenorrhea, or prolonged
for most women but may be slightly less periods
effective for women who weigh more than 90 kg  Depression
(198 lb).  Scarring at the insertion site
 Patches can be put on four places: the upper  Need for removal Injection
outer arm, upper torso (front or back, but not on  A single intramuscular injection of
the breasts), abdomen (belly), or buttocks. Don't medroxyprogesterone acetate (DepoProvera [DMPA]),
place them where you'll use makeup, lotions, or a progesterone, given every 12 weeks inhibits
creams, or at the waist where they might come ovulation, alters the endometrium, and changes the
off when you bend. Also, avoid areas with red or cervical mucus (Box 6.8). The effectiveness rate of
irritated skin or any open sores. this method is almost 100%, making it an increasingly
 You can wear contraceptive patches in the popular contraceptive method (Chrousos, 2008). Do
shower, while bathing, or while swimming. If a not massage the injection site after administration as
23
 you want the drug to absorb slowly from the collapsed position, then enlarged to its final shape in
muscle. Because DepoProvera contains only the uterus when the inserter is withdrawn. The woman
progesterone, it can be used during may feel a sharp cramp as the device is passed
breastfeeding. through the internal cervical os, but she will not feel
 Advantageous effects are reduction in ectopic the IUD after it is in place. Properly fitted, such
pregnancy, endometrial cancer, endometriosis, devices are contained wholly within the uterus,
and, for unknown reasons, reduction in the although the attached string protrudes through the
frequency of sickle cell crises (Burkman, 2007). cervix into the vagina.
 Potential side effects are similar to those of  IUDs have several advantages over other
subdermal implants: irregular menstrual cycle, contraceptives.
headache, weight gain, and depression.  Only one insertion is necessary, so there is no
Depo-Provera may impair glucose tolerance in continuing expense.
women at risk for diabetes. Because there also  The device does not require daily attention or interfere
may be an increase in the risk for osteoporosis with sexual enjoyment.
from loss of bone mineral density, advise  It is appropriate for women who are at risk for
women to include an adequate amount of complications associated with COCs or who wish to
calcium in their diet (up to 1200 mg/day) and to avoid some of the systemic hormonal side effects.
engage in weight-bearing exercise daily to  They may create lighter or fewer periods.
minimize this risk, rules that are good for all  Teach women to regularly check after each menstrual
women. flow, to make sure the IUD string is in place, and to
 Two disadvantages are that a woman must obtain a yearly pelvic examination.
return to a health care provider for a new
injection every 4 to 12 weeks for the method to SIDE EFFECTS AND CONTRAINDICATIONS
remain reliable, and the return to fertility is often  A woman may notice some spotting or uterine
delayed by 6 to 12 months. cramping the first 2 or 3 weeks after IUD insertion; as
long as this is present, she should use an additional
INTRAUTERINE DEVICES form of contraception, such as vaginal foam.
An intrauterine device (IUD)  Occasionally, a woman continues to have cramping
is a small plastic object that is and spotting after insertion; in such instances, she is
inserted into the uterus likely to expel the device spontaneously. Women with
through the vagina IUDs in place should take active steps to avoid toxic
(Postlethwaite et al., 2007). shock syndrome (TSS; a staphylococcal infection
IUDs became popular as a from the use of tampons), because infection might
method of birth control in the 1980s, and although travel by the IUD string into the uterus to cause
still a popular choice worldwide, IUDs are used by uterine infection.
only a small number of U.S. women. Few  IUDs are not recommended for women with an
manufacturers continue to provide them since increased risk of contracting STIs, such as those who
several lawsuits were filed in association with the have multiple sexual partners, because this
increased incidence of pelvic inflammatory disease combination could lead to pelvic infection.
(PID) in women using one particular brand, now no  They also are not recommended for women who have
longer available. never been pregnant (their small uterus could be
 Today, the IUD is thought to prevent fertilization punctured with insertion) or who have a history of
as well as creating a local sterile inflammatory having had PID. If PID is suspected, the device
condition that prevents implantation. When should be removed and the woman should receive
copper is added to the device, sperm mobility antibiotic therapy to treat the infection.
appears to be affected as well. This decreases  IUDs are also contraindicated in the woman whose
the possibility that sperm will successfully cross uterus is distorted in shape (the device might
the uterine space and reach the ovum. perforate an abnormally shaped uterus).
 An IUD must be fitted by a physician, nurse  They are not advised for women with severe
practitioner, or nurse-midwife, who first dysmenorrhea (painful menstruation), menorrhagia
performs a Pap test and pelvic examination. (bleeding between menstrual periods), or a history of
The device is inserted before a woman has had ectopic (tubal) pregnancy, because their use may
coitus after a menstrual flow, so the health care increase the symptoms or incidence of these
provider can be assured that the woman is not conditions.
pregnant at the time of insertion.  Women with valvular heart disease may be advised
 The insertion against the use of an IUD because the increased risk
procedure is of PID could lead to accompanying valve involvement
performed in an from bacterial endocarditis.
ambulatory setting
such as a
physician’s office or
a reproductive
planning clinic. The device is inserted in a
24
 EFFECT ON PREGNANCY
If a woman with an IUD in place suspects that
she is pregnant, she should alert her primary health
care provider. Although the IUD may be left in place
during the pregnancy, it is usually removed vaginally
to prevent the possibility of infection or spontaneous
miscarriage during the pregnancy. The woman
should receive an early ultrasound to document
placement of the IUD. This can also rule out ectopic
pregnancy, which has an increased incidence
among IUD users who become pregnant with the
IUD in place. SIDE EFFECTS AND CONTRAINDICATIONS
Vaginally inserted spermicidal products are
BARRIER METHODS contraindicated in women with acute cervicitis, because
Barrier methods are forms of birth control that they might further irritate the cervix. They are generally
work by the placement of a chemical or other barrier inappropriate for couples who must prevent conception
between the cervix and advancing sperm so that (perhaps because the woman is taking a drug that would
sperm cannot enter the uterus or fallopian tubes and be harmful to a fetus or the couple absolutely does not
fertilize the ovum. A major advantage of barrier want the responsibility of children), because the overall
methods is that they lack the hormonal side effects failure rate of all forms of these products is about 20%.
associated with COCs. However, compared with Some women find the vaginal leakage after use of these
COCs, their failure rates are higher and sexual products bothersome. Vaginal suppositories, because of
enjoyment may be lessened. the cocoa butter or glycerin base, are the most
bothersome in this regard.
1. CHEMICAL BARRIERS
 A spermicide is an agent that causes the death 2. MECHANICAL BARRIERS
of spermatozoa before they can enter the cervix. Mechanical barriers,
Such agents are not only actively spermicidal such as a diaphragm, work
but also change the vaginal pH to a strong acid by blocking the entrance of
level, a condition not conducive to sperm sperm into the cervix.
survival. They do not protect against STIs. A diaphragm is a circular
 In addition to the general benefits for barrier rubber disk that is placed
contraceptives, the advantages of spermicides over the cervix before
include: intercourse. A Lea’s Shield,
 They may be purchased without a prescription made of silicone rubber and bowl shaped, is a new design.
or an appointment with a health care provider, Although use of a spermicide is not required for
so they allow for greater independence and diaphragms, use of a spermicidal gel with a diaphragm
lower costs. combines a barrier and a chemical method of
 When used in conjunction with another contraception. With this, the failure rate of the diaphragm
contraceptive, they increase the other method’s is as low as 6% (ideal) to 16% (typical use).
effectiveness.  A diaphragm is prescribed and fitted initially by a
 Various preparations are available, including physician, nurse practitioner, or nurse-midwife to
gels, creams, sponges, films, foams, and ensure a correct fit. Because the shape of a woman’s
suppositories. cervix changes with pregnancy, miscarriage, cervical
 Another form of spermicidal protection is a film surgery (dilatation and curettage [D&C]), or elective
of glycerin impregnated with a spermicidal termination of pregnancy, teach
agent that is folded and inserted vaginally. On women to return for a second
contact with vaginal secretions or precoital fitting if any of these
penile emissions, the film dissolves and a circumstances occur. A woman
carbon dioxide foam forms to protect the cervix should also have the fit of the
against invading spermatozoa. diaphragm checked if she gains
 Sponges are foam-impregnated synthetic or loses more than 15 lb,
sponges that are moistened to activate the because this could also change
impregnated spermicide and then inserted her pelvic and vaginal contours.
vaginally to block sperm access to the cervix.  A diaphragm is inserted into the
Well liked by most users, they are easy to insert vagina, after first coating the rim
and have an efficiency rate of 80% (ideal) and a and center portion with a
typical use failure rate of about 60% spermicide gel, by sliding it
(Cunningham et al., 2008). They should remain along the posterior wall and pressing it up against the
in place for 6 hours after intercourse to ensure cervix so that it is held in place by the vaginal fornices.
sperm destruction. A woman should check her diaphragm with a finger
after insertion to be certain that it is fitted well up over

25
 the cervix; she can palpate the cervical os  A history of cervical cancer
through the diaphragm.  An undiagnosed vaginal bleeding
 A diaphragm should remain in place for at least  A condom is a latex
6 hours after coitus, because spermatozoa rubber or synthetic sheath
remain viable in the vagina for that length of that is placed over the
time. It may be left in place for as long as 24 erect penis before coitus
hours. If it is left in the vagina longer than this, to trap sperm. Condoms
the stasis of fluid may cause cervical have an ideal failure rate
inflammation (erosion) or urethral irritation. of 2% and a typical failure
 After use, a diaphragm should be washed in rate of about 15%, because breakage or spillage
mild soap and water, dried gently, and stored in occurs in up to 15% of uses (Kaplan & Love-Osborne,
its protective case. With this care, a diaphragm 2007).
will last for 2 to 3 years.  A major advantage of condoms is that they are one of
the few “male responsibility” birth control measures
SIDE EFFECTS AND CONTRAINDICATIONS available, and no health care visit or prescription is
Diaphragms may not be effective if the uterus is needed. Latex condoms have the additional potential
prolapsed, retroflexed, or anteflexed to such a of preventing the spread of STIs, and their use has
degree that the cervix is also displaced in relation to become a major part of the fight to prevent infection
the vagina. Intrusion on the vagina by a cystocele or with human immunodeficiency virus (HIV).
rectocele, in which the walls of the vagina are Recommend them for any partners who do not
displaced by bladder or bowel, may make insertion maintain a monogamous relationship.
of a diaphragm difficult. Users of diaphragms may  To be effective, condoms must be applied before any
experience a higher number of urinary tract penilevulvar contact, because even preejaculation
infections (UTIs) than nonusers, probably because of fluid may contain some sperm. A condom should be
pressure on the urethra. positioned so that it is loose enough at the penis tip to
Other contraindications include: collect the ejaculate without placing undue pressure
 History of toxic shock syndrome (TSS; on the condom. The penis (with the condom held
staphylococcal infection introduced through the carefully in place) must be withdrawn before it begins
vagina) to become flaccid after ejaculation. If it is not
 Allergy to rubber or spermicides withdrawn at this time, sperm may leak from the now
 History of recurrent UTIs loosely
 A cervical cap is yet  fitting sheath into the vagina.
another barrier method of Some men find that condoms
contraception. Caps are dull their enjoyment of coitus;
made of soft rubber, are Condoms for females are latex
shaped like a thimble with a sheaths made of polyurethane
thin rim, and fit snugly over and prelubricated with a
the uterine cervix. The spermicide. The inner ring (closed end) covers the
failure rate is estimated to cervix, and the outer ring (open end) rests against the
be as high as 26% (ideal) to 32% (typical use). vaginal opening. The sheath may be inserted any
The precautions for use are the same as for time before sexual activity begins and then removed
diaphragm use except they can be kept in place after ejaculation occurs. Like male condoms, they are
longer. intended for one-time use and offer protection against
 Many women cannot use cervical caps because both conception and STIs
their cervix is too short for the cap to fit properly.  Male and female
Also, caps tend to dislodge more readily than condoms should not be
diaphragms during coitus. An advantage is that used together. The failure
cervical caps can remain in place longer than rate is somewhat greater
diaphragms, because they do not put pressure than the failure rate for
on the vaginal walls or urethra; however, this male condoms, 12% to
time period should not exceed 48 hours, to 22%. Most failures occur because of incorrect or
prevent cervical irritation. Cervical caps, like inconsistent use.
diaphragms, must be fitted individually by a
health care provider. SURGICAL METHODS OF REPRODUCTIVE
LIFE PLANNING
 They are contraindicated in any woman who Surgical methods of reproductive life planning, often
has: called sterilization, include tubal ligation for women and
 An abnormally short or long cervix vasectomy for men. Tubal ligation is chosen by about
 A previous abnormal Pap smear 28% of all women in the United States of childbearing age
 A history of TSS as their contraceptive of choice. Vasectomy is the
 An allergy to latex or spermicide contraceptive method of choice for about 11% of men,
 A history of pelvic inflammatory disease, making these two procedures the most frequently used
cervicitis, or papillomavirus infection
26
methods of contraception in the United States for for the future can have it stored in a sperm bank
couples older than 30 years of age. before vasectomy.
 Counseling should be especially intensive for  Tubal ligation, where the fallopian tubes are occluded
men and women by cautery, crushing, clamping, or blocking, thereby
younger than 25 years of preventing passage of both sperm and ova. A
age, because the fimbriectomy, or removal of the fimbria at the distal
possibility of divorce, end of the tubes, is another possible but little used
death of a sexual partner, technique. Tubal ligation has a 99.5% effectiveness
loss of a child, or rate (Cunningham et al., 2008). Although the reason
remarriage could change is not clear, tubal ligation is associated with a
a person’s philosophy decreased incidence of ovarian cancer.
toward childbearing in the future. In addition,  The most common operation to achieve tubal ligation
sterilization is not recommended for is laparoscopy. After a menstrual flow and before
individuals whose fertility is important to their ovulation, an incision as small as 1 cm is made just
self-esteem. under the woman’s umbilicus with the woman under
 In a vasectomy, a small incision or puncture general or local anesthesia. A lighted laparoscope is
wound is made on each side of the scrotum. inserted through the incision. Carbon dioxide is then
The vas deferens at that point is then located, pumped into the incision to lift the abdominal wall
cut and tied, cauterized, or plugged, blocking upward and out of the line of vision. The surgeon
the passage of spermatozoa. Vasectomy can locates the fallopian tubes by viewing the field through
be done under local anesthesia in an a laparoscope.
ambulatory setting, such as a physician’s office  The procedure can also be done by culdoscopy (a
or a reproductive life planning clinic. The man tube inserted through the posterior fornix of the
experiences a small amount of local pain vagina) or colpotomy (incision through the vagina),
afterward, which can be managed by taking a but the incidence of pelvic infection is higher with
mild analgesic and applying ice to the site. these procedures and visualization is less. The
 The procedure is 99.5% woman is discharged from the hospital a few hours
effective (MacKay, after the procedure. She may notice abdominal
2009). Spermatozoa bloating for the first 24 hours, until the carbon dioxide
that were present in the infused at the beginning of the procedure is absorbed.
vas deferens at the time This can also cause sharp diaphragmatic or shoulder
of surgery can remain pain if some of the carbon dioxide escapes under the
viable for as long as 6 diaphragm and presses on ascending nerves.
months. Therefore,  A woman may return to having coitus as soon as 2 to
although the man can resume sexual 3 days after the procedure. Be certain that they
intercourse within 1 week, an additional birth understand. that tubal ligation, unlike a hysterectomy,
control method should be used until two does not affect the menstrual cycle, so they will still
negative sperm reports have been obtained have a monthly menstrual flow. Be certain that
(proof that all sperm in the vas deferens have women know to have no unprotected coitus before a
been eliminated, usually requiring 10 to 20 tubal ligation (sperm trapped in the tube could fertilize
ejaculations). an ovum there and cause an ectopic pregnancy).
 They can be assured that vasectomy does not
interfere with the production of sperm; the FAMILY PLANNING
testes continue to produce sperm as always,
 The concept of enhancing the quality of families w/c
but the sperm simply do not pass beyond the
includes:
severed vas deferens
• Regulating & spacing childbirth
and are absorbed at
• Helping subfertile couples beget children
that point. The man will
• Counseling parents and would-be parents
still have full erection
 It means it is essentially says that it's the
capacity. Because he
responsibility and choice of a married couple to
also continues to form
decide, with love, when and how many children they
seminal fluid, he will
want to have. However, this decision should have a
ejaculate seminal
good reason behind it and should be made using
fluid—it will just not contain sperm.
ethical methods. It's a personal decision that takes
 A few men develop chronic pain after
into account each person's background, experiences,
vasectomy (postvasectomy pain syndrome);
and cultural beliefs. To make this decision, careful
having the procedure reversed relieves this pain.
planning is needed to ensure that the chosen method
Some men develop autoimmunity or form
is suitable and can be used effectively.
antibodies against sperm, so that even if
reconstruction of the vas deferens is successful,
the sperm they produce do not have good
mobility and are incapable of fertilization. Men
who feel a need to have their sperm available
27
 FUNCTION OF THE HEALTH PROFESSIONAL • Ogino-knaus formula:
IN FAMILY PLANNING 1. Determine the shortest and longest cycle
To providing support, guidance, and information ex. Shortest cycle = 28 days
to help someone or a couple make their own Longest cycle = 36 days
decisions based on their personal beliefs, values, 2. If the cycle is irregular, subtract 18 from the shortest and
and preferences. It involves offering reassurance 11 from the longest
and letting them choose what they think is best for ex. 28-18=10 ex. 25-18=7
themselves, considering their individual, societal, 36-11=25 29-11=18
and religious beliefs. 3. The difference between the shortest cycle and 18
FAMILY PLANNING SERVICES determines the earliest time when ovulation occur.
4. The difference between the longest cycle and 11
TEMPORARY CONCEPTION CONTROL determines the last day when ovulation can occur
• Methods used to prevent conception 5. OVULATION CAN OCCUR ANYTIME IN BETWEEN.
• Methods used to prevent ovulation 6. In a regular 28 day cycle, abstinence should be
• Methods used to prevent implantation observed from day 9 to day 17. (count 5 days before the
earliest ovulation and 3 days after the last day
STERILIZATION / PERMANENT
CONCEPTION CONTROL
• Tubal Occlusion / Bilateral Tubal Ligation
• Vasectomy or Vas Ligation
WITHDRAWAL
• Removal of penis from the vagina before
ejaculation occurs
• NOT a sufficient method of birth control by itself
• Effectiveness rate is 80% (very unpredictable in
teens, wide variation)
• 1 of 5 women practicing withdrawal become
pregnant
• Very difficult for a male to ‘control’
COITUS RESERVATUS
• Male does not reach orgasm and therefore no
ejaculation occurs
• Requires considerable control over the sexual urge PHASES OF WETNESS / DRYNESS
RHYTHMIC ABSTINENCE 1. Wet – menstruation
• Identification of the periods of fertility and the 2. Dry – basic infertile pattern
periods of sterility in the menstrual cycle of a woman - sequence of dry days (or days of unchanging mucus)
and the restriction of sexual intercourse to the sterile indicating low level of estrogen and present infertility
periods or the time when the pregnancy is unlikely - duration is invariable, could be days, weeks,months
because the woman is biologically unprepared to or zero (if cycle is short)
conceive.
• Also known as “safe or infertile period” technique 1. Wet – days of possible fertility
and “natural birth control” or NFP because there is - changing mucus; non-slippery at first later becoming
nothing artificial used to prevent conception. slippery
• These methods are based on the ff. principles: - peak: last day of slippery mucus
• The human ovum is susceptible to fertilization for - days 1-3 after the peak are part of fertile period
approx. 18-24 hours after ovulation 2. Dry – infertile days
• The sperms deposited in the vagina are - day 4 after the peak till the end of the cycle
ordinarily capable of fertilizing the ovum for no more - ends about 2 weeks after the peak
than 72 hours
• Present methods of determining ovulation time EMERGENCY CONTRACEPTION (ECP)
are inexact and seldom sufficiently predictive (by at Emergency contraception pills can reduce the chance
least 48 hours) so that in practice, it is necessary to of a pregnancy by 75% if taken within 72 hours of
avoid intercourse for a far longer period of time than unprotected sex!
72 hours before ovulation and 24 hours after • Must be taken within 72 hours of the act of unprotected
ovulation intercourse or failure of contraception method
• Must receive ECP from a physician
CALENDAR METHOD • 75 – 84% effective in reducing pregnancy
• The use of mathematical calculations to predict the • Floods the ovaries with high amount of hormone and
probable time of ovulation. “Ovulation most often prevents ovulation
takes place 14 days before the onset of the next • Alters the environment of the uterus, making it disruptive
menstruation.” to the egg and sperm
• Two sets of pills taken exactly 12 hours apart
28
 FEMALE CONDOM 1. Decidua basalis, the part of the endometrium that lies
The female condom is a lubricated polyurethane directly under the embryo (or the portion where the
sheath, similar in appearance to a male condom. It is trophoblast cells establish communication with maternal
inserted into the vagina. The closed end covers the blood vessels).
cervix. Like the male condom, it is intended for 2. Decidua capsularis, the portion of the endometrium
one-time use and then discarded. The sponge is that stretches or encapsulates the surface of the
inserted by the woman into the vagina and covers trophoblast
the cervix blocking sperm from entering the cervix. 3. Decidua vera, the remaining portion of the uterine lining.
The sponge also contains a spermicide that kills As the embryo continues to grow, it pushes the decidua
sperm. It is available without a prescription. capsularis before it like a blanket. Eventually, the embryo
enlarges so much that this action brings the decidua
How to use the female condoms capsularis into contact with the opposite uterine wall (the
• Open the Female condom package carefully; tear decidua vera). Here, the two decidua areas fuse, which is
at the notch on the top right of the package. Do not why, at birth, the entire inner surface of the uterus is
use scissors or a knife to open. stripped away, leaving the organ highly susceptible to
• The outer ring covers the area around the opening hemorrhage and infection
of the vagina. The inner ring is used for insertion and
to help hold the sheath in place during Intercourse B. CHORIONIC VILLI
• While holding the Female condom at the closed After implantation, the
end, grasp the flexible inner ring and squeeze it with trophoblastic cells in the
the thumb and second or middle finger so it becomes blastocyst start growing
long and narrow finger-like structures
• Choose a position that is comfortable for called chorionic villi, which
insertion – squat, raise one leg, sit or lie reach into the uterus and
down. eventually become the
• Gently insert the inner ring into the vagina. Feel the placenta, with around 200
inner ring go up and move into place. of these structures forming by the end of pregnancy.
• Place, the index finger on the inside of the condom, Chorionic villi are structures
and push the inner ring up as far as it will go. Be sure in the placenta that contain a
the sheath is not twisted. The outer ring should core of fetal blood vessels
remain on the outside of the vagina. surrounded by two layers of
• To remove the Female condom, twist the outer ring cells, with the outer layer called
and gently pull the condom out. the syncytiotrophoblast, which
• Wrap the condom in the package or in tissue, and produces important hormones for pregnancy.
throw it in the garbage. Do not put it into the toilet. The middle layer of the placenta, called the
cytotrophoblast or Langhans' layer, is present early in
VAGINAL DIAPHRAGM pregnancy and helps protect the growing embryo from
• A shallow,dome-shaped rubber device with a certain infections like syphilis, but it disappears between
flexible wire rim that covers the cervix; maybe the 20th and 24th weeks, so syphilis becomes more
inserted several hours before intercourse and left in harmful to the fetus after this point. However, this layer
place for at least 6 hours after the last intercourse doesn't offer much protection against viral infections
• Initially fitted by a health professional throughout pregnancy.
• Weight loss/gain of 15 lbs may require re-fitting
• Inserted before intercourse with the woman in THE PLACENTA
squatting or supine position, or with one leg elevated The placenta, which
on a chair gets its name from its
• May cause cervicitis if left in place for too long pancake-like shape,
• Washed with mild soap & water, lasts for 2-3 years develops from trophoblast
• 97% efficiency tissue and grows alongside
the fetus, eventually
PRENATAL CARE FOR THE MOTHER becoming a 15 to 20 cm
EMBRYONIC STRUCTURE wide, 2 to 3 cm thick organ
A. THE DECIDUA that covers about half of
After fertilization, a hormone called hCG keeps the inside of the uterus during pregnancy.
the corpus luteum in the ovary active, preventing it
from shrinking. This allows the lining of the uterus to CIRCULATION
keep thickening and preparing for pregnancy instead As early as the 12th day of pregnancy, during the third
of shedding during a regular menstrual cycle. The week of pregnancy, nutrients from the mother's blood start
endometrium is now termed the decidua (the Latin moving into the embryo through tiny structures called
word for “falling off”), because it will be discarded chorionic villi, nourishing the developing baby.
after the birth of the child. Placental osmosis allows most substances, including
The decidua has three separate areas: drugs, to pass from the mother to the fetus, so it's crucial

29
for pregnant women to avoid unnecessary drugs, 3. Progesterone
alcohol, and nicotine to protect the baby's health. Estrogen is often referred to as the “hormone of
During pregnancy, the baby's and mother's blood women”; progesterone as the “hormone of mothers.” This
do not directly mix thanks to osmosis, but tiny breaks is because, although estrogen influences afemale
in the outer chorionic villi layer after the third appearance, progesterone is necessary to maintain the
trimester can occasionally allow fetal cells and endometrial lining of the uterus during pregnancy. It is
enzymes to enter the mother's bloodstream. present in serum as early as the fourth week of pregnancy,
About 100 maternal uterine arteries supply the as a result of the continuation of the corpus luteum. After
mature placenta. To provide enough blood for placental synthesis begins (at about the 12th week), the
exchange, the rate ofuteroplacental blood flow in level of progesterone rises progressively during the
pregnancy increases from about 50 mL/min at 10 remainder of the pregnancy. This hormone also appears to
weeks to 500 to 600 mL/min at term. The woman’s reduce the contractility of the uterus during pregnancy,
heart rate, total cardiac output, and blood volume preventing premature labor.
increase to supply blood to the placent 4. Human Placental Lactogen (Human Chorionic
Lying on the left side during pregnancy helps Somatomammotropin)
blood flow to the placenta by preventing the uterus hPL is a hormone with both growth-promoting and
from pressing on a major blood vessel, which can lactogenic (milk-producing) properties. It is produced by
lead to low blood pressure and poor circulation if the placenta beginning as early as the sixth week of
lying on the back. pregnancy, increasing to a peak level at term. It can be
At term, the placental circulatory network has assayed in both maternal serum and urine. It promotes
grown so extensively that a placenta weighs 400 to mammary gland (breast) growth in preparation for lactation
600 g (1 lb), onesixth the weight of the baby. If a in the mother. It also serves the important role of regulating
placenta is smaller than this, it suggests that maternal glucose, protein, and fat levels so that adequate
circulation to the fetus may have been inadequate. A amounts of these nutrients are always available to the
placenta larger than this may also indicate that fetus (Taylor & Lebovic, 2007).
circulation to the fetus was threatened, because it
suggests that the placenta was forced to spread out 5. Placental Proteins
in an unusual manner to maintain a sufficient blood The placenta also produces several plasma proteins.
supply. The fetus of a woman with diabetes may also The function of these has not been well documented, but it
develop a larger-than-usual placenta from excess is thought that they may contribute to decreasing the
fluid collected between cells. immunologic impact of the growing placenta through being
part of the complement cascade (Knuppel, 2007).
ENDOCRINE FUNCTION
Aside from serving as the conduit for oxygen and C. THE AMNIOTIC MEMBRANES
nutrients for the fetus, the syncytial (outer) layer of The chorionic villi inside the uterus gradually become a
the chorionic villi develops into a separate, important smooth surface called the chorion laeve, which later
hormone-producing system becomes the outermost fetal membrane, holding amniotic
fluid, while another membrane, the amniotic membrane,
1. Human Chorionic Gonadotropin forms beneath it. These
The hormone hCG, which is checked in membranes merge during
pregnancy tests, can be detected in a woman's pregnancy and cover the
blood and urine shortly after a missed period until placenta's fetal side,
about the 100th day of pregnancy, and a negative making it shiny. They have
result can occur before or after this time. After giving no nerve supply, so when
birth, hCG disappears from the blood within 1 to 2 they break during birth,
weeks, confirming that the placenta is no longer neither the mother nor the
present. baby feels pain.
The purpose of hCG is to act as a fail-safe The amniotic membrane not only supports the amniotic
measure to ensure that the corpus luteum of the fluid but also creates it, and it produces a substance that
ovary continues to produce progesterone and can start contractions and possibly kickstart labor.
estrogen. This is important because, if the corpus
luteum should fail and the level of progesterone fall, D. THE AMNIOTIC FLUID
the endometrial lining will slough and the pregnancy Amniotic fluid is constantly being newly formed and
will be lost. hCG also may play a role in suppressing reabsorbed by the amniotic membrane, so it never
the maternal immunologic response so that placental becomes stagnant. Some of it is absorbed by direct
tissue is not detected and rejected as a foreign contact with the fetal surface of the placenta. The major
substance. method of absorption, however, occurs because the fetus
2. Estrogen continually swallows the fluid. In the fetal intestine, it is
Estrogen, mainly estriol, is made by placental absorbed into the fetal bloodstream. From there, it goes to
cells and helps a woman's breasts get ready for milk the umbilical arteries and to the placenta, and it is
production and makes her uterus grow to support the exchanged across the placenta. At term, the amount of
growing baby amniotic fluid has increased so much it ranges from 800 to
1200 mL

30
 If for any reason the fetus is unable to swallow cord that contains only a single vein and artery. From 15%
(esophageal atresia or anencephaly are the two to 20% of these infants are found to have accompanying
most common reasons), excessive amniotic fluid,or chromosomal disorders or congenital anomalies,
hydramnios(more than 2000 mL in total, or pockets particularly of the kidney and heart (Lubusky et al.,
of fluid larger than 8 cm on ultrasound), will result. 2007).Blood can bewithdrawn from the umbilical vein or
Hydramnios also tends to occur in women with transfused into the vein during intrauterine life for fetal
diabetes, because hyperglycemia causes excessive assessment or treatment (termed percutaneous umbilical
fluid shifts into the amniotic space (Bush & Pernoll, blood sampling [PUBS]).
2007). >> The umbilical cord typically has one vein and two
Early in fetal life, as soon as the fetal kidneys arteries, but some infants have only one vein and artery,
become active, fetal urine adds to the quantity of the which can indicate potential health issues, like
amniotic fluid. A disturbance of kidney function may chromosomal disorders or kidney and heart problems in
cause oligohydramnios, or a reduction in the amount about 15% to 20% of cases, and the umbilical vein can be
of amniotic fluid (less than 300 mLin total, or no used for fetal assessments or treatments.
pocket on ultrasound larger than 1 cm) (Knuppel, In about 20% of all births, a loose loop of cord is found
2007). around the fetal neck (nuchal cord) at birth. If this loop of
The most important purpose of amniotic fluid is to cord is removed before the newborn’s shoulders are born,
shield the fetus against pressure or a blow to the so that there is no traction on it, the oxygen supply to the
mother’s abdomen. Because liquid changes fetus remains unimpaired (Jackson, Melvin, & Downe,
temperature more slowly than air, it also protects the 2007). Because the umbilical cord contains no nerve
fetus from changes in temperature. As yet another supply, it can be cut at birth without discomfort to either the
function, it aids in muscular development, because it child or woman
allows the fetus freedom to move. Finally, it protects
the umbilical cord from pressure, protecting the fetal F. PRIMARY GERM LAYERS
oxygen supply. Even if the amniotic membranes At the time of
rupture before birth and the bulk of amniotic fluid is implantation, a blastocyst
lost, some will always surround the fetus in utero, already has differentiated
because new fluid is constantly formed. Amniotic to a point at which two
fluid is slightly alkaline, with a pH of about 7.2. separate cavities appear in
Checking the pH of the fluid at the time of rupture the inner structure: (1) a
helps to differentiate it from urine, which is acidic (pH large one, the amniotic
5.0–5.5). cavity, which is lined with a
distinctive layer of cells, the
E. THE UMBILICAL CORD ectoderm, and (2) a smaller
The umbilical cord is formed from the fetal cavity, the yolk sac, which
membranes (amnion and chorion) and provides a is lined with entoderm
circulatory pathway that connects the embryo to cells.In humans, the yolk
thechorionic villi of the placenta. Its function is to sac appears to supply
transport oxygen and nutrients to the fetus from the nourishment only until
placenta and to return waste products from the fetus implantation. After that, its main purpose is to provide a
to the placenta. It is about 53 cm (21 in) in length at source of red blood cells until the embryo’s hematopoietic
term and about 2 cm (3 ⁄4 in) thick. The bulk of the system is mature enough to perform this function (at about
cord is a gelatinous mucopolysaccharide called the 12th week of intrauterine life). The yolk sac then
Wharton’s jelly, which gives the cord body and atrophies and remains only as a thin white streak
prevents pressure on the vein and arteries that pass discernible in the cord at birth. Between the amniotic cavity
through it. The outer surface is covered with amniotic and the yolk sac, a third layer of primary cells, the
membrane. mesoderm, forms. The embryo will begin to develop at the
>> The umbilical cord is like a lifeline that connects a point where the three cell layers (ectoderm, entoderm, and
developing baby to the placenta in the mother's mesoderm) meet, called the embryonic shield. Each of
womb, allowing it to get food and oxygen and get rid these germ layers of primary tissue.
of waste, and it's made of a jelly-like substance to Understanding the origins of body structures helps
protect the important blood vessels inside. doctors determine which screenings to perform on
An umbilical cord contains onlyone vein (carrying newborns with birth defects, like checking the kidneys for a
blood from the placental villi to the fetus) but two baby born with a heart problem or looking for reproductive
arteries (carrying blood from the fetus back to the issues in a child with urinary tract abnormalities, because
placental villi). The number of veins and arteries in all organ systems start forming by 8 weeks of pregnancy,
the cord is always assessed and recorded at birth and this early development stage is most susceptible to
because about 1% to 5% of infants are born with a harmful factors like smoking.

31
G. FETAL CIRCULATION II. End of 8th Gestational Week
As early as the third week of intrauterine life, fetal  Length: 2.5 cm (1 in)
blood begins to exchange nutrients with the maternal  Weight: 20 g
circulation across the chorionic villi. Fetal circulation  Organogenesis is complete.
differs from extrauterine circulation because the  The heart, with a septum and valves, is beating
fetus derives oxygen and excretes carbon dioxide rhythmically.
not from gas exchange in the lung but from gas  Facial features are definitely discernible.
exchange in the placenta.  Arms and legs have developed.
Blood arriving at the  External genitalia are forming, but sex is not yet
fetus from the placenta is distinguishable by simple observation.
highly oxygenated. This  The primitive tail is regressing.
blood enters the fetus  The abdomen bulges forward because the fetal
through the umbilical vein intestine is growing so rapidly.
(called a vein even though  An ultrasound shows a gestational sac, diagnostic of
it carries oxygenated pregnancy (Fig. 9.8).
blood, because the
direction of the blood is III. End of 12th Gestational Week (First Trimester)
toward the fetal  Length: 7–8 cm
heart).Blood flows from  Weight: 45 g
the umbilical vein to the ductus venosus, an  Nail beds are forming on fingers and toes.
accessory vessel that directs oxygenated blood  Spontaneous movements are possible, although they
directly to the fetal liver. are usually too faint to be felt by the mother.
Blood then empties into the fetal inferior vena  Some reflexes, such as the Babinski reflex, are
cava so oxygenated blood is directed to the right present.
side of the heart. Because there is no need for the  Bone ossification centers begin to form.
bulk of blood to pass through the lungs, it is shunted,  Tooth buds are present.
as it enters the right atrium, into the left atrium  Sex is distinguishable by outward appearance.
through an opening in the atrial septum, called the  Urine secretion begins but may not yet be evident in
foramen ovale. From the left atrium, it follows the amniotic fluid.
course of adult circulation into the left ventricle and  The heartbeat is audible through Doppler technology.
into the aorta. A small amount of blood that returns to
the heart via the vena cava does leave the right IV. End of 16th Gestational Week
atrium via the adult circulatory route—that is, through  Length: 10–17 cm
the tricuspid valve into the right ventricle, and then  Weight: 55–120 g
into the pulmonary artery and lungs to service the  Fetal heart sounds are audible by an ordinary
lung tissue. However, the larger portion of even this stethoscope.
blood is shunted away from the lungs through an  Lanugo is well formed
additional structure, the ductus arteriosus, directly  Liver and pancreas are functioning.
into the aorta,  Fetus actively swallows amniotic fluid, demonstrating
an intact but uncoordinated swallowing reflex; urine is
MILESTONES OF FETAL GROWTH AND present in amniotic fluid.
DEVELOPMENT  Sex can be determined by ultrasound.
I. End of 4th Gestational Week
At the end of the fourth week of gestation, the V. End of 20th Gestational Week
human embryo is a group of rapidly growing cells but  Length: 25 cm
does not yet resemble a human being.  Weight: 223 g
 Length: 0.75–1 cm  Spontaneous fetal movements can be sensed by the
 Weight: 400 mg mother.
 The spinal cord is formed and fused at the  Antibody production is possible.
midpoint.  The hair forms on the head, extending to include
 Lateral wings that will form the body are folded eyebrows.
forward to fuse at the midline.  Meconium is present in the upper intestine.
 The head folds forward and becomes prominent,  Brown fat, a special fat that will aid in temperature
representing about one-third of the entire regulation at birth, begins to be formed behind the
structure. kidneys, sternum, and posterior neck.
 The back is bent so that the head almost  Vernix caseosa begins to form and cover the skin.
touches the tip of the tail. •  Passive antibody transfer from mother to fetus begins.
 The rudimentary heart appears as a prominent  Definite sleeping and activity patterns are
bulge on the anterior surface. distinguishable (the fetus has developed biorhythms
 Arms and legs are budlike structures. • that will guide sleep/wake patterns throughout life)
Rudimentary eyes, ears, and nose are
discernible

32
 VI. End of 24th Gestational Week  Fetus kicks actively, hard enough to cause the mother
(Second Trimester) considerable discomfort.
 Length: 28–36 cm  Fetal hemoglobin begins its conversion to adult
 Weight: 550 g hemoglobin. The conversion is so rapid that, at birth,
 Meconium is present as far as the rectum about 20% of hemoglobin will be adult in character.
 Active production of lung surfactant begins.  Vernix caseosa is fully formed.
 Eyebrows and eyelashes become well defined.  Fingernails extend over the fingertips.
 Eyelids, previously fused since the 12th week,  Creases on the soles of the feet cover at least two
now open. thirds of the surface
 Pupils are capable of reacting to light.
 When fetuses reach 24 weeks, or 601 g, they PREVENTING FETAL EXPOSURE TO TERATOGENS
have achieved a practical low-end age of A teratogen is any factor, chemical or physical, that
viability (earliest age at which fetuses could adversely affects the fertilized ovum, embryo, or fetus. At
survive if born at that time), if they are cared for one time, it was assumed that a fetus in utero was
after birth in a modern intensive care facility. protected from chemical or physical injury by the presence
 Hearing can be demonstrated by response to of the amniotic fluid and by the absence of any direct
sudden sound. placental exchange between mother and fetus. When
infants were born with disorders, it was attributed to the
VII. End of 28th Gestational Week influence of fate, bad luck, or, in some cultures, evil spirits.
 Length: 35–38 cm Today, it is acknowledged that a fetus is extremely
 Weight: 1200 g vulnerable to environmental injury.
 Lung alveoli begin to mature, and surfactant can
be demonstrated in amniotic fluid. EFFECTS OF TERATOGENS ON A FETUS
 Testes begin to descend into the scrotal sac Several factors influence the amount of damage a
from the lower abdominal cavity. teratogen can cause. The strength of the teratogen is one
 The blood vessels of the retina are formed but of these. For example, radiation is a known teratogen. In
thin and extremely susceptible to damage from small amounts (everyone is exposed to some radiation
high oxygen concentrations (an important every day, such as from sun rays), it causes no damage.
consideration when caring for preterm infants However, in large doses (e.g., the amount of radiation
who need oxygen) necessary to treat cancer of the cervix), serious fetal
defects or death can occur.
VIII. End of 32nd Gestational Week The timing of the teratogenic insult makes a significant
 Length: 38–43 cm impact on damage done to the fetus. If a teratogen is
 Weight: 1600 g introduced before implantation, either the zygote is
 Subcutaneous fat begins to be deposited (the destroyed or it appears unaffected. If the insult occurs
former stringy, “little old man” appearance is when the main body systems are being formed (in the
lost) second to eighth weeks of embryonic life), a fetus is very
 Fetus responds by movement to sounds outside vulnerable to injury. During the last trimester, the potential
the mother’s body. for harm again decreases because all the organs of a fetus
 Active Moro reflex is present. are formed and are merely maturing.
 Iron stores, which provide iron for the time Two exceptions to the rule that deformities usually
during which the neonate will ingest only milk occur in early embryonic life are the effects caused by the
after birth, are beginning to be developed. organisms of syphilis and toxoplasmosis. These two
 Fingernails grow to reach the end of fingertips. infections can cause abnormalities in organs that were
originally formed normally.
IX. End of 36th Gestational Week A third factor determining the effects of a teratogen is
 Length: 42–48 cm the teratogen’s affinity for specific tissue. Lead and
 Weight: 1800–2700 g (5–6 lb) mercury, for example, attack and disable nervous tissue.
 Body stores of glycogen, iron, carbohydrate, Thalidomide, a drug once used to relieve nausea in
and calcium are deposited. pregnancy, causes limb defects. Tetracycline, a common
 Additional amounts of subcutaneous fat are antibiotic, causes tooth enamel deficiencies and, possibly,
deposited. long-bone deformities. The rubella virus can affect many
 Sole of the foot has only one or two crisscross organs: the eyes, ears, heart, and brain are the four most
creases, compared with the full crisscross commonly attacked.
pattern that will be evident at term.
 Amount of lanugo begins to diminish. TERATOGENIC MATERNAL INFECTIONS
 Most babies turn into a vertex (head down) 1. TOXOPLASMOSIS
presentation during this month.  Toxoplasmosis, a protozoan infection, is spread most
commonly through contact with uncooked meat,
X. End of 40th Gestational Week although it may, also be contracted through handling
(Third Trimester) cat stool in soil or cat litter (Friars, 2007).
 Length: 48–52 cm (crown to rump, 35–37 cm)  As many as 1 in 900 pregnancies may be affected by
 Weight: 3000 g (7–7.5 lb) toxoplasmosis.
33
 A woman experiences almost no symptoms of 3. CYTOMEGALOVIRUS
the disease except for a few days of malaise  Cytomegalovirus (CMV), a member of the herpes
and posterior cervical lymphadenopathy. Even virus family, is another teratogen that can cause
in light of these mild symptoms, extensive damage to a fetus while causing few
 if the infection crosses the placenta, the infant symptoms in a woman (Lilleri et al.,2007).
may be born with central nervous system  It is transmitted from person to person by droplet
damage, hydrocephalus, microcephaly, infection such as occurs with sneezing.
intracerebral calcification, and retinal  If a woman acquires a primary CMV infection during
deformities. pregnancy and the virus crosses the placenta, the
 Prepregnancy serum analysis can be done to infant may be born severely neurologically challenged
identify women who have never had the disease (hydrocephalus, microcephaly, spasticity) or with eye
and so are susceptible (about 50% of women). damage (optic atrophy, chorioretinitis), hearing
 Instruct pregnant women to avoid undercooked impairment, or chronic liver disease. The child’s skin
meat and also not to change a cat litter box or may be covered with large petechiae
work in soil in an area where cats may defecate (“blueberry-muffin” lesions).
to avoid exposure to the disease.  However, diagnosis in the mother or infant can be
 If the diagnosis is established by serum analysis established by the isolation of CMV antibodies in
during pregnancy, therapy with sulfonamides blood serum.
may be prescribed.  Unfortunately, there is no treatment for the infection
 Pyrimethamine, an antiprotozoal agent, may even if it presents in the mother with enough
also be used. This drug is an antifolic acid drug, symptoms to allow detection. Because there is no
so it is administered with caution early in treatment or vaccine for the disease, routine
pregnancy to prevent reducing folic acid levels. screening for CMV during pregnancy is not
recommended.
2. RUBELLA  Women can help prevent exposure by thorough
 The rubella virus usually causes only a mild handwashing before eating and avoiding crowds of
rash and mild systemic illness in a woman, but young children at daycare or nursery settings.
the teratogenic effects on a fetus can be
devastating (Johnson & Ross, 2007). 4. HERPES SIMPLEX VIRUS
 Fetal damage from maternal infection with (GENITAL HERPES INFECTION)
rubella (German measles) includes hearing  The first time a woman contracts a genital herpes
impairment, cognitive and motor challenges, infection, systemic involvement occurs. The virus
cataracts, cardiac defects (most commonly spreads into the bloodstream (viremia) and crosses
patent ductus arteriosus and pulmonary the placenta to a fetus posing substantial fetal risk
stenosis), intrauterine growth restriction (IUGR), (ACOG, 2007).
thrombocytopenic purpura, and dental and  If the infection takes place in the first trimester, severe
facial clefts, such as cleft lip and palate. congenital anomalies or spontaneous miscarriage
 Typically, a rubella titer from a pregnant woman may occur.
is obtained on the first prenatal visit. A titer  If the infection occurs during the second or third
greater than 1:8 suggests immunity to rubella. A trimester, there is a high incidence of premature birth,
titer of less than 1:8 suggests that a woman is intrauterine growth restriction, and continuing
susceptible to viral invasion. A titer that is infection of the newborn at birth. Unless recognized
greatly increased over a previous reading or is and treated, the fetal mortality and morbidity rates are
initially extremely high suggests that a recent as high as 80% (ACOG, 2007).
infection has occurred.  If a woman has had herpes simplex virus type 1
 A woman who is not immunized before infections before the genital herpes invasion or if the
pregnancy cannot be immunized during genital herpes (type 2) infection is a recurrence,
pregnancy because the vaccine uses a live antibodies to the virus in her system prevent spread of
virus that would have effects similar to those the virus to a fetus across the placenta.
occurring with a subclinical case of rubella. After  If genital lesions are present at the time of birth,
a rubella immunization, a woman is advised not however, a fetus may contract the virus from direct
to become pregnant for 3 months, until the exposure during birth. For women with a history of
rubella virus is no longer active. genital herpes and existing genital lesions, cesarean
 All pregnant women should avoid contact with birth is often advised to reduce the risk of this route of
children with rashes. Infants who are born infection. This awareness of the
tomothers who had rubella during pregnancy  Placental spread of herpes simplex virus has
may be capable of transmitting the disease for a increased the importance of obtaining information
time after birth. Because of this, an infant may about exposure to genital herpes or any painful
be isolated from other newborns during the perineal or vaginal lesions that might indicate this
newborn period. infection at prenatal visits.

34
 Intravenous or oral acyclovir (Zovirax) can be 2007). When the baby’s primary teeth come in, they are
administered to women during pregnancy oddly shaped (Hutchinson teeth).
(Karch, 2009). The primary mechanism for
protecting a fetus, however, focuses on disease B. LYME DISEASE
prevention. Urging women to practice safe sex Lyme disease, a multisystem disease caused by the
is important to lessen their exposure to this and spirochete Borrelia burgdorferi, is spread by the bite of a
other sexually deer tick. The highest incidence occurs in the summer and
 Transmitted infections. Advising adolescents to early fall. The largest outbreaks of the disease are found
obtain a vaccine against HPV (Gardasil) should on the east coast of the United States (Mullen, 2007). After
lessen the incidence of genital herpes infection a tick bite, a typical skin rash, erythema chronicum
in the future. migrans (large, macular lesions with a clear center),
develops. Pain in large joints such as the knee may
5. OTHER VIRAL DISEASES develop. Infection in pregnancy can result in spontaneous
 It is difficult to demonstrate other viral miscarriage or severe congenital anomalies.
teratogens, but rubeola (measles), To spread the spirochete, the tick must be present on
coxsackievirus, infectious parotitis (mumps), the body possibly as long as 24 hours. After returning
varicella (chickenpox), poliomyelitis, influenza, home from an outing, therefore, a woman should inspect
and viral hepatitis all may be teratogenic. her body carefully and immediately remove any ticks found.
Parvovirus B19, the causative agent of If she has any symptoms that suggest Lyme disease or
erythema infectiosum (also called fifth disease), knows she has been bitten, she should contact her primary
a common viral disease in school age children, health care provider immediately.
if contractedduring pregnancy, can cross the Treatment of Lyme disease for pregnant women differs
placenta and attack the red blood cells of a from that for nonpregnant women. The drugs used for
fetus. Infection with the virus during early nonpregnant adults, tetracycline and doxycycline, cannot
pregnancy is associated with fetal death. If the be used during pregnancy because they cause tooth
infection occurs late in pregnancy, the infant discoloration and, possibly, long-bone malformation in a
may be born with severe anemia and congenital fetus. A course of penicillin will be prescribed to reduce
heart disease (Barankin, 2008). symptoms in the pregnant woman.
Because the symptoms of Lyme disease are chronic
A. SYPHILIS but not dramatic (a migratory rash and joint pain), women
Syphilis, a sexually transmitted infection, is of may not report them at a prenatal visit unless they are
great concern for the maternal–fetal population educated about their importance and are asked at prenatal
despite the availability of accurate screening tests visits if such symptoms are present.
and proven medical treatment, as it is growing in
incidence and places a fetus at risk for intrauterine or 6. POTENTIALLY TERATOGENIC VACCINES
congenital syphilis (Walker, 2009). Early in  Live virus vaccines, such as measles, HPV, mumps,
pregnancy, when the cytotrophoblast layer of the rubella, and poliomyelitis (Sabin type), are
chorionic villi is still intact, the causative spirochete of contraindicated during pregnancy because they may
syphilis, Treponema pallidum, cannot cross the transmit the viral infection to a fetus (Rojas, Wood, &
placenta and damage the fetus. When this layer Blakemore, 2007). Care must be taken in routine
atrophies at about the 16th to 18th week of immunization programs to make sure that
pregnancy, however, the spirochete then can cross adolescents about to be vaccinated are not pregnant.
and cause extensive damage. If syphilis is detected Women who work in biologic laboratories where
and treated with an antibiotic such as benzathine vaccines are manufactured are well advised not to
penicillin in the first trimester, a fetus is rarely work with live virus products during pregnancy.
affected. If left untreated beyond the 18th week of
gestation, hearing impairment, cognitive challenge, 7. TERATOGENIC DRUGS
osteochondritis, and fetal death are possible.  Many women, assuming that the rule of being
For this reason, serologic screening (by either a cautious with drugs during pregnancy applies only to
VDRL or a rapid plasma reagin test) should be done prescription drugs, take over-the-counter drugs or
at a first prenatal visit; the test may then be repeated herbal supplements freely. Although not all drugs
again close to term (the 8th month) if exposure is a cross the placenta (heparin, for example, does not
concern. Even when a woman has been treated with because of its large molecular size), most do. Also,
appropriate antibiotics, the serum titer remains high even though most herbs are safe, ginseng, for
for more than 200 days; an increasing titer, however, example, used to improve general well-being, or
suggests that reinfection has occurred. In an infant senna, used to relieve constipation, may not be safe
born to a woman with syphilis, the serologic test for (Der Marderosian & Beutler, 2007).
syphilis may remain positive for up to 3 months even  Any drug or herbal supplement, under certain
though the disease was treated during pregnancy. circumstances, may be detrimental to fetal welfare.
The newborn with congenital syphilis may have Therefore, during pregnancy, women should not take
congenital anomalies, extreme rhinitis (sniffles), and any drug or supplement not specifically prescribed or
a characteristic syphilitic rash, all of which identify approved by their physician or nurse-midwife.
the baby as high risk at birth (Chakraborty & Luck,
35
 A woman of childbearing age and ability should 9. TERATOGENICITY OF CIGARETTES
not take any drug other than one prescribed by  Cigarette smoking is associated with infertility in
a physician or nurse-midwife to avoid exposure women. Cigarette smoking by a pregnant woman has
to a drug should she become pregnant. been shown to cause fetal growth restriction
 The use of recreational drugs during pregnancy (Lawrence & Haslam, 2007). In addition, a fetus may
puts a fetus at risk in two ways: the drug may be at greater risk for being stillborn (Hogberg &
have a direct teratogenic effect, and intravenous Cnattingius, 2007) and, after birth, may be at greater
drug use risks exposure to diseases such as risk than others for sudden infant death syndrome.
HIV and hepatitis B (Donnelly et al., 2008). Low birth weight in infants of smoking mothers results
 Narcotics such as meperidine (Demerol) and from vasoconstriction of the uterine vessels, an effect
heroin have long been implicated as causing of nicotine. This limits the blood supply to a fetus.
intrauterine growth restriction (IUGR). The use  Another contributory effect may be related to inhaled
of marijuana alone apparently does not, carbon monoxide. Secondary smoke, or inhaling the
although the long-term effects of marijuana smoke of another person’s cigarettes, may be as
during pregnancy are still unstudied. Cocaine, harmful as actually smoking the cigarettes. All
particularly its crack form, is potentially harmful prenatal healthcare settings should be smoke-free
to a fetus because it causes severe environments for this reason.
vasoconstriction in the mother, compromising  The best way to urge women to discontinue smoking
placental blood flow and perhaps dislodging the is to educate them about the risks to themselves and
placenta. Its use is associated with their fetus at a first prenatal visit. It may be effective to
spontaneous miscarriage, preterm labor, encourage women to sign a contract with a health
meconium staining, and IUGR (Rojas, Wood, & care provider to try to stop or to join a
Blakemore, 2007). smoking-cessation program.
 An area of recreational drug use that needs to
be examined is that of inhalant abuse (“huffing”). 10. RADIATION
Substances frequently used as inhalants  Rapidly growing cells are extremely vulnerable to
include gasoline, butane lighter fluid,Freon, glue, destruction by radiation. That makes radiation a
and nitrous oxide (NIOSH, 2007). potent teratogen to unborn children because of their
high proportion of rapidly growing cells. Radiation
8. TERATOGENICITY OF ALCOHOL produces a range of malformations depending on the
 Evidence over the years has shown that when stage of development of the embryo or fetus and the
women consume a large quantity of alcohol strength and length of exposure. If the exposure
during pregnancy, their babies show a high occurs before implantation, the growing zygote
incidence of congenital deformities and apparently is killed. If the zygote is not killed, it
cognitive impairment. It was assumed in the survives apparently unharmed. The most damaging
past that these defects were the result of the time for exposure and subsequent damage is from
mother’s poor nutritional status (drinking alcohol implantation to 6 weeks after conception (when many
rather than eating food), not necessarily the women are not yet aware that they are pregnant). The
direct result of the alcohol. nervous system, brain, and retinal innervation are
 However, alcohol has now been firmly isolated most affected.
as a direct teratogen. Fetuses cannot remove  As a rule, therefore, all women of childbearing age
the breakdown products of alcohol from their should be scheduled for pelvic x-ray examinations
body. The large buildup of this leads to vitamin only in the first 10 days of a menstrual cycle (when
B deficiency and accompanying neurologic pregnancy is unlikely be-cause ovulation has not yet
damage. occurred), except in emergency situations. A serum
 Women during pregnancy should be screened pregnancy test can be done on all women who have
for alcohol use because an infant born with fetal reason to believe they might be pregnant before
alcohol syndrome (FAS) not only is small for diagnostic tests involving x-rays are scheduled.
gestational age but can be cognitively
challenged (Shankar, Ronis, & Badger, 2007). PRENATAL CARE FOR THE FETUS
 Women are best advised, therefore, to abstain OBSTETRIC DATA
from alcohol completely. Be certain to ask about  Gravida - Number of pregnancy regardless of
binge drinking (consuming more than five duration as long as the mother becomes pregnant
alcohol drinks in an evening) as women may even abnormal.
refer to this as only “occasional drinking.” Refer  Para/Parity- number of viable pregnancy or the total
women with alcohol addiction to an alcohol number of pregnancies in which the fetus has
treatment program as early in pregnancy as reached the age of viability and subsequently
possible to help them reduce their alcohol delivered whether dead or alive at birth.
intake.  Viability- Ability of the fetus to live outside the uterus
at the earliest possible gestational age.

36
 Primigravida - Woman who is pregnant for the LEOPOLD’S MANEUVER
first time 1st MANEUVER: Purpose: to determine the fetal
 Primipara - Woman who has given birth to one presentation/lie through fundal palpation
child past age of viability; woman who has  If palpated a round, hard and movable - BREECH
completed one pregnancy to age of viability and presentation
subsequently delivered the fetus, whether alive  If palpated round, soft and immovable -
or dead at birth. HEAD/CEPHALIC presentation
 Multigravida - Woman who has been pregnant 2nd MANEUVER: Purpose: to determine the back of fetus
previously; 2 or more pregnancy to hear the fetal heart sound
 Grandmultigravida - woman who has had six  If smooth hard and resistant surface - FETAL BACK
or more pregnancies  If angular nodulations - KNEES AND ELBOWS
 Multipara - Woman who has carried two or
more pregnancies to viability; woman who has 3rd MANEUVER: Purpose: to determine the degree of
carried two or more pregnancies of stage of engagement by palpating the lower uterine segment
viability and subsequently born alive or dead.  If the presenting part is movable: NOT ENGAGED
 Nulligravida - Woman who has never been and  If the presenting part is immovable: ENGAGED
is not currently pregnant >> HARD: HEAD
 Nullipara - woman who has not carried a >> SOFT, GLOBULAR, LARGE: BUTTOCKS
pregnancy beyond 20 weeks 4th MANEUVER: Purpose: to determine the fetal attitude
 Grandmultipara - woman who has had 6 or –relationship of fetus to each part or degree of flexion by
more viable deliveries, whether, the fetuses grasping the lower quadrant of abdomen. It is done only if
were alive or dead. the fetus is in cephalic presentation.
 Full Flexion if the fetal chin touches chest
PRINCIPLES IN IDENTIFYING PARITY PSYCHOLOGICAL CHANGES OF PREGNANCY
1. Number of pregnancies is counted and not the ● Pregnancy is such a huge change in a woman’s life and
number of fetuses. brings about more psychological
2. Abortion is not included in parity count changes than any other life event beside puberty.
3. Live birth or stillbirth is counted in parity count. ● A woman’s attitude towards a pregnancy depends a
great deal on psychological aspects: such as:
OB SCORING o The environment in which she was raised
T - Term: Number of full-term infants born 37 weeks o The messages about pregnancy her family
P - Pre-term: Number of preterm infants born 20 – 36 communicated to her as a child
weeks o The society and culture in which she lives as an adult
A - Abortion: termination of pregnancy before the o Whether the pregnancy has come at a good time in her
age of viability (less than 20 weeks) life
L - Number of Currently Living Children 1. Social Influences
M - Multiple Pregnancy 2. Cultural Influences
3. Family Influences
NAGELE’S RULE 4. Individual Differences
 Use to determine expected date of delivery 5. Partners Adaptation
(EDD or EDB). It is important to determine the
SOCIAL INFLUENCES
mother’s LMP.
 If Jan – March = +9 +7 FROM THE PAST TODAY
 If Apr – Dec = -3 +7 +1 The pregnancy was Pregnancy is viewed as a
conveyed as a 9-month healthy span of time best
MC DONALD’S RULE shared with supportive
 Use to determine age of gestation in weeks long illness
partner and or family
using FUNDIC HEIGHT
FORMULA: The pregnant woman The woman brings their
 AOG in WKS = FUNDIC HEIGHT x 8/7 went alone to a families for prenatal care
FORMULA: physician’s office for care visits as well as to watch
 AOG in MONTHS = FUNDIC HEIGHT x 2/7 the birth
At the time of birth, she The woman chooses
BARTHOLOMEW’S RULE was separated from her what level of pain
Use to determine age of gestation by proper family management they want
location of fundus at abdominal cavity to use for labor and birth
 < 12 weeks = not palpable/pelvic cavity The woman was
 3 months = above symphysis hospitalized in seclusion
 5 months = level of umbilicus from visitors and even They expect to breastfed
 7 months = bet. Umbilicus and xyphoid from the new baby for 1 their newborn
 9 months = touching/below xyphoid week afterward so the
 10 months = level of 9 months due to lightening; newborn could be fed by
about 4 cm nurses
37
● The woman and her partner feel during pregnancy NURSE’S ROLE
and prepared to meet the challenges: are related to 1. Assessing and counselling pregnant woman
them: 2. Fill the role of an attentive listener
a. Cultural background
b. Personal beliefs PARTNER’S ADAPTATION
c. Experiences reported by friends and relatives ● The more emotionally attached a partner is to a pregnant
d. Current plethora of information available woman, the closer the partner’s attachment is apt to be to
the child.
NURSE’S ROLE Factors that affect the pregnant woman’s decision
1. Teaching the woman about their health care making:
option a. Cultural background
2. Continue to work with other health care provider to b. Past experience
“demedicalize” childbirth c. Relationships with the family members

CULTURAL INFLUENCES PSYCHOLOGICAL TASKS OF PREGNANCY

● Cultural beliefs and taboos can place restrictions 1. FIRST TRIMESTER: Accepting the Pregnancy
on a woman’s behavior and activities regarding her ● Task: Accepting the pregnancy - woman and partner
pregnancy both spend time recovering from shock of learning they are
● During prenatal visits, ask the woman and her pregnant and concentrate on what it feels like to be
partner if there is anything, they believe that should pregnant. A common reaction is ambivalence, or feeling
or should not be done to make the pregnancy both pleased and not pleased about the pregnancy.
successful and keep the fetus healthy.
Examples: Beliefs THE WOMAN
● Lifting the arms over the head during pregnancy ● Accept the reality of the pregnancy, later will come the
will cause the cord to twist task of accepting the baby, following their initial surprise
● Watching a lunar eclipse will cause a birth women often experience the feeling of ambivalence
deformity ● Ambivalence – refers to the interwoven feelings of
wanting and not wanting feelings which can be confusing
FAMILY INFLUENCES to an ordinarily organized woman
●The family in which woman raised can be influential ● Most women who were not happy about being pregnant
to her beliefs about pregnancy at the beginning are able to change their attitude towards
● Woman and her siblings were loved and seen as a their pregnancy by the time they feel the child move inside
pleasant outcome is more likely to have a ● Woman often comment after such visit they feel “more
positive attitude towards her pregnancy pregnant” or it makes a first visit more than an ordinary
● A woman who views mothering a positive activity is one
more likely to be pleased when she becomes ● Early diagnosis is important because the earlier a
pregnant than one who does not value mothering woman realizes she is pregnant, the sooner she can begin
● Negative Influences - woman and her siblings were to safeguard fetal health by discontinuing all drugs not
blamed for the breakup of a marriage or a prescribed or approved by her health care provider.
relationship. HEALTH CARE PLAN:
1. Routine sonogram - to assess for growth anomalies
INDIVIDUAL DIFFERENCES and can be a major step in promoting acceptance because
A woman’s ability to cope with or adapt to stress women can see a beating heart or fetal outline or can learn
plays a major role in how she can resolve any the sex of their fetus.
conflict and adapt: 2. First prenatal visits - hearing their pregnancy officially
a. To being a mother without needing mothering, to diagnosed at a first prenatal visit is another step toward
loving a child as well as partner accepting a pregnancy
b. To becoming a mother for each new child
depends on her basic temperament on whether she THE PARTNER
adapts to new situations quickly or slowly, whether ● All partners are important and should be encouraged to
she face them with intensity or maintain a low-key play a continuing emotional and supportive role in
approach, and whether she had experience coping pregnancy
with change and stress ● Accepting the pregnancy for a partner means not only
c. The extent to which a woman feels secure in her accepting the certainty of the pregnancy and the reality of
relationship with the people around her the child to come but also accepting the woman in her
d. Past experiences influence on how woman changed state
perceive pregnancy as a positive or negative ● Partner may also experience feeling of ambivalence
experience ● Partner may feel proud and happy at the beginning of
e. To being concerned about her appearance pregnancy
f. To being worry that pregnancy will rob her ● Soon begin to feel both overwhelmed with what the loss
financially and ruin her chances of job promotion of salary will mean to the family if the woman has to quit
work

38
● Feeling close to jealousy of the growing baby who Assessing events that could contribute to difficulty
although not yet physically apparent, seems to be accepting Pregnancy:
taking up a great deal of the woman’s time and 1. Pregnancy is unintended
though 2. Learning the pregnancy is a multiple, not a single one
HEALTH CARE PLAN: 3. Learning the fetus has developmental abnormality
o Prenatal visit or fetal testing – provide an outlet 4. Pregnancy is less than 1 year after the previous one
for both male and female partners to discuss 5. Family has to relocate during pregnancy (Involves a
concerns and offer parenting information. need to find new support people
6. The main family support person suffers a job loss
2. SECOND TRIMESTER: Accepting the Baby 7. The woman’s relationships end because of partner’s
● Task: Accepting the baby - Woman and partner infidelity
move through emotions such as narcissism and 8. There is a major illness in self, partner, or a relative
introversion as they concentrate on what it will feel 9. Complications of pregnancy occur (Hypertension)
like to be a parent. Roleplaying and increased 10. The woman has a series of developing experiences
dreaming are common (failure in school work)

THE WOMAN Emotional responses that can cause concern in

● Psychological task of a woman is to accept she is Pregnancy
having a baby, a step up from accepting the ● Emotional responses and common reactions helpful to
pregnancy caution a pregnant woman and her partners that the
● The change usually happens at quickening or the common changes may occur so they’re not alarmed if they
first moment a woman feels fetal movement. appear:
● Woman who carefully planned the pregnancy, this 1. Grief
moment of awareness may occur soon as she 2..Narcissism
recovers from the surprise of learning she has 3. Introversion versus Extroversion
actually conceived 4. Body image and Boundary
● She announces the news to her parents and hear 5. Stress
them express their excitement and see a look of 6. Depression
pride on her partner’s face
● A good way to measure the level of a woman’s THE CONFIRMATION OF PREGNANCY
acceptance is to measure how well she follows o A medical diagnosis of pregnancy serves to date when
prenatal instructions the birth will occur and helps predict the existence of a
high-risk status
THE PARTNER o Pregnancy was diagnosed on symptoms reported by a
● A partner may become overly absorbed in work, woman and the signs elicited by a health care provider
striving to produce something concrete on the job
that may limit the amount of time a partner spends SIGNS AND SYMPTOMS OF PREGNANCY
with family 1. Presumptive Signs (Subjective Symptoms) - are
● Some men have difficulty enjoying the pregnancy findings in connection with the body system in which they
because they have been misinformed about occur and are experienced by the woman but cannot be
sexuality, pregnancy, and women’s health. documented by an examiner
a. Breast changes – feelings of tenderness, fullness,
3. THIRD TRIMESTER: Preparing for Parenthood tingling, enlargement and darkening of areola
● Task: Preparing for the baby and end of b. Nausea and vomiting – on arising or when fatigue
pregnancy - Woman and partner prepare clothing c. Amenorrhea – absence of menstruation
and sleeping arrangements for the baby but also d. Frequent urination – sense of having to void more
grow impatient with pregnancy as they ready often than usual
themselves for birth e. Fatigue - general feeling of tiredness
f. Uterine enlargement – uterus can be palpated over
THE WOMAN AND PARTNER symphysis pubis
● Couples begin “nest building” activities (Planning g. Quickening - fetal movement felt by woman
the infant’s sleeping arrangements, choosing a name h. Linea Nigra – line of dark pigment forms on the
for the infant, ensuring safe passage) by learning abdomen
about birth i. Melasma – dark pigmentation forms on face
● Couples are usually interested in attending j. Striae Gravidarum) - red streaks forms on abdomen
prenatal classes and or classes on preparing for
childbirth. 2. Probable Signs (Objective Symptoms) – are findings
● Childbirth education class and or preparing for and can verified by an examiner
parenthood can not only help a couple accept but o Chadwick’s sign - color change of the vagina from pink
also expose them to other parents as a role models to violet
who can provide practical information about o Goodell’s sign – softening of the cervix
pregnancy a concern child care. o Hegar’s sign - softening of the lower uterine segment
o Sonographic evidence of gestational sac
39
o Braxton Hick’s contraction – periodic uterine ● Chadwick’s sign - changes in color from light pink to a
tightening deep violet
o Fetal outline felt by examiner through palpation d. Ovarian Changes – active production of estrogen and
o Ballottement – the fetus can feel through progesterone
bimanual examination
2. BREAST CHANGES
● Laboratory Tests – blood serum and urine ● Feeling of fullness, tingling or tenderness because of
specimen to detect the presence of human chorionic increased estrogen level
gonadotrophin (hCG) ● Breast size increase because of the growth in mammary
a. Serum pregnancy test – hCG appear as early as alveoli and in fat deposit
24 – 48 hrs. after implantation and reach a ● Areola of the nipple darkens and the diameter increases
measurable level about 50 unit/ml 7-9 days after from about 3.5 cm (1.5 inches) to 5cm or 7 cm (2 or 3
conception inches)
b. Urine sample – concentrated such as a first urine
in the morning 3. ENDOCRINE CHANGES
c. Home Pregnancy Test - it takes 2-3 mins. to ● Increased thyroid and parathyroid hormone production
complete and have a high degree of accuracy ● Palmar erythema
d. Early prenatal care – is the best safeguard to ● Insulin production is decreased early during pregnancy
ensure successful pregnancy. and increases after the 1st trimester
● Prolactin, Melanocyte-stimulating hormone, and human
3. Positive Signs of Pregnancy growth hormone of the pituitary gland increase, ESTOGEN
a. Sonographic evidence of fetal outline – fetal AND PROGESTERONE produced
outline can be seen and measure by sonogram ● Placenta as a transient endocrine organ
b. Fetal movement felt by examiner ● Colostrum can be expelled as early as 16 weeks
c. Fetal heart audible – doppler ultrasound reveal ● Increase vascularity
heartbeat (10th – 12th week of gestation ) ● Enlarge and protuberant nipples

PHYSIOLOGIC CHANGES OF PREGNANCY 4. RESPIRATORY SYSTEM

o They can categorize as local (confined to the ● Shortness of breathing is common
reproductive organs or systemic affecting the entire ● Marked congestion or stuffiness – due to increase
body) estrogen
1. REPRODUCTIVE SYSTEM CHANGES
a. Uterine Changes – increase the size of the uterus 5. CARDIOVASCULAR SYSTEM
to accommodate the growing fetus. ● 30-50% increase in the total cardiac volume
The uterus increases in length, depth, width, ● Physiologic Anemia of pregnancy may occur
weight, wall thickness and volume ● Increases heart rate
● Length – from 6.5 - 32 cm; ● Palpitations is common
● Width – from 4cm to 24 cm; ● Edema and varicosities of the lower extremities
● Weight - increases from 50g to 1000g;
● Depth - increases from 2.5 cm to 22 cm 6. GASTROINTESTINAL SYSTEM
● Uterine wall thickens from 1cm to 2cms ● Slow emptying time of the stomach
● Volume – increases from 2 ml. to more than1,000 ● Nausea and vomiting
ml.can hold a total of 4000g at term (7-lb (3.175 g.) ● Decreased pH of the saliva
fetus, 1,000 ml. amniotic fluid ● Hemorrhoids is common due to constipation, pressure of
● Fundus height at various the uterus, slow peristalsis
week of pregnancy
20-22nd week – reaches 7. URINARY SYSTEM
the level of the umbilicus ● Glomerular Filtration rate increases
36th week – touches the ● BUN and Plasma Creatinine decreases
xiphoid process ● Renal threshold for sugar decreases
38th week – fetal head ● Frequent urination in 1st trimester, normalizes in 2nd
settles into the pelvis trimester, frequent urination in 3rd trimester
● Hegar’s signs –
extreme softening of the lower uterine segment 8. MUSCULAR SYSTEM
● Ballottement – the fetus can be felt to bounce or ● Calcium and Phosphorus needs are increased
rise in the amniotic fluid ● Gradual softening of the pelvic ligaments
● Braxton Hick’s contraction ● Wide separation of the symphysis pubis
● Amenorrhea
b. Cervical changes – becomes more vascular and 9. IMMUNE SYSTEM
edematous ● IgG production decreases
● Goodell’s sign - softening of the cervix ● WBC simultaneously increases
c. Vaginal Changes – increase vascularity of the
vagina
40
 RECOMMENDED WEIGHT GAIN Human Chorionic Gonadotropin – the first placental
DURING PREGNANCY hormone produced and can be found shortly after
o A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is implantation.
recommended as an average weight gain in
pregnancy. Specimens:​
o Weight gain in pregnancy occurs from both fetal 1. URINE – test to yield accurate results and it should be
growth and accumulation of maternal stores and done 10 to 14 days after the missed menstrual period. This
occurs at approximately 0.4 kg (1 lb) per month period guarantee level of hCG and prevents false negative
during the rst trimester and then 0.4 kg (1 lb) per results.
week during the last two trimesters (a trimester a. Gravindex and Pregnosticon - are immunologic
pattern of 3-12-12). pregnancy test and approximately 95% accurate in
o As a general rule, in the average woman, weight diagnosing pregnancy and 98% accurate in
gain is considered excessive if it is more than 3 kg determining the absence of pregnancy
(6.6 lb) a month during the second and third b. Radioimmunoassay – tests for the beta subunit of
trimesters; it is less than usual if it is less than 1 kg hCG and considered to be so accurate as to be
(2.2 lb) per month during the second and third diagnostic for pregnancy.
trimesters.
o Women can be assured that most of the weight
gained with pregnancy will be lost afterward

To ensure adequate fetal nutrition, advise women

not to diet to lose weight during pregnancy. Weight
gain will be higher for a multiple pregnancy than for a
single pregnancy. You can encourage women
pregnant with multiple fetuses to gain at least 1lb per
week for a total of 40to 45 lb
URINE TESTS: (hCG)
Sudden increases in weight that suggest fluid  Collect first voided urine using clean, dry bottle free of
retention or polyhydramnios (excessive Amniotic detergent or contamination.
fluid) or a loss of weight that suggests illness should  Do not drink fluids from 8pm the night before to
be carefully evaluated at prenatal visits. concentrate the urine
 Refrain from taking any drug 24 hrs. before the test
DIETARY REFERENCE INTAKES FOR  Label the specimen with the woman’s name, date,
NON-PREGNANT AND PREGNANT WOMAN and time of voiding.
 Bring the specimen to the laboratory immediately
 Refrigerate urine specimen-if more than one hour is
pass before the specimen gets to the laboratory
because room temperature is high enough to destroy
hCG

2. BLOOD – with sensitive assays hCG can be detected

in maternal blood at 7 days after conception and are
accurate close to 100% of the time.

NORMAL DIAGNOSTIC LABORATORY

FINDINGS AND DEVIATION 3. PROGESTERONE WITHDRAWAL TEST – a
A medical diagnosis of pregnancy serves to contraceptive pill is taken OD or TID (3xdays)
date when the birth will occur and also helps predict  If menstruation occurs
the existence of high-risk status. within 10-15 days, the
 With advancements in science and technology, woman is not pregnant.
pregnancy tests today are commercially  If corpus luteum
available and can be performed by the trained produces enough
personnel that are highly accurate and precise, hormones to neutralize
if done with the correct technique. the effect of withdrawn
Pregnancy testing – relies on the detection of an synthetic progesterone
antibody to the hormone human chorionic and no bleeding occurs, the woman is pregnant
gonadotropin (hCG) or a subunit in the urine or
serum
41
4. ULTRASOUND IMAGING – (Ultrasound PLACENTAL GRADING FOR GRADES:
scanning or Scanning) involves exposing a part of 0 – between 12 and 24 wks.
the body to high frequency sound waves to produce 1 – 30 – 32 wks.
pictures of the inside of the body 2 – 36 wks.
3 – 38 wks. – suggest fetus is mature
 It is a popular
and safe 4. Amniotic fluid volume –
diagnostic tool in the amount of amniotic fluid
the care of the present estimate fetal health
pregnant woman a. 20-24 cm. – indicates
and her fetus. Hydramnios
 It provides the b. < 5-6 cm –
physician, and Oligohydramnios
other members of the health team the ability to 5. Nuchal translucency – described the appearance of a
approach the developing fetus aa a separate collection of fluid under the skin behind fetal neck
patient with an identifiable set of reflexes 6. Magnetic resonance Imaging (MRI) – can identify
reactions to outside stimuli and activity patterns. structural anomalies or soft tissue disorder
 7-11 wks. if the date of LMP is unknown, 7. Lateral Pelvimetry – in suspected cephalopelvic
between 16-20 wks. gestation to verify fetal disproportion (CPD) with a danger sign of absence of
structures and gender. lightening in a primigravida in active labor

TYPES OF PELVIC ULTRASOUND Indications for lateral Pelvimetry

a. Abdominal or Transabdominal – with the Suspected CPD
woman in supine position, the a. Previous difficult delivery
sonographer/radiologist applies the transducer b. History of severe vitamin D and calcium deficiency in
on the lower abdomen childhood
b. c. History of pelvic or spine injury
c. Vaginal or transvaginal – with the woman in d. Cases of severe scoliosis
lithotomy position, the
8. Laboratory Assessment
sonographer/radiologi
a. Urinalysis – tested for proteinuria, glycosuria, nitrates,
st inserts into the
pyuria
vagina 2-3 inches of
b. Complete blood count
the vaginal
c. Genetic screen (G6PD glucose6phosphate
transducer’s end with
dehydrogenase)
the protective cover
d. VDRL serologic test for syphilis
and lubricating gel
e. Blood typing (Rh factor)
f. Maternal serum a-fetoprotein – done between 16-18
PURPOSE:
wks. of pregnancy
1. Diagnose pregnancy as early as 6 wks.
g. Combs test – determination of whether Rh antibodies
Gestation.
are present in an Rh (-) woman
2. Confirm the size, location of the placenta and
h. HIV screening
amniotic fluid.
i. Serum antibody titers for rubella, hepatitis, varicella
3. Discover complications of pregnancy.
j. Blood Serum Studies
4. Establish if fetus is growing and no congenital
k. Tuberculosis Screening (Mantoux Test)
anomalies.​
5. Predict maturity by measurement of biparietal ASSESSING FETAL WELL-BEING
diameter of the head 1. FETAL BIOPHYSICAL PROFILE
INDICTIONS:
ULTRASONOGRAPHY 1. Mother with gestational hypertension
1. Biparietal diameter – used to predict fetal 2. Fetus appears to be small or not growing properly
maturity. 3. Fetus is less active than normal (movement)
a. Measurement of fetal head (8.5 cm. or 4. Too much or too little amniotic fluid
greater)​  Is a noninvasive method of assessing the general well
b. Weight. 2500 g (5.5 lb.) being of the fetus and the fetal assessment.
2. Doppler Umbilical Velocimetry – measures the  BPP may be used as
velocity at which RBC in the​ early as 26-28 weeks
uterine and fetal vessels to assess blood flow for the surveillance of
3. Placental grading for maturity – graded based high risk pregnancy.
on the amount of calcium deposits present in the
base of the placenta

42
 The test requires the use of an ultrasound and Purposes of Amniotic Fluid Analysis:​
the electronic fetal monitor and the observation  Detection of fetal abnormalities early in pregnancy
time takes about 30 minutes.  To determine fetal lung maturity
 Lecithin/Sphingomyelin ratio
Five Parameters:  Lung Profile
1. Fetal reactivity  Amniotic Fluid Bilirubin
2. Fetal breathing movements  Rh incompatibility
3. Fetal body movements  For detection of certain infections
4. Fetal tone  Detection of fetal abnormalities early in pregnancy
5. Amniotic fluid volume
RESULTS: Nursing Care During Amniocentesis:
8 - 10 fetus is considered to be doing well  Assist client to empty her bladder before the
6 – 7 is considered suspicious procedure
4 - denotes a fetus probably in jeopardy  Place in supine position and drape properly
 Put rolled towel under right hip to tip body to the left
BIOPHYSICAL PROFILE SCORING and remove pressure of uterus on vena cava
1. Fetal breathing - at least one episode of 30secs.  Instruct not to take a deep breath and hold it while the
of sustained breathing movement w/in 30mins needle is being inserted as it will shift the uterus and
2. Fetal movement - at least 3 episodes of fetal limb needle may hit placenta or fetus.
or trunk movement w/in 30mins.  Inform the patient that it is not painful because
3. Fetal tone - Observation must extend and then anesthesia will be applied at the insertion site. She
flex extremities or spine at least once in 30 mins. may experience pressure sensation during the
4. Fetal heart reactivity - 2 or more heart insertion of the needle.
accelerations at least 15 beats/min  Monitor FHT before, during and in 30 minutes after
5. Amniotic fluid volume - A range of amniotic fluid the test.
between 5 and 25 cm must be present  Instruct patient to observe for:
-- Infection
FETAL HEART RATE -- Uterine cramping
Fetal heart sounds -- Vaginal bleeding
a. 10 – 11 wks. – ultrasound
b. 10 wks. – Doppler 3. CHORIONIC VILLI SAMPLING (CVS)
 Is a transcervical or transabdominal insertion of a
Daily fetal Movement Count (Kicks Count)​ needle into the fetal portion of the placenta, at the
c. 18 – 20 wks. – quickening felt by the mother area of the chorion frondosum
d. 28 – 38 wks. – 10 x / hr. peaks in intensity  CVS is performed at 8-12 weeks gestation under
ultrasound guidance to ensure that the fetus is
Rhythm Strip Testing​ – assessment of the fetal unharmed.
heart rate.​  Chorionic villi cells are examined to detect
▪ Average FHR – 130 beats/ min. chromosome abnormalities such as Down syndrome
▪ Average fetal moves – twice every 10 mins. - and genetic disorders such as cystic fibrosis
causes heart rate to increase  Is a biopsy & analysis of chorionic villi for
Vibroacoustic Stimulation – for acoustic (sound)​ chromosomal analysis done at 8 to 10 weeks of
stimulation acoustic stimulator applied to the pregnancy chorion cells are located by ultrasound
mother’s abdomen to produce sharp sound (80  A thin catheter is inserted vaginally or needle biopsy
db.), startling and waking the fetus is inserted intravaginally or inserted abdominally, and
a number of chorionic cells are removed chromosone
2. AMIOCENTESIS analysis (genetic defect)
 Amnion for sac and  Instruct client to report bleeding, infection or leakage
kentesis for puncture. of fluid after procedure
Scheduled between the  Some instances of limb reduction syndrome
14th and 16th week  Less than 1% risk leading to excessive bleeding, or
 Amniocentesis is the pregnancy loss
removal of fluid from  Reportable s/sx:
the amniotic cavity by -- Chills or fever
needle puncture. An (infection)
ultrasound is performed first to determine the -- Uterine contraction or
safe site where the needle can be inserted. vaginal bleeding
 During the procedure, the fetus is continuously (threatened
monitored by ultrasound to ensure its wellbeing. miscarriage)
 Complications includes hemorrhage from the
penetration of the placenta, infection of the
amniotic fluid and puncture of the fetus.

43
4. AFP / TRIPLE SCREEN
 This test involves measurement of AFP, estriol c. LATE DECELERATIONS
and HCG in maternal serum at 15-20 weeks of -- delayed decelerations until 30 to 40 seconds after the
gestation to screen for fetal structural & onset of a contraction and continue beyond the end of the
chromosomal abnormalities. contraction
 Alpha-feto protein is a substance produced by -- Ominous pattern in labor (uteroplacental insufficiency) or
the liver that is present in amniotic fluid and ↓ blood flow through the intervillous spaces of the uterus
maternal serum. during contraction
 Estriol is initially tested. If the result is abnormal, -- The lowest point of the deceleration (nadir) occurs near
the woman is next referred for ultrasound to the end of the contraction instead of at its peak
confirm gestational age and to evaluate for -- Occur with hypertonia or with abnormal uterine tone
neural tube defects (NTD) and other structural caused by administration of oxytocin
abnormalities. -- Stop or slow the administration of oxytocin
 A low estriol, elevated HCG, and low AFP -- Change the position from supine to lateral to relieve
finding is often associated with Trisomy 21 pressure from the Vena Cava
(Down syndrome). -- Administer IVF or O2 as prescribed
 High in the maternal serum (MSAFP) if the fetus -- If late decelerations persist – prepare for possible
has an open spinal or abdominal defect. prompt birth of the infant

5. NONSTRESS TEST (NST) d.VARIABLE DECELERATIONS

● is an assessment of fetal well-being that analyses -- Decelerations that occur at unpredictable times in
the response of the fetal heart to fetal movement relations to contractions.
● When the fetus has adequate oxygenation and -- Indicate compression of cord
intact CNS, the are accelerations of FHR with fetal -- Cord prolapsed
movement. -- Fetus is lying on the cord -
● The baby’s heart rate should accelerate, by 15 -- Occurs more frequently: after rupture of membranes
beats for at least 15 seconds, twice in a twenty -- Oligohydramnios
minute period. This is called a reactive NST and is a -- U, V or W – shaped waves
good sign that the fetus is healthy. -- Position: lateral or T-position
● A reactive NST indicates intrauterine survival for -- Administer fluids and O2 as prescribed
one week. The doctor may order a CST if the NST is -- If not relieved, amnioinfusion may be prescribed
nonreactive. The usual preparation is to feed the
mother with food or fluids before the test to stimulate Interpretation of Results of CST:
fetal movements. ● Positive : there is persistent late decelerations w/ more
than half the contractions; maybe associated w/ minimal or
6. CONTRACTION STRESS TEST (CST) absent variability. A positive CST means that the fetus is
● assess the ability of the fetus to withstand the no longer receiving adequate oxygen and needs to be
stress of uterine contraction done during labor delivered.
● CST is a means of evaluating the respiratory ● Negative : There is no late deceleration in a 10-minute
function of the placenta. period and this means that it is safe for the fetus to remain
● Induced or spontaneous contraction decrease in utero for the next 7 days
transport of O2 to the fetus. A healthy fetus
maintains a steady heart rate.
● If placental reserve is insufficient, fetal hypoxia and
decrease in FHR occur.
● Testing is initiated when 3 contractions in every 10
minutes are attained. The test takes about 60-90
minutes to perform.

PERIODIC CHANGES
a. ACCELERATIONS
-- temporary normal increases in FHR caused by
fetal movement or compression of the umbilical vein
during contraction
b. EARLY DECELERATIONS
-- periodic decreases in FHR resulting from pressure
of the fetal head during contractions.
-- Beginning when the contractions begins and
ending when the contractions end (mirror image)
-- Normal – late in labor

44
 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
HISTORY
CU 1: INTRODUCTION TO DRUGS A. Babylonians - earliest surviving “prescriptions”
on clay tablets in 3000 B.C
B. Chinese - Recorded the Pen Tsao (great herbal)
PHARMACOLOGY
a 40 volume compendium of plant remedies dating
 The study of the biological effects of chemicals.
to 2700 B.C
 Drugs are chemical that are introduced into
C. Egyptians - archives of remedies on a document
the body to cause some sort of change.
known as Erb’s Papyrus in 1500 B.C
 Nurses deals with pharmacotherapeutics, or
D. Pharmacologia sen Manuductio and Materia
clinical pharmacology.
Medicum - first recorded reference to the word
 Some drugs effects are therapeutic or helpful
pharmacology
but others are undesirable or potentially
E. Early 1800s - chemists isolates specific
dangerous.
substances from complex mixtures
pharmacologists then study their effects in animals.
BRANCH OF PHARMACOLOGY
F. Fredrich Serturner - first isolated morphine from
opium, injected himself and three other friends with
PHARMACODYNAMICS
huge doses (100 mg)
 Deals with the biochemical and physiological
effects of drugs.
DRUG
 How the drug affects the body.
- are chemicals that alter physiochemical
processes in body cells. Used interchangeably with
PHARMACOKINETICS
medicines.
 Absorption, distribution, biotransformation and
excretion of drugs.
NURSE RESPONSIBILITY
 How the body acts on the drug.
 Administering drug
 Assesses for adverse drug effects
PHARMACOTHERAPEUTICS
 Intervening to make the drug regimen more
 How drugs maybe used in the treatment of
tolerable
disease.
 Providing patient teachings about drugs and
 Which drug would be most or least appropriate
/the drug regimen
to use for a specific disorder.
 Monitoring and prevention of medication errors.
 What dose of drug would be required.
SOURCES OF DRUG INFORMATION
PHARMACOGNOSY
 Study of drugs derived for natural sources.
 Drug Label
- drug labels have specific information that
TOXICOLOGY
identifies a specific drug.
 Study of poisons and poisonings.
- understanding how to read a drug label is
essential.
PHARMACOVOGILANCE
 Package Insert
 Monitoring the effects of medical drugs after
- prepared by the manufacturer
they have been licensed for use especially in
- contains all of the chemical and study information
order to identify and evaluates previously
that led to the drug’s approval
unreported adverse reactions.
- difficult to understand and read

DRUG NAMES
 Generic or Nonproprietary Name:
PHARMACY
- Name approved by the MEDICAL or
 Art of preparing, compounding and dispensing
Pharmaceutical Associations in the original country
drugs. It also refers to the place where drugs
of manufacture and is adopted by all countries.
are prepared and dispensed.
E.g: Paracetamol
PHARMACIST
 Brand Name or Trade Name:
 A person licensed to prepare and dispense
- Name given by the manufacturer of the drug.
drugs to make up prescriptions.
E.g: Adol or Panadol or Biogesic

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
 Chemical Name:
- Name that describes the atomic or chemical  Phase IV Studies
structure. - continual evaluation of the drug
Eg: Para-acetylaminophenol
PHASES OF DRUG EVALUATION
SOURCES OF DRUGS 1. Pre-clinical Trials
 Determine whether they have presumed
A. Natural Sources effects in living tissues
1. Plants  To evaluate any adverse effect
 Synthetic versions of the active chemical found  At the end will be discarded because:
in a plant - chemical lacks therapeutic activity when used
 Main components of the growing alternative with living animals
therapy movement - too toxic to living animals yo be worth the risk of
developing into drug
E.g: Digitalis purpurea = digitalis / Poppy plant = - highly teratogenic
opiates, morphine and codeine. - safety margins are so small that chemical would
not be useful in the clinical setting.
2. Animal Products
 Used to replace human chemical that are not
produced because of disease or genetic LEGISLATION
problems. Table 1.5 Federal Legislation Affecting the
 Genetic engineering Clinical Use of Drugs
 Many of these preparations are now created
synthetically
e.g: cow & pig pancreas tissue = insulin

3. Inorganic compounds
 Salts of various elements can have therapeutic
effects in the human body
 E.g: aluminum fluoride, iron , gold

B. Synthetic Sources
 Genetic engineering alter bacteria to produce
chemicals that are therapeutic and effective
 Original prototypes
 E.g: escherichia coli.

ORPHAN DRUG
- Are chemicals that are discarded Phase I
- Will not participate in the next phase
Criteria:
- Lack therapeutic activity in humans
- Too toxic
- Produce unacceptable side effects
- Teratogenic

DRUG EVALUATION
 Pre-clinical Trials
- chemicals tested on laboratory animals
 Phase I studies
- chemicals tested on human volunteers
 Phase II Studies
- drug tried on informed patients

 Phase III Studies

- drug used in vast clinical market

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
PREGNANCY CATEGORIES DRUG ENFORCEMET AGENCY SCHEDULES
The FDA has established five categories to indicate OF CONTROLLD SUBSTANCES
the potential for a systemically absorbed drug to
cause birth defects.

 Category A: studies in pregnant women have

no demonstrated a risk to the fetus in the first
trimester of pregnancy and there is no
evidence of risk in later trimester.
 Category B: animal studies have not
demonstrated a risk to the fetus but there are
no adequate studies in pregnant women or
animal studies have shown an adverse effect,
but adequate studies in pregnant women have
not demonstrated a risk to the fetus during the
first trimester of pregnancy and there I no
evidence of risk in later trimesters.
 Category C: animal studies have shown an
adverse effect on the fetus but there are no
adequate studies in humans; the benefits from
the use of the drug in pregnant women may be
acceptable despite its potential risks or there
are no animal reproduction studies and no
adequate studies in humans.
 Category D: There is evidence of human fetal
risk, but the potential benefits from the use of
the drug in pregnant women may be
acceptable despite its potential risks.
 Category X: Studies in animals or humans
demonstrate fetal abnormalities or adverse
reaction; reports indicate evidence of fetal risk.
The risk of use in a pregnant woman clearly
outweighs any possible benefit. GENERIC DRUGS
 Chemicals that produced by companies
Regardless of the designated Pregnancy involved solely in the manufacturing of drugs.
Category or presumed safety, no drug should  Bioavailability of the drug
be administered during pregnancy unless it is  “dispensed as written” - important in drugs that
clearly needed. have narrow safety margins.

CONTROLLED SUBSTANCES OVER-THE-COUNTER DRUGS

 Act of 1970
- Control over the coding of drugs and the  Products that are available without prescription
enforcement of these codes to the FDA and the for self-treatment of a variety of complaints.
Drug Enforcement Agency (DEA), a part of the U.S - Some of these agents were approved as
Department of Justice. prescription drugs.
 Prescription, Distribution, storage, and use of - Later were found to be very safe and useful for
these drugs are closely monitored. patients e.g: loratidine
 Local policies and procedures might be even - Many of these drugs were “grandfathered”
more rigorous.
 Nurses should consider several problems
related to OTC drug use:
- Taking these drugs could mask the signs and
symptoms of underlying disease, making diagnosis
difficult.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
✓ Correct identification of the patient:
- Taking these drugs with prescription with ✓ ID band or ID bracelet (BEST: Kozier)
medications could result in drug interaction and ✓ Ask the patient’s name
interfere with drug therapy. ✓ Avoid: calling the client in NAME
- Not taking these drugs as directed could result in ✓ May answer “YES” to the wrong name
serious overdoses.
OBSERVE THE TEN RIGHTS
DOSAGE FORMS OF DRUG ✓ Right Client - by checking the client
Solid Forms identification bracelet by having the client state her
1. TABLET: or his name.
a. Scored ✓ Right Medication - means that the client
b. Layered receives the drug that was prescribed, check at
c. Enteric-coated least three times prior to administration.
d. Chewable ✓ Right Dose -
e. Sustained released ✓ Right Time - which the prescribed dose should
be administered.
2. Capsule ✓ Right Route - necessary for adequate or
a. Soft gel appropriate absorption.
b. Hard gel ✓ Right Client Education - requires that the client
received accurate and through information about
3. Lozenges the medication and how it relates to his or her
4. Suppository situation.
✓ Right Documentation - requires that the nurses
A. Liquid Forms immediately record the appropriate information
1. Syrup about drug administered.
2. Suspension ✓ Right to Refuse - client can and do refuse to
3. Elixir take medication.
4. Emulsion ✓ Right Assessment - requires the appropriate
5. Inhalants date be collected before administration of drugs
✓ Right Evaluation - requires that the
B. Topical Forms effectiveness of the medication be determined by
1. Cream the client response to medication.
2. Ointment
3. Lotion ORAL MEDICATION
4. Patch
5. Gels Most common route
 CONTRAINDICATIONS:
 Client is vomiting
PRINCIPLES OF DRUG ADMINISTRATION  Client with intestinal or gastric suction
 Uncoscious client
 MEDICATIONS  Inability to swallow
- Are substances administered for the diagnosis,  TABLET OR CAPSULE:
cure, treatment, or relief of symptoms or prevention  (+) Difficulty in swallowing
of disease.  Crush and mix with small amount of water.
 Liquid medications
PRACTICE GUIDELINES  Mic before pouring.
✓ RNs are responsible for own actions, illegible
order should be questioned or clarified PARENTERAL MEDICATION
✓ RNs should be knowledgeable about the  Intradermal Site:
medication  Inner lower arm
✓ If the RN is uncertain about the calculation, ask  Upper chest
another nurse to double check  Anterior chest
✓What you prepare, you administer  Upper back beneath the scapula
✓ Do not leave medications at bedside  Angle: almost parallel to the skin 10 - 15
✓ If the client vomits, report to charge nurse, MD, degrees
or both.  Gauge: #25, #26, #27
✓When error is made, assess the patient first and  Length: 3/8 , 5/8 , 1/2
report to MD immediately.  Max CC: 0.1 to 0.2 ml

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023

 Subcutaneous Site:  Ophthalmic Medications

 Outer aspect of the upper arms ✓ Preparation:
 Anterior thighs - Clean the eyelid and lashes from inner to outer
 Abdomen canthus
 Upper back - Instruction before administration
 Ventrogluteal Look up
 Dorsogluteal - Where and How to Apply:
 Angle: LIQUID:
- 45 degrees (1 inch of tissue can be grasped) Instill correct number of drops
- 90 degrees (2 inch of tissue can be grasped) Outer third of the lower conjunctival sac
 Gauge: #25, #26, #27’ - Instruction after Instillation
 Length: 3/8 , 5/8 , 1/2 Do PUNCTAL OCCLUSION for 30 seconds
 Max cc: 1-3 ml OINTMENT:
Discard the first bead
 Intramuscular Site Squeeze 2 cm on the lower conjunctival sac
 Ventrogluteal - Instruction after Instillation
- > 1y/o and adult CLOSE but not SQUEEZE the eyelid
- No large nerve or blood vessels
- Sealed off by bone  Otic Medications
- Contains less fat than buttocks ✓ Preparation:
 Vastus lateralis ✓ Clean the pinna and the meatus of the ear canal
- site of choice for 1 y/o and younger ✓Warm the medication:
Infants with fully developed gluteal muscles In between hands
 Dorsogluteal Place in warm water
- for adults and children with well developed gluteal ✓ Straighten The Auditory Canal:
muscles. Adult: (>3 y/o): Pull the Pinna UPWARD and
 Contraindicated: children under 3 y/o BACKWARD
increased risk of striking the sciatic nerve. Child: (<3 y/o): Pull the Pinna DOWNWARD and
BACKWARD
✓ INSTILL THE MEDICATION:
 Deltoid Along the side of the canal
- Small muscle, very close to the radial nerve and ✓ ACTIONS AFTER:
artery Gently press the TRAGUS
- Rapid absorption for adults. Insert small piece of cotton fluff loosely
- Cannot administer more than 1 ml. ✓ Instruction After:
- Recommended site for Hepa B vaccine Remain in side-lying for 5 minutes
administration.

 Rectus Femoris DRUG ACTION

- Can be used for self administration  Replace or act as substitute for missing
- Disadvantage: causes discomfort chemicals.
- Gauge: 24, 23, 22, 21, 20  To increase or stimulate certain cellular
- Length: 1’, 1 1/2”, 2” activities.
- Max cc: 2-5 ml  To depress or slow cellular activities.
- Angle: 90 degrees  To interfere with the functioning of foreign cells.

 Intravenous / Intravascular A. Drug Toxicity

- Gauge: 22, 23, 22, 21, 20  Deleterious effects of a drug resulting from
- Length: 1”, 1 1/2”, 2” over dosage ingestion of external use of drug,
- Max cc: Push 10 ml / Infusion: 4L in 24 hrs. and accumulation on the blood stream
B. Drug Allergy
 Tropical Medication  Immunologic reaction to drug
- Transdermal patch C. Drug Tolerance
- Site: trunk or lower abdomen  Exists in person with unusually low physiologic
- Areas that are: hairless response to a drug
- Avoid:cuts, burns, abrasions, distal extremity

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023

CU 2: PHARMACODYNAMICS C. BIOTRANSFORMATIONS
 The liver is the single most important site for
biotransformation (metabolism)
PHARMACODYNAMICS
 Breaks down medicationns
 Is the study of effect of drugs on the body.
 Helps to prevent medication from causing
 Drugs act within the body to mimic the actions
adverse effect on the body
of the body’s own chemical messenger.
D. EXCRETION
RECEPTOR CELLS
 Removal of drugs from the body
 Receptor site reacts to certain chemicals.
 Kidneys play the most important role in
 The better the fit the more pronounced the
excretion of medication.
reaction will be.
 Half-life is the time it takes for the amount of
 Enzymes within the body are needed to
drug in the body to decrease to one-half the
breakdown the chemicals to open up the
peak level.
receptor site.
FACTORS INFLUENCING DRUGS EFFECTS
PHARMACOKINETICS
 Weight
 Onset of drug action
 Age
 Drug half-life
 Gender
 Timing of the peak effect
 Physiological factors
 Duration of drug effects
 Pathological factors
 Metabolism or biotransformation of the drug
 Genetic factors
 Site of excretion
 Immunological factors
 Psychological factors
Critical Concentration
 Environmental factors
- amount of a drug that is needed to cause a
 Drug tolerance
therapeutic effect.
 Cumulative effect
Loading Dose
DRUG TO DRUG INTERACTIONS
- a higher dose than that usually used for treatment.
 Can occur anytime two or more drugs are
taken together.
Dynamic Equilibrium
 can occur at:
- the actual concentration that a drug reaches in
- Site of absorption
the body. Affected by:
- During distribution
a. Absorption
- During biotransformation
b. Distribution
- During excretion
c. Biotransformation
- At the time of action
d. Excretion
DRUG FOOD INTERACTIONS
 Certain foods interact with drugs.
A. ABSORPTION
 Drugs are best taken on an empty stomach.
Administration
 Affected by route of administration
DRUG LABORATORY TEST INTERACTIONS
 Oral medications affected by presence of food
 Drugs may alter the results of lab testing
in the stomach.
 Laboratory test may be used to monitor the
First Pass Effect
effects of other medications.
 Medications are extensively metabolized by
the liver.
Dose-Response Relationship
 The body’s physiologic response to changes in
B. DISTRIBUTION
drug concentration at the site of action.
 Protein Binding
 Potency - refers to the amount of drug needed
 Blood Brain Barrier
to elicit a specific physiologic response to a
 Placenta/Breast Milk
drug.
 Efficacy - magnitude of effect a drug can
cause when exerting its maximal effect.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
 Maximal efficacy - the point at which Adverse Drug Effects
increasing a drugs dosage no longer increases 1. Side Effects
the desired therapeutic response.  Results from the pharmacologic effects of the
drug
Parameters if Drug Action  Most common as a result of lack of specificity
 Therapeutic Index - describe the relationship of action within the therapeutic range.
between the therapeutic dose of a drug and 2. Allergic Reactions
the toxic dose of a drug  Unpredictable adverse drug effects; more
 Therapeutic dose of a drug - is the dose of a serious
drug that produces a therapeutic response in %  Response to patient’s immunological system to
of the population. the presence of the drug.
 Toxic dose of a drug - is the dose that 3. Idiosyncratic Reaction
produces a toxic response in % of the  Occurs when the patient is first exposed to the
population. drug
 Onset - is the time it takes for a drug to reach  Abnormal reactivity to the drug caused by a
the minimum effective concentration. genetic difference between the patient and
 Peak - occurs when it reaches its highest normal individual
concentration in the blood/plasma 4. Toxicity
concentration. 30 minutes after infusion.  The degree to which a drug can be poisonous
 Duration of action - is the length of time the and thus harmful to the human body.
drug exerts a therapeutic effect. 5. Lastrogenic responses
 Unintentional responses as a result of medical
treatment
LOCK AND KEY THEORY  Nephrotoxicity; ototoxicity
 Specific chemical approaches a cell
membranes and finds kit at receptor site -
affects enzyme system within cell produce Dermatological Reaction
certain effects. Allergy Assessment Intervention
 Drug + Receptor = Effect Rash / Hives - Abnormalities - May need to
in the skin, red discontinue the
Adverse Drug Reaction area, blisters. medication.
 The drug may have other effects on the body Stomatitis - Inflammation - Frequent
besides the therapeutic effect. of the mucous mouth care
 The patient is sensitive to the drug being given membrane
 The drug actions on the body causes other
responses Drug-Induced Tissue and Organ Damage
 The patient is taking too much or too little of Assessment Intervention
the drug. Superinfections Fever Mouth and
- Destruction of Diarrhea skin care,
Types of Adverse Reactions the body’s Vaginal administer
 Primary Actions normal flora discharge antifungal
- Overdose; extension of the desired effect medications,
 Secondary Actions may need to
- Undesired effects produced in addition to stop drug
the pharmacologic effect responsible for
 Hypersensitivity Reactions the infection.
- Excessive response to primary or Blood Fever Monitor blood
secondary effect of drug. Dyscrasia Chills counts,
- Bone marrow Weakness protective
Types of Drug Allergies suppression isolation
 Anaphylactic Reaction
 Cytotoxic Reaction Poisoning
 Serum Sickness Reaction - occurs when an overdose of a drug damages
 Delayed Allergic Reaction multiple body systems.
- damage to multiple systems can lead to a fatal
reaction.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
Altered lucose Metabolism Example: Tetracycline + antacid= decreased of
Assessment Intervention tetracycline.
Hypoglycemia Low serum Restore
blood glucose glucose to the
level body CU 3: PHARMACOKINETICS
Hyperglycemia High serum Administer
glucose level medications to PHARMACOKINETICS
decrease - is the process of drug movement throughout the
glucose level body that is necessary to achieve drug action.
(insulin) Processes:
1. Liberation
Categories of Drug Action 2. Absorption
1. Stimulation/Depression 3. Distribution
 Stimulation - increased rate of cell activity / 4. Metabolism - Biotransformation
secretion From the gland T3/T4 for 5. Excretion - Elimination
hypothyroidism
 Depression - decreased cell activity and Liberation
functions of a specific organ. Iodine and  First step in the process by which medication
propylthiouracil. enters the body and liberates the active
ingredients that has been administered.
2. Replacement - replaces essential body Absorption
compounds.  Movement of the drug into the bloodstream
Example: Insulin after administration.
 Movement of drug molecules from site of
3. Inhibition / killing of Organism- Interferes with administration to circulatory system.
bacterial cell growth. FACTORS:
Example: Antibiotics 1. Drug Solubility - lipid soluble drugs pass readily
through GI membrane, water soluble drugs need
4. Irritation an enzyme or protein.
Example: Laxative= irritates the inner wall of colon, 2. Local condition at site of absorption - weak
increased peristalsis and increased defecation. acids less ionized in stomach readily pass through
the small intestine.
3. Pain/ stress/ solid foods/ fatty or hot food -
Drug-Drug Interaction slow down gastric emptying time.
1. Additive Effect - 2 drugs with similar actions are
taken for a doubled effect 1+1 = 2 Distribution
Example: Ibuprofen + paracetamol = added  Process by which drug becomes available to
analgesic effect body fluids and tissues.
Codeine with acetaminophen = better pain control  is the movement of the drug from the
circulation to body tissues.
2. Synergistic - combined effect of 2 drugs is FACTORS:
greayer than the sum of the effect of each drug 1. Size of the organ
given alone; 1 + 1 = 3 2. Blood flow
Example: 3. Solubility - lipid soluble drugs can also cross
Aspirin = 30% analgesic effect the blood-brain barrier and enter the brain.
Codeine = 30% analgesic effect
Combination = 90% analgesic effect Metabolism
 Or biotransformation is the process by which
3. Potentiation - a drug has no effect enhancces the body chemically changes drugs into a form
the effects of the second drug. 0 + 1 = 2 that can be excreted.
Example: Other sites of metabolism:
Alcohol enhances the analgesic activity of aspirin. A. Plasma
Prozac + Zestril B. Kidneys
C. Membranes of intestine
4. Antagonistic - one drug inhibits the effect of
another drug 1 + 1 = 0

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
FACTORS:
1. Genetic - some people metabolize drugs rapidly,
others more slowly
2. Physiologic
- Liver disease
- Infants: decreased rate of metabolism
- Elderlies: decreased liver size, blood flow,
enzyme production slows metabolism.
3. Environment - cigarette some may affect rate of
some drugs.
4. Stressful environment - Prolonged illness,
surgery and illness.

FIRST PASS EFFECT OR FIRST PASS

METABOLISM
 GI tract --- intestinal lumen -- liver---some
drugs aremetabolized to an inactive form and
excreted--- reducedamount of active drug.
 Liver enzymes – cytochrome P450 system –
convert drugs tometabolites.
 Decreased drug metabolism rate will result in
excess drugaccumulation that can lead to
toxicity
 Drug half-life is the time it takes for the
amount of drug in thebody to bereduced by
half.
Example:
Ibuprofen has a half life of about 2 hours.
if the patient takes 200 mg, in 2 hours, 50% of the
drug will be gone, leaving 100 mg.
after 2 hours - 50 mg.
after 2 hours – 25 mg
after 2 hours – 12.5 mg
after 2 hours – 6.25 mg
 Half-life/ Elimination half-life (t ½)- time it
takes for one half of drug concentration to be
eliminated
Short t1/2= 4-8hrs: given several times a day
(ex. Penicillin G)

Long t ½ = >12 hours: given 2x or 1x/day (Ex.

Digoxin

Excretion
 Removal of the drug from the body. Drug is
changed into inactive form and excreted by the
body.
 Routes:
- Kidney: main organ for drug
- Elimination: leave the body through urine.
- Free or unbound water soluble drugs - filtered in
the kidney
- (+) kidney disease: dose must be decreased.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
CU 4: NURSING PROCESS IN COMPREHENSIVE COLLECTION DATA, INCLUDING:
PHARMACOLOGY a. HISTORY
The patient’s past experiences and illnesses can
THE NURSING PROCESS influence a drug’s effect. This will help to promote safe
 Utilizing steps of nursing process ensures that and effective use of the drug and prevent adverse effects
theinterdisciplinary practice of pharmacology results errors.
in safe, effective, and individualize
medicationadministration and outcomes for patients. b. CHRONIC CONDITIONS
 Although not all nursing theorists completely agree Chronic conditions can affect the pharmacokinetics
onthis process that defines the practice of nursing, and pharmacodynamics of a drug. Certain conditions
most do include certain key elements: (e.g., renal disease, heart disease, diabetes, chronic lung
- assessment disease) may be contraindications to the use of a drug.
- nursing diagnosis
- implementation c. DRUG USE
- evaluation. Patients may forget to tell their healthcare providers
 Application of the nursing process with drug therapy about non-prescription drugs, alternative therapies, and
ensures that thepatient receives the best, safest, other substances they use because they may not see
most efficient,scientifically based, holistic care. them as "real" drugs or may be embarrassed to admit
using them, but these substances can still affect how their
prescribed medications work.

d. ALLERGIES
A person's previous allergies can impact their
treatment because they might react to a drug, food, or
animal product they were exposed to before, so doctors
need to be careful when prescribing such things.

e. LEVEL OF EDUCATION AND UNDERSTANDING

Assessing how much a patient knows about their
condition or treatment helps the nurse figure out what
information the patient needs and how well they can learn
it, considering factors like stress and their environment.
1. ASSESSMENT
- The initial step in the nursing process, involving the f. SOCIAL SUPPORT
organized gathering of patient data that covers Patients are now leaving hospitals and clinics sooner
physical, intellectual, emotional, social, and than before, but they still require assistance at home for
environmental aspects for comprehensive care. ongoing care and medication management.
- This data helps identify current and potential health
issues and serves as a foundation for the subsequent g. FINANCIAL SUPPORTS
steps. Financial difficulties can prevent a patient from taking
- Key methods for data collection include patient their prescribed medication because the drug might be
interviews, medical histories, physical examinations, too costly or they might not have a way to get it from the
observations, and lab tests. pharmacy. Sometimes, a cheaper alternative could work
- Assessment focuses on the patient's medical history just as well.
and their current physical condition.
h. PATTERN OF HEALTH CARE
THREE REASONS FOR OBTAINING Understanding how a patient typically seeks
A DRUG HISTORY healthcare helps nurses create effective teaching plans
 To evaluate need for medication and can reveal undisclosed medical conditions or
 To obtain current and past use of over-the-counter medications.
medication
 To identify problems related to drug therapy i. PHYSICAL EXAMINATION
This statement means assessing whether there are
RELIES ON THREE SOURCES any health conditions or concerns that would make it risky
 Primary source: produced by patient or questionable to use a specific drug and establishing a
 Secondary sources: relatives, significant others, starting point for measuring how well the drug works and
medical records, lab reports if it causes any negative side effects.
 Tertiary sources: literature to provide background
information, diagnostic tests, diet j. WEIGHT
A patient’s weight helps to determine whether the
recommended drug dose is appropriate.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
k. AGE NURSING ACTIONS ARE SUGGESTED
The child’s developmental age will influence Dependent actions: performed by a nurse based on
pharmacokinetics and pharmacodynamics; A child's age health care provider’s orders
affects how their body processes and responds to Interdependent actions: implemented with
medicines, as their liver and kidneys might not work the thecooperation of a team
same as an adult's, and as people get older, their bodies Independent actions: provided by nurse by virtue
change, which can also impact how drugs work. ofeducation and license

2. NURSING DIAGNOSIS Three types of nursing interventions are frequently

The nurse reviews the information in the database to involved in drug therapy:
identify real or possible health issues, which can cover a. drug administration
physical, mental, or social aspects, and then expresses b. provision of comfort measures
these issues as nursing diagnoses, defining them as c. patient/family education
problems that nurses are trained and authorized to
address. a. PROPER DRUG ADMINISTRATION
A complete nursing diagnosis consists of two statements: The nurse must consider seven points, or “rights,” to
(1) a statement of the patient's actual or potential health ensure safe and effective drug administration.
problem, followed by 1. Right drug and patient,
(2) a statement of the problem's probable cause or risk 2. Right storage of drug,
factors. 3. Right and most effective route,
4. Right dose,
5. Right preparation,
FIVE TYPES OF NURSNG DIAGNOSIS 6. Right timing, and
 Actual: based on human responses and supported 7. Right recording of administration.
by defining characteristics
 Risk/high-risk: patient may be more susceptible to Remembering to review each point before administering
a particular problem a drug will help to prevent medication errors and improve
 Possible: suspected problems requiring additional patient outcomes.
data
 Wellness: clinical judgment about a transition from b. COMFORT MEASURES
one level to a higher level Patients are more likely to follow their medication
 Syndrome: cluster signs and symptoms to predict schedule if the treatment doesn't cause too much
certain circumstances or events discomfort or difficulty.
3. PLANNING c. PLACEBO EFFECT
In the planning step, nurses create a personalized The anticipation that a drug will be helpful (placebo
care plan for each patient by setting goals, priorities, and effect) has proved to have a tremendous impact on the
interventions, which can involve other healthcare actual success of drug therapy. For example, a back rub,
providers, and they continuously adjust it as they gather a kind word, and a positive approach may be as
new information. beneficial as the drug itself.
FOUR PHASES OF A NURSING CARE PLAN d. MANAGING ADVERSE EFFECTS
a. SETTING PRIORITIES Such interventions include environmental control (e.g.,
 Identify problems and prioritize which ones are more temperature, light), safety measures (e.g., avoiding
important and must be attended to first, depending driving, avoiding the sun, using side rails), and physical
on patient needs comfort measures (e.g., skin care, laxatives, frequent
b. DEVELOPING MEASURABLE GOAL/OUTCOME meals).
STATEMENTS
 Write short- and long-term goals for the patient to be e. LIFESTYLE ADJUSTMENT
followed when providing care Certain medications require patients to adjust their
c. FORMULATING NURSING INTERVENTIONS AND daily routines, like being near a bathroom when taking
d. FORMULATING ANTICIPATED THERAPEUTIC diuretics or taking bisphosphonates on an empty
OUTCOMES stomach and staying upright for a while before eating.
 Plan which intervention to use based on anticipated
patient behavior f. PATIENT AND FAMILY EDUCATION
Patients are now expected to have all the information
4. IMPLEMENTATION they need to safely and effectively manage their
This process in nursing involves using gathered medications at home, including written instructions, as
information to create care plans, set goals, and ensure some states mandate.
safe and effective use of medications for patients by
considering their response, minimizing side effects, and 5. EVALUATION
understanding the drug regimen. Evaluation in patient care involves regularly checking
how a patient is responding to treatment, monitoring for

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
any negative effects or interactions with medications, and CU 5: DRUGS AFFECTING THE BODY
making necessary adjustments to improve their care as
needed. SYSTEM AND NURSING
CONSIDERATIONS: ANS
DRUG CALCULATION:
 CLARK’S RULE INTRODUCTION
Child’s Dose = Adult Dose x Weight in Pounds Drugs that affect the nervous system can change how
150 it works, and to understand how they do this, it's
 YOUNG’S RULE important to know that the nervous system is made up of
Child’s Dose = Adult Dose x Age in Years the Central Nervous System and Autonomic System.
 The main job of nerve cells (neurons) is to send
Age in Years + 12
messages, which they do through a combination
of electrical signals called action potentials and
 FRIED’S RULE
chemical messengers called neurotransmitters.
Child’s Dose = Adult Dose x Age in Months
150 CENTRAL NERVOUS SYSTEM
Desired Dose Brain & Spinal Cord – very important structure of the
Dose = x Quantity CNS is its protective mechanisms that not all chemicals
Stock can pass through it, this affects the pharmacodynamics of
 CALCULATING INTRAVENOUS FLUID RATE drugs because some of them cannot penetrate the CNS.
Amount to be Infused Drop Factor
Rate = x One vital protective structure is the Blood Brain Barrier
Hour of Infusion 60 minutes / Hour (BBB). This represents therapeutic challenge to drug
treatment of brain related disorders because a large
TERMINOLOGIES percentage of drugs are carried bound to plasma proteins
ASSESSMENT: information gathering regarding the and are unable to cross the brain.
current status of a particular patient, including
evaluation of past history and physical examination; PERIPHERAL NERVOUS SYSTEM
provides a baseline of information and clues to Autonomic Nervous System & Somatic Nervous
effectiveness of therapy. System
 Synapses made by the peripheral nervous system
EVALUATION: part of the nursing process; determining conduct impulses that are chemical in nature. These
the effects of the interventions that were neurotransmitters have specific receptors in the neural
instituted for the patient and leading to further membrane to facilitate conduction of nerve impulses.
assessment and intervention. Drugs may act in the nervous system to either stimulate
or block the receptors to correct alterations in the
IMPLEMENTATION: actions undertaken to meet a nervous functions.
patient’s needs, such as administration of drugs, AUTONOMIC NERVOUS SYSTEM
comfort measures, or patient teaching. The division of the peripheral nervous system that supply
NURSING: the art of nurturing and administering to the involuntary muscles, glands and other effectors not
sick, combined with the scientific application of innervated by the somatic nervous system. Autonomic
chemistry, anatomy, physiology, biology, nutrition, nervous system is responsible for all involuntary actions
psychology, and pharmacology to the particular clinical of the body that the person is not aware of.
situation.
This is divided into two divisions:
NURSING DIAGNOSIS: statement of an actual or a. Parasympathetic Nervous System
potential problem, based on the assessment of a b. Sympathetic Nervous System
particular clinical situation, which directs needed nursing
interventions. PARASYMPATHETIC NERVOUS SYSTEM
Parasympathetic nervous system (PNS) comes from the
NURSING PROCESS: the problem-solving process used cranio
to provide efficient nursing care; it involves  sacral outflow of the peripheral nervous system.
gathering information, formulating a nursing diagnosis  Cranial nerve X, IX, VII, III participate in the cranial
statement, carrying out interventions, and flow. Majority of the PNS comes from cranial nerve X
evaluating the process. ( Vagus nerve ).
 the only cranial nerves that extend up to the thorax
and abdomen to supply majority of parasympathetic
innervation, so a vagal stimulation is synonymous
with parasympathetic innervation.

There are 2 types of cholinergic receptors:

1. Nicotinic Receptors
2. Muscarinic receptors
By: Torres & Belmonte
 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
such drug may also be referred to as parasympatholytic
SYMPATHETIC NERVOUS SYSTEM drug
 The division of the autonomic nervous system, If a drug stimulates receptors for SNS, it is called
Sympathetic nervous system (SNS) from the adrenergic agonist, increasing SNS effect so such drug
thoraco- lumbar outflow, spinal nerves from this is also referred to as sympathomimetic drugs. A drug
region send nerve fibers to the sympathetic ganglia that blocks the adrenergic receptors decreases SNS
located near the CNS, then post ganglionic neurons responses called adrenergic agonist or it is also called
send innervation to the involuntary muscles and sympatholytic drugs.
glands and other effectors mostly associated with Remember, knowing the responses of the PNS and
involuntary process in the body. SNS is very important to understand actions of
 The preganglionic neuron of the SNS is shorter than autonomic drugs, because these drugs would only
PNS and the post ganglionic neuron is longer than stimulate or block the receptors.
PNS. SNS is responsible for “FIGHT OR FLIGHT”
involuntary responses of the body. Impulses ● CHOLINERGIC DRUGS – majority of these drugs
transmitted across the synapses also are mediated affect the PNS.
by the neurotransmitters. o DIRECT ACTING CHOLINERGIC AGONIST
 Acetylcholine is released by the preganglionic directly stimulates the cholinergic receptors to increase
neurons, while epinephrine and norepinephrine are its effects
the neurotransmitters released by the post ganglionic ▪ Pharmacokinetics: well absorbed with relatively short
neurons, except for those post ganglionic neurons half – life. Metabolism and excretion may occur at the
innervating adrenal medulla, pilo erector muscles, synaptic level but exact mechanism is unknown
sweat glands and some smooth muscles of the blood ▪ Contraindications and Cautions: These drugs
vessels. Their receptors are called Adrenergic enhance parasympathetic effect so must not be given to
Receptors. patients with hypotension, bradycardia or heart block,
intestinal obstruction and urinary retention.
There are 2 types of adrenergic receptors: ▪ Adverse effects: These are related to increase
1. Alpha receptors parasympathetic responses such as bradycardia,
2. Beta receptors diarrhea, urinary incontinence. Increase sweating may
happen because of the acetylcholine present
Drugs affecting the Autonomic Nervous System are in the sweat glands.
called Autonomic Drugs ▪ Drug – Drug interaction: Effects of these drugs maybe
increase if combined with anticholinesterase drugs or the
CLASSIFICATION OF AUTONOMIC DRUGS indirect acting cholinergic agonists.
 Drugs affecting the PNS are called Cholinergic ▪ Examples
Drugs 1. Bethanecol – indicated for non – obstructive urinary
 Drugs affecting the SNS are called Adrenergic retention like
Drugs in neurogenic bladder
2. Carbachol – indicated for glaucoma, causing pupillary
In the study of pharmacodynamics, one action of the constriction
drugs is its binding with the receptors that may stimulate 3. Pilocarpine – indicated for glaucoma, causing
the receptors (drugs are called agonist) and drugs that pupillary constriction
may block the receptors (drugs are called antagonists). If
a student is aware of the responses of the PNS and SNS, o INDIRECT ACTING CHOLINERGIC AGONIST
it would be easier to remember drug actions, they would – this drug increases acetylcholine effect by inhibiting
either stimulate the receptors and produce the same the action of acetylcholinesterase (an enzyme that
effect or block the receptors or inhibit the effects. removes acetylcholine in the synapse.
- If acetylcholinesterase is not removed in the synaptic
Most of the effectors are innervated by both sympathetic cleft, more acetylcholine stays in the synapse stimulating
and parasympathetic and in such case the response of more receptors, thus enhancing their effects. These
the body is opposite. See examples below: drugs are used for treatment of Myasthenia gravis and
Alzheimer’s disease.
EFFECTORS SNS PNS
Heart Increase HR Decrease HR  MYASTHENIA GRAVIS is an autoimmune disease
Lungs Bronchodilate Bronchoconstrict of the neuromuscular junction (NMJ). This is
Blood Vessels Vasoconstrict Vasodilate characterized by destruction of cholinergic receptors
at the NMJ that will slow down impulses going to the
Therefore, if a drug stimulates the receptors for PNS, it is skeletal muscles.
called cholinergic agonist, enhancing PNS effect so - This disease is characterized by the development
such drug is also referred to as parasympathomimetic of muscle weakness and paralysis.
drug. A drug that blocks the cholinergic receptors is - To increase junctional transmission, indirect acting
called cholinergic antagonist, also called cholinergic agonist inhibits acetylcholinesterase
anticholinergic drugs, inhibiting PNS response and making more acetylcholine present in the junction to
improve impulse transmission and muscle function.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
These drugs are also called anticholinesterase o Provide emotional support and encouragement to help
drugs. the patient cope with drug regimen

Anticholinesterase drugs for Myasthenia gravis  CHOLINERGIC ANTAGONIST also being referred
include: to as anticholinergic drug or parasympatholytic. The
 Edrophonium HCL (Tensilon) – short acting drugs act to block the cholinergic receptors in the
anticholinesterase drug used to diagnose the PNS. The drugs may also block some cholinergic
disease. The action lasts for 10 to 20 minutes. receptors present in the SNS.
 Neostigmine, Physostigmine, Pyridostigmine –
long acting anticholinesterase drugs used for ▪ Pharmacokinetics: The drugs are well absorbed and
therapeutic purposes. The onset of action starts 20 distributed. Drugs pass the BBB, placenta and breastmilk.
to 30 minutes and may last for 3 – 6 hours. The drugs are excreted in the urine.
▪ Contraindications and Cautions: The drugs are not
 ALZHEIMER’S DISEASEis a degenerative disease given to patients with known allergy to the drugs. Should
of the CNS characterized by loss of neurons in the not be used in clients with cardiovascular,gastrointestinal
CNS which may slow down impulse transmission or genitourinary conditions because
across the synapses of the CNS. One important they may exacerbate anticholinergic effect add worsen
cause of this is explained by loss of acetylcholine the conditions. Contraindicated in client with glaucoma as
receptors in the post synaptic neurons, like the drug may cause pupillary dilation and further increase
myasthenia gravis, less receptors mean lesser intraocular pressure. Caution is used to patients with
impulse transmission. So anticholinesterase drugs hepatic or urinary impairment.
that inhibit acetylcholinesterase enzyme will ▪ Adverse effects: These are associated with
increase acetylcholine effect and promote impulse anticholinergic effects of drugs such as drying o themouth,
transmission in the CNS. Can drugs for myasthenia constipation, urinary retention, tachycardia, mydriasis.
gravis be used to patients with Alzheimer’s disease? Drowsiness, confusion and insomnia are allrelated to the
The answer is no simply because those drugs CNS effects of anticholinergic drugs
cannot pass the BBB. Therefore, Alzheimer’s ▪ Examples:
disease will have its own anticholinesterase drugs. Atropine – indicated to decrease secretions, treat
bradycardia, pylorospams, ureteral colic, cause pupil
Acetylcholinesterase drugs used for Alzheimer’s disease dilation (mydriasis) indicated as preop drug for
are called Anti Alzheimer’s drugs which include: cataractextraction. Use as antidote for cholinergic crisis
 Rivastigmine Dicyclomine – use for hyperactive bowel in adults
 Donepezil Scopolamine – use in motion sickness, indicated to
 Tacrine decrease secretion, pupil dilation

● Pharmacokinetics: These drugs are well absorbed  ADRENERGIC DRUGS these drugs act to either
and distributed in the body. Drugs for myasthenia do not stimulate or block the adrenergic receptors in the
pass the BBB. The drugs are metabolized in the liver and SNS
excreted in the urine. o Adrenergic agonist – stimulate the receptors to
● Contraindications and Cautions: The drugs are not increase sympathetic effect and is also referred to as
given to those with known allergy to the drugs. The drugs sympathomimetic drugs
may exacerbate bradycardia, diarrhea and urinary o Adrenergic antagonist – block the receptors to
incontinence decrease sympathetic effect and is also referred to as
● Adverse effects: Exacerbation of parasympathetic sympatholytic drugs
effects may be seen in the patient such as bradycardia,
hypotension and incontinence Adrenergic receptors have 2 types and subtypes.
Classification is based on their actual locations in the
● NURSING CONSIDERATIONS body. Below are some adrenergic receptor sites and their
o Properly administer eye medication specific locations in the body
o Slow IV administration to avoid severe cholinergic
effectso Cholinergic agonist oral preparation must TYPES OF THE ADRENERGIC RECEPTORS
betaken with an empty stomach to decrease nausea and 1. Alpha receptors
vomiting a. Alpha 1 receptors
o Closely monitor vital signs and exacerbation of b. Alpha 2 receptors
parasympathetic effects 2. Beta receptor
o Provide safety measures a. Beta 1 receptors
o Monitor patients with Alzeimer’s disease forprogression b. Beta 2 receptors
of the disease. Drugs will not cure thedisease
o Monitor patients with Myasthenia gravis for underside
or overdose of medication
o Provide health teaching on the name of drugs, itsaction
and adverse effects to promote client’s understanding
and compliance

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023

RECEPTORS LOCATION
Alpha 1 receptors when stimulated will
Alpha 1 receptors Vascular smooth muscles, iris,
causevasoconstriction, pupillary dilation and closure of
visceral smooth muscles like the
urinary bladder sphincter causing urinary retention. When
urinary bladder and iris
the receptors are block? What would be the
Alpha 2 receptors CNS neurons, pancreatic islets
expectedeffects?
Alpha 2 receptors in the CNS neurons when Beta 1 receptors Myocardium, Kidneys,
stimulatedwill decrease norepinephrine flow from the CNSneurons
CNS to the SNS therefore decreasing sympathetic Beta 2 receptors Visceral smooth muscles like in
response. Take note that this is the drug that stimulate the lungs, some vascular smooth
adrenergic receptors but decreasing SNS effect because muscles, CNS neurons
thereceptors being stimulated are located in the CNS. vasoconstriction to lessen congestion in the nose
Beta 1 receptors in the heart when stimulated will therefore called decongestants.
increase heart rate. When we use a drug that o Alpha 2 adrenergic agonist – Clonidine better known
blocks the receptor, what is the effect? for its brand name as Catapres acting on the CNS
Beta 2 receptorsare located in the lungs, if we use a neurons to decrease norepinephrine flow. This drug is
drug that stimulates receptors, the effect indicated for treatment of hypertension.
isbronchodilation, what is the effect if we block
thereceptor? 3. Beta specific adrenergic agonist – these drugs
specifically stimulate the beta receptors and not the
● Classifications of Adrenergic Agonist alpha receptors.
1. Alpha and Beta adrenergic
drugs( Sympathomimetic drugs ) – these ● Pharmacokinetics: well absorbed and distributed in
drugsstimulate all adrenergic receptors to enhance the body, metabolized in the liver and excreted in the
their effects. urine. The drugs pass the placenta and breastmilk, use in
● Pharmacokinetics: these drugs are rapidly absorbed, pregnancy and lactation only if benefits outweigh the
metabolized in the liver and excreted in the urine. These risks
drugs may cross the placenta and breastmilk ● Contraindications and Cautions: The drugs are
● Contraindications and Cautions: Should not be contraindicated in clients with allergy to the drugs.
given in client with allergy to these drugs and to patients Caution is used in clients with cardiovascular disease like
with pheochromocytoma as the drugs may exacerbate hypertension and tachycardia.
the signs and symptoms ● Adverse effects: These are related to the primary
● Adverse effects: These are all related to increase SNS effects of drugs which will increase sympathetic effects
response like tachycardia, hypertension, constipation, like hypertension and tachycardia.
urinary retention, pupillary dilation ● Examples
● Examples o Isoproterenol – for treatment of cardiogenic shock and
o Epinephrine – the drug of choice during CPR, heartblock in transplanted heart.
indicated for treatment of shock o Salbutamol – for treatment of obstructive respiratory
o Dobutamine – used for treatment of congestive heart disease like COPD and bronchial asthma
failure
o Dopamine – usually given for congestive heart failure ● Nursing Considerations
and cardiogenic shock o Avoid sudden withdrawal of the drug because it may
o Norepinephrine – like epinephrine, may be indicated cause rebound hypertension, arrhythmias and flushing
for cardiac arrest o Monitor vital signs especially blood pressure and heart
rate
2. Alpha specific adrenergic agonist – these drugs o Avoid comfort measures including rest
specifically stimulate only the alpha receptors and andenvironmental control to decrease CNS irritation.
not the beta receptors o Provide adequate health teaching on the name of drug,
● Pharmacokinetics: these drugs are well absorbed and prescribed dosage, effects and adverse effects to
distributed, reach peak levels in 20 to 45 minutes. These increase patient’s knowledge and
drugs are metabolized in the liver and excreted in the subsequentcompliance.
urine
● Contraindications and Cautions: these drugs are not ● Classifications of Adrenergic Antagonist Drugs
indicated to clients with allergy to the drugs, those with (Sympatholytic drugs)
hypertension and close angle glaucoma. Caution is used 1. Alpha and Beta adrenergic antagonist – these
in clients with cardiovascular disease. drugs block all adrenergic receptors
● Adverse effects: these are related to the overdose of ● Pharmacokinetics: these drugs are well absorbed and
drugs that may increase sympathetic effects like distributed in the body, metabolized in the liver and
hypertension, gastrointestinal depression excreted in the urine and the feces.
andgenitourinary effects like urinary retention ● Contraindications and Cautions: These drugs
● Examples should not be given to clients with allergy to the drugs. To
o Alpha 1 adrenergic agonist – Phenylephrine used for those with hypotension and bradycardia. Caution is used
treatment of common colds and allergy. This drug causes in clients with cardiovascular disease andobstructive lung
disorders
By: Torres & Belmonte
 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
● Adverse effects: these mainly on the effects of the some beta blockers. These drugs are known teratogenic
drugs in the lungs like bronchospasm, blood in animals as it passes the placenta and breast milk
vesselscausing vasodilation and hypotension. ● Contraindications and Cautions: Contraindicated in
● Examples clients with allergy to the drugs. Caution should be usedin
o Carvedilol clients with bradycardia and heart block as well on
o Labetalol patients with obstructive lung diseases like COPD
▪ Both examples maybe indicated to clients with severe andbronchial asthma
hypertension caused by pheochromocytoma ● Adverse effects: these are related to the bradycardia
and bronchoconstriction effect of the
2. Alpha adrenergic antagonist – these drugs block drug.Gastrointestinal effects like nausea and
only the alpha receptors, specific drugs act on the alpha 1 vomiting,genitourinary symptoms may be disturbing to
and alpha 2 receptors. clients as well.
● Pharmacokinetics: these drugs are well absorbed and ● Examples
distributed, metabolized in the liver and excreted in the ● Beta adrenergic antagonists or Beta blockers
urine. o Propranolol
● Contraindications and Cautions: The drugs should o Pindolol
not be given to clients with hypotension and urinary ● Beta 1 specific adrenergic antagonists or Beta 1
incontinence blockers
● Adverse effects: related to the primary action of the o Metoprolol
drug causing vasodilation and hypotension o Atenolol
● Examples
o Phentolamine – more specific drug hypertension in ● Nursing considerations
pheochromocytoma, that will have less adverse effects o Avoid sudden withdrawal of the drug because it may
cause rebound hypertension, arrhythmias and flushing
o Monitor vital signs especially blood pressure and heart
3. Alpha 1 selective adrenergic antagonist – these rate
drugs block only the alpha receptors, specific drugs acton
the alpha receptors on the blood vessels and urinary
bladder to case vasodilation for treatment ofhypertension
and bladder emptying for treatment ofurinary retention. o Monitor ECG
Although some drugs may act in both blood vessels and o Avoid comfort measures including rest and
urinary bladder at the same time environmental control to decrease
● Pharmacokinetics: drugs are absorbed in the GIT, CNS irritation.
metabolized in the liver and excreted in the urine. o Provide adequate health teaching on the name of drug,
● Contraindications and Cautions: Contraindicated in prescribed dosage, effects and adverse effects to
clients with allergy to the drugs. This may exacerbate increase patient’s knowledge and subsequent
hypotension and urinary incontinence. Caution is used to compliance.
clients with cardiovascular disease, gastrointestinal
andgenitourinary conditions
● Adverse effects: related to the sympatholytic effect of
drugs causing hypotension and urinary incontinence. TERMINOLOGIES
● Examples Neurotransmitters
o Prazosin – indicated for treatment of hypertension = chemicals in the body acting as messengers
o Terazosin – indicated for treatment of Sympathetic Nervous System
hypertension and BPH causing urinary retention = a branch of peripheral nervous system involved in
o Doxazosin – indicated for treatment of preparing the body for stress-related activities
hypertension and BPH causing urinary retention = “ fight or flight “
o Alfuzosin indicated for treatment of BPH Parasympathetic Nervous System
o Tamsulosin – indicated for treatment of BPH = associated with returning the body to routine,day-to-day
operations
4. Beta adrenergic antagonists – these drugs block = “ rest and digest “
both beta 1 and beta 2 receptors, particularly affecting Adrenergic
both the heart and the lungs, these drugs increase heart = means “working on adrenaline (epinephrine) or
rate and bronchoconstriction of the lungs noradrenaline (norepinephrine) (or on their receptors)
5. Beta 1 specific adrenergic antagonist–these drugs Cholinergics
block specifically beta 1 receptors in the heart. = means “working on acetylcholine or on their receptors
Thesedrugs are most commonly known as beta
blockers.These drugs are indicated to clients with ADRENERGIC AGONISTS
hypertension,dysrhythmias, angina and use to support Adrenergic agonists, also called sympathomimetics,
cardiac functionin clients with congestive heart failure are drugs that mimic the effects of the SNS and are used
● Pharmacokinetics: these drugs are absorbed in the to stimulate the adrenergic receptors within the SNS. The
gastrointestinal tract and undergo hepatic metabolism. adverse effects associated with these drugs are usually
The presence of food may increase the bioavailability of also a result of sympathetic stimulation.

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 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
parasympathetic nerves, some nerves in the brain,
●Adrenergic agonists include; and the neuromuscular junction.
oalpha- and beta-adrenergic agonists  Direct-acting cholinergic drugs react with the ACh
●which stimulate both types of adrenergic receptors inthe receptor sites to cause cholinergic stimulation.
SNS  Use of direct-acting cholinergic drugs is limited by
oalpha-specific adrenergic agonists the systemic effects of the drug. One drug is used to
●stimulate only alpha receptors induce miosis and to treat glaucoma; one agent is
obeta-specific adrenergic agonists available to treat neurogenic bladder and bladder
●stimulate only beta-receptors atonypostoperatively or postpartum and another
agent is available to increase GI secretions and
▪Alpha-specific adrenergic agonists stimulate only the relieve the dry mouth of Sjogren’s syndrome.
alpha-receptors within the SNS. Clonidine specifically  All indirect-acting cholinergic drugs are
stimulates alpha2 – receptors and is used to treat acetylcholinesterase inhibitors. They block
hypertension because its action blocks the release of acetylcholinesterase to prevent it from breaking
norepinephrine from nerve axons. down ACh in the synaptic cleft.
 Cholinergic stimulation by acetylcholinesterase
▪ Many of the beta2 - adrenergic agonists are used to inhibitors is due to an accumulation of the ACh
manage and treat asthma, bronchospasm and other released from the nerve ending.
obstructive pulmonary diseases.  Myasthenia gravis is an autoimmune disease
characterized by antibodies to the ACh receptors.
▪ Isoproterenol, a nonspecific beta-specific adrenergic, is This results in a loss of ACh receptors and eventual
used to treat shock, cardiac standstill, and certain loss of resonse at the neuromuscular junction.
arrhythmias when used systematically; it is especially  Acetylcholinesterase inhibitors are used to treat
effective in the treatment f heart block in transplanted myasthenia gravis because they allow the
hearts. accumulation of ACh in the synaptic cleft, prolonging
stimulation of any ACh sites that remain.
CLASSIFICATION:  Alzheimer’s disesse is a progressive dementia
 ALPHA-and-BETA ADRENERGIC AGONISTS characterized by a loss of ACh-producing neurons
 Epinephrine (P) and ACh receptor sites in the neurocortex.
 Dopamine  Acetylcholineserase inhibitors that corss the
 Ephedrine blood-brain barrier are used to manage Alzheimer’s
 Norepinephrine disease by increasing ACh levels in the brain and
slowing the progression of the disease.
 Side effects associated with the use of these drugs
 ALPHA-SPECIFIC ADRENERGIC AGONISTS are related to stimulation of the parasympathetic
 Alpha-1 specific Adrenergic Agonists: nervous system and may limit the usefulness of
 Phenylephrine (P) some of these drugs.
 Midodrine
 Alpha-2 specific Adrenergic Agonists: CLASSIFICATION:
 Clonidine (P)  DIRECT-ACTING CHOLINERGIC AGONISTS
 Methyldopa  Bethanechol (P)
 BETA-SPECIFIC ADRENERGIC AGONISTS  Carbachol
 ( Beta1 and Beta2 )  Cevimeline
 Isoproterenol (P)  Pilocarpine
 Albuterol
 Arformoterol  INDIRECT-ACTING CHOLINERGIC AGONISTS
 Indacaterol ( AGENTS for MYASTHENIA GRAVIS )
 Levalbuterol  Pyridostigmine (P)
 Metaproterenol  Edrophonium
 Olodaterol  Neostigmine
 Salmeterol
 Terbutaline ?????  AGENTS for ALZHEIMER’S DISEASE
 Donepezil (P)
 Beta-1 specific adrenergic agonists  Galantamine
 Dobutamine (P)  Rivastigmine
 Beta-2 specific adrenergic agonists
 Terbutaline ADRENERGIC ANTAGONISTS
 Isoxsuprine
 Adrenergic blocking agents, or sympatholytic drugs,
CHOLINERGIC AGONISTS lyse or block the effects of the SNS
 Both the therapeutic and the adverse effects
 Cholinergic drugs are chemicals that act at the same associated with these drugs are related to their
site as the neurotransmitter ACh, stimulating the blocking of the normal responses of the SNS

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 BACHELOR OF SCIENCE IN NURSING 2YA-11 (PHARMACOLOGY)
NCMA216 : BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
 The alpha- and beta-adrenergic blocking agents  Timolol
block all of the receptor sites within the SNS, which
results in lower blood pressure, slower pulse and  Beta1-Selective Adrenergic Blocking Agents
increased renal perfusion with decreased renin  Atenolol (P)
levels. These drugs are indicated for the treatment of  Acebutolol
essential hypertension. They are associated with  Betaxolol
many adverse effects, including the blocking of  Bisoprolol
reflex bronchodilation, cardiac suppression and  Esmolol
diabetic reactions.  Metoprolol
 Selective adrenergic blocking agents have been
developed that, at therapeutic levels, have specific CHOLINERGIC ANTAGONISTS
affinity for alpha- or beta-receptors for specific ( ANTICHOLINERGIC AGENTS )
alpha1-, beta1- or beta2-receptor sites. This
specificity is lost at levels higher than the therapeutic  Anticholinergic drugs, also called parasympatholytic
range. drugs, block the effects of ACh at cholinergic
 Alpha-adrenergic drugs specifically block the alpha receptor sites, thus blocking the effects of the
receptors of the SNS. At therapeutic levels, they do parasympathetic nervous system.
not block beta-receptors.  Parasympathetic nervous system blockade causes
 Nonspecific alpha-adrenergic blocking agents are an increase in heart rate, decrease in GI activity,
used to treat pheochromocytoma, a tumor of the decrease in urinary bladder tone and function and
adrenal medulla pupil dilation and cycloplegia.
 Alpha1-selective adrenergic blocking agents block  These drugs also block cholinergic receptors in the
the postsynaptic alpha1-receptr sites, causing a CNS and sympathetic postganglionic cholinergic
decrease in vascular tone and a vasodilation that receptors, including those that cause sweating.
leads to a fall in blood pressure without the reflex  Many systemic adverse effects associated with the
tachycardia that occurs when the presynaptic use of anticholinergic drugs are due to the systemic
alpha2-receptor sites are also blocked. cholinergic blocking effects that also produce the
 Beta-blockers are drugs used to block the desired therapeutic effect.
beta-receptors within the SNS. These drugs are  Atropine is the most commonly used anticholinergic
used for a wide range of conditions, including drug. It is indicated for a wide variety of conditions
hypertension, stage fright, migraine, angina and and is available in oral, parenteral and topical forms.
essential tremors.  Patients receiving anticholinergic drugs must be
 Blockade of all beta-receptors results in a loss of the monitored for dry mouth, difficulty swallowing,
reflex bronchodilation that occurs with sympathetic constipation, urinary retention, tachycardia, pupil
stimulation. This limits the use of these drugs in dilation and photophobia, cycloplegia and blurring of
patients who smoke or have allergic or seasonal vision and heat intolerance caused by a decrease in
rhiitis, asthma or COPD. sweating.
 Beta1-selective adrenergic blocking agents do not
block the beta1-receptors that are responsible for CLASSIFICATION:
bronchodilation and therefore are preferred in  Anticholinergic Agents / Parasympatholytics
patients with respiratory problem  Atropine (P)
 Dicyclomine
CLASSIFICATION:  Fesoterodine
 Nonselective Adrenergic Blocking Agents  Glycopyrrolate
 Labetalol (P)  Hyscyamine
 Amiodarone  Ipratropium
 Carvedilol  Meclizine
 Scopolamine
 Nonselective Alpha-Adrenergic Blocking Agents  Solifenacin
 Phentolamine (P)  Toliterodine

 Alpha1-Selective Adrenergic Blocking Agents

 Doxaxosin (P)
 Alfuzosin
 Prazosin
 Tamsulosin
 Terazosin

 Nonselective Beta-Adrenergic Blocking Agents

 Propranolol (P)
 Carteolol
 Nadolol
 Sotalol

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
CHN 211 | LESSON 1: GLOBAL AND HEALTH OF OLDER CHILDREN
NATIONAL HEALTH SITUATION ANDADOLESCENTS
 HIV “the biggest hazards to children at the 21st
Century” “In 1997, 590 000 children age under 15
GLOBAL
became infected with HIV”
WHO | WORLD HEALTH ORGANIZATION
 Potentially deadly "rites of passage" as violence,
delinquency, drugs, alcohol, motor accidents and
 "The attainment by all peoples of the highest
sexual hazards such as HIV and other sexually
possible level of health.”
transmitted diseases.
 “We are building a better, healthier future for
people all over the world. Together we strive to
HEALTH OF ADULTS
combat diseases – communicable diseases like
Developing Countries
influenza and HIV, and noncommunicable
 “Infectious diseases will still dominate”
diseases like cancer and heart disease.”
 As these countries' economies grow and people adopt
Who We Established 7 April 1948. – a date WHO celebrate more Western lifestyles, there will be an increase in
Are? every year as World Health Day. non-communicable diseases like heart disease,
Headquarters in Geneva, Switzerland
diabetes, and cancer because of habits like smoking,
What We The main areas of work are healthsystems; health
Do? through the life-course; unhealthy diets, obesity, and insufficient exercise.
noncommunicable and communicable diseases; Developed Countries
preparedness, surveillance and response; and  “non-communicable diseases will remain dominant.
corporate services Heart disease and stroke have declined as causes of
Where We WHO support countries as they coordinate the
Work? efforts of governments and partners – death in recent decades, while death rates from some
including bi- and multilaterals, funds and cancers have risen.”
foundations, civil society organizations and the  Cancer will remain one of the leading causes of death
private sector worldwide.
How We Are The World Health Assembly is attended by
Governed? delegations from all Member States, and
determines the policies of the Organization HEALTH OF OLDER PEOPLE
Who We WHO partners with countries, the United Nations  Cancer and heart disease are more related to the
Work With? system, internationalorganizations, civil society, 70-75 age group than any other; people over 75
foundations, academia, and research institutions become more prone to impairments of hearing, vision,
mobility and mental function.
GLOBAL HEALTH SITUATION  Over 80% of circulatory disease deaths occur in
people over 65.
POPULATION
 Worldwide, circulatory disease is the leading cause of
1955 1995 2025 death and disability in people over 65 years.
Population 2.8 Billion 5.8 Billion 8 Billion
1955 1995 2025 NATIONAL
Rural 68% 55% 41% DOH | DEPARTMENT OF HEALTH
Urban 32% 45% 59%
613 M 1.7 B 3.1 B 390 M  “a national health policymaker and regulatory
Children Age 5 - 19 Age 20 - 64 Elderly institution.”
Under 5 Over 65
Mission To lead the country in the development of a
1955 1995 2025
productive, resilient, equitable
Life 48 y.o. 65 y.o. 73 y.o.
andpeople-centered health system
Expectancy Vision Filipinos are among the healthiest people in
Southeast Asia by 2022, and Asia by 2040
LEADING CAUSES OF GLOBAL DEATHS Roles in the (1) leadership in health; (2) enabler and
1997 Health capacity builder; and (3) administrator of
 17.3 Million Infectious and Parasitic Disease + Sector specific services
 15.3 Million Circulatory Disease + Mandate To develop national plans, technical
 6.2 Million Cancer +
standards, and guidelines on health
 2.9 Million Respiratory Disease +
 3.6 Million Perinatal Conditions
‘
 52.2 Million Deaths

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
TODAY’S HEALTH SITUATION GLOBAL
As of June 26, 2020 | WHO: Situation Report- 158
The Ebola virus disease outbreak in northeastern
Congo has ended after almost two years, and now the
World Health Organization and its partners are using
their experience to help combat COVID-19 in the
country and assist other African nations dealing with
the pandemic's surge.
COVID-19 is a contagious illness caused by a new
coronavirus that emerged in Wuhan, China, in
December 2019, and it has spread worldwide,
becoming a global pandemic.

As of April 10, 2020 | DOH: About Covid 19

“Coronavirus Disease 2019 (COVID-19) is an
infectious disease caused by a new coronavirus
recently introduced to humans for the first time. The
World Health Organization (WHO) has called it a
pandemic. This means that the virus has spread all
over the world. About 80% of those who
haveCOVID-19 have mild symptoms.”

As of April 7, 2020 | WHO: Urgent Need for

Investment in Nursing
“In the Philippines, the projected shortfall of nurses
is expected to be 249,843 by 2030, unless greater
investment is made now to retain them in the
Philippine health sector.”

As of January 30, 2020 | WHO: Polio vaccination

must intensify until the last child is reached and
fully protected
“In response to the re-emergence of Polio in the
Philippines in September 2019, the Department of
Health conducted vaccination campaigns in specific
areas, successfully reaching over 1.4 million children
under 5 in the National Capital Region and 2.9 million
children in Mindanao by December 2019.”

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023

Overview of Public Health Nursing in the Two main Types of Communities:

Overview of Public Health Nursing in the
Philippines 1. Geopolitical Communities
Philippines
(Public Health / Community Health Nursing )  Also called as territorial communities
( Public Health / Community Health Nursing )  Traditionally recognized
 Defined or formed by both natural and man-
LESSON 2: made boundaries.
INTRODUCTION TO COMMUNITY HEALTH 2. Phenomenological Communities
NURSING  Also called as functional communities
 Community health nursing is the synthesis of  Refers to relational, interactive groups or
nursing practice and public health practice. setting is more abstract and people share a
 GOAL: group perspective.
- Health promotion and health maintenance.
- Identification of population at risk. DETERMINANTS OF HEALTH
 MISSION: 1. Income and Social Status
- Social justice that entitles all people to basic  Higher income and social status are linked to
necessities, such as adequate income and health better health. The greater the gap between the
protection. richest and poor health, the greater differences
in health.
TERMONOLOGIES: 2. Education
Health  Low education levels are linked with poor
 State of complete physical mental and social health, more stress and lower selfconfidence.
well-being 3. Physical environment
 A state of well-being in which the person is  “safe water and clean air, healthy workplaces,
able to use purposeful, adaptive responses safe houses communities and roads all
and processes physically, mentally, contribute to good health.
emotionally, spirituality and socially. 4. Employment and working conditions
 A state of person that is characterized by  “people in employment are healthier,
soundness or wholeness of developed human particularly those who have control over their
structure and pf bodily and mental functioning. working conditions.
 Actualization of inherent and acquired human 5. Social support networks
potential through goal-directed behavior.  greater support from families, friends and
Social - relating to living together in organized communities is linked to better health.
groups or similar close aggregates. 6. Culture
Social Health - connotes community vitality and is  “customs and traditions, and the beliefs of the
a result of positive interaction among groups within family and community all affect health.
the community with an emphasis on health 7. Genetics
promotion and illness prevention.  inheritance plays a part in determining lifespan,
Population - typically used to denote a group of healthiness and the likelihood of developing
people having common personal or environmental illnesses.
characteristics. 8. Personal behavior and coping skills
Aggregates - subgroups or sub-populations that  balanced eating, keeping active, smoking,
have some common characteristics or concerns. drinking and how we deal with life’s stresses
and challenges all affect health.
Community 9. Health services
 Collection of people who interact with one  access and use of services that prevent and
another treat disease influences health.
 Group of people who share something in 10. Gender
common and interact with one another  men and women suffer from different types of
 A group of people who share common interest diseases at different ages
 A locality-based entity composed of systems of
formal organization. HEALTH INDICATORS
1. Health status indicators (Morbidity)
2. Health status indicators (Mortality)
3. Population indicators
4. Indicators for the provision of health care
5. Risk reduction indicators
6. Social and economic indicators

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
7. Disability indicators 9. Research, development, and implementation of
8. Health policy indicators innovative public health solution.
Individuals / Organizations Gathering Health
Indicators:
COMMUNITY HEALTH
National Epidemiology Center of DOH, PSA and Extends the realm of public health to include
Local Health Centers/ Offices/ Departments organized health efforts at the community level
 provide morbidity, mortality and other health through both government and private efforts.
status related data.
HEALTH PROMOTION AND LEVEL OF
Local Health Centers/ Offices/ Departments PREVENTION
 are responsible for collecting morbidity and  Health Promotion
mortality data and forwarding the information to Activities enhances resources directed at improving
the higher lever of health, such as Provincial well-being
Health office.  Disease Prevention
Activities protect people from disease and effects
Nurses of disease.
 should participate in investigative efforts to
determine what is precipitating the increased LEAVELL AND CLARK’S THREE LEVELS OF
disease rate and work to remedy the identified PREVENTION
threats or risks. 1. Primary Prevention
- preventing a problem before it occurs by altering
PUBLC HEALTH AND COMMUNITY HEALTH susceptibility or detection and prompt intervention.
“Public health is the science and art of: 2. Secondary Prevention
(1) preventing disease, - Early detection and prompt intervention during the
(2) prolonging life period of early disease.
(3) promoting health and efficiency through 3. Tertiary Prevention
organized community effort for: - Focuses on limitations of disability and
rehabilitation.
a) sanitation of the environment
b) Control communicable infections
c) Education of the individual in personal hygiene,
d) Organization of medical and nursing services
for the early diagnosis and preventive treatment
of disease. DEFINITION AND FOCUS OF COMMUNITY
e) development of the social machinery to ensure HEALTH NURSING , PUBLIC HEALTH NURSING
everyone a standard of living adequate for the AND COMMUNITY-BASED NURSING
maintenance of health, so organizing these
benefits as to enable every citizen to realize his Community Health Nursing
birthright of health and longevity” Encompasses sub-specialties that include public
health nursing, school nursing, occupational health
9 ESSENTIAL PUBLIC HEALTH FUNCTIONS nursing, and other developing fields of practice.
1. Health situation monitoring and analysis
2. Epidemiological surveillance/ disease prevention Public Health Nursing
and control  field of professional practice in nursing and in
3. Development of policies and planning in public public health in which technical nursing,
health interpersonal, analytical, and organizational
4. Strategic management of health systems and skills are applied to problems of health as they
services for population health gain affect the community.
5. Regulation and enforcement to protect public  comprehensive nursing care of familiesfor
health health education of the publicand for the
6. Human resources development and planning in mobilization of the public for health action.
public health  practice of promoting and protecting the health
7. Health promotion, social participation and of populations.
empowerment
8. Ensuring the quality of personal and population-
based health service.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
Community-Based Nursing 8. Delegated functions – direct care tasks that the
 Application of the nursing process in caring for nurse carries out
individuals, families and group. 9. Health teaching – communicates facts, ideas
 emphasis is on acute and chronic care. and skills that change knowledge, attitudes values,
behaviors and practice.

Community Community-
Health based Nursing 10.Counseling – establishes an interpersonal
Nursing relationships; with the intention of increasing or
Emphasis Preservation Managing enhancing their capacity for self-care and coping
and protection acute and 11.Consultation – seeks information and
of health chronic care generates optional solutions to perceived problems
Primary Community Individual and 12.Collaboration – commits two or more persons
Clients Family or an organization
13.Coalition building – develops alliances among
POPULATION-FOCUSED APPROACH AND organizations
COMMUNITY HEALTH NURSING 14.Community organizing – helps community
INTERVENTIONS groups to identify common problems or goals
Population-Focused Nursing mobilizes resources and develop and implement
Specific groups of people and focuses on health strategies
promotion and disease prevention. 15.Advocacy – pleads someone’s cause or acts
 Its goal is to promote healthy communities. on someone’s behalf
16.Social marketing – utilizes commercial
PRACTICE: marketing principles for programs
1. focuses on the entire population 17.Policy development and enforcement –
2. is based on assessment of the populations’ place issues on decision makers’ agendas,
health status acquires plan of resolution.
3. considers the broad determinants of health
4. emphasizes all levels of prevention EMERGING FIELDS OF CHN IN THE
5. 5.intervenes with communities,systems, PHILIPPINES.
individuals and families HOME HEALTH CARE
 This practice involves providing nursing care
CHN Practice Requires the following type of nursing care to individuals and families in their
data for scientific approach and population own places of residence mainly to minimize the
focus: effects of illness and disability.”
1. The epidemiology or body knowledge of a HOSPICE HOME CARE
particular problem and its solution  Home care rendered to the terminally ill.
2. Information about community Palliative care is particularly important.
ENTREPRENURSE
17 PUBLIC HEALTH INTERVENTIONS AND  To promote nurse entrepreneurship by
DEFINITIONS introducing a home health care industry.
1. Surveillance – monitors health events  PURPOSE:
2. Disease and other health event investigation 1. Reduce the cost of health care for the countries
– systematically gathers and analyzes data indigent population.
regarding threats to the health of populations 2. Maximize employment opportunities.
3. Outreach – locates populations of interests or 3. Utilize the countries unemployed human
populations at risk resources.
4. Screening – identifies individuals with  AIMS: public health services and the
unrecognized health risk factors achievement of the country’s Millennium
5. Case finding – identifies risk actors and Development Goals (MDG) on maternal and
connects them with resources child health.
6. Referral and follow-up – assists individuals and
families, families, groups,organizations ad Faith Community Nursing or Parish Nursing:
communities to identify and access necessary This is the practice of nursing combined with
resources spiritual care. They may work in either paid or
7. Case management – optimizes self-care unpaid positions in a variety of religious faiths.
capabilities of individuals and families.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
6. Personal and Professional Development
identification of own learning needs, pursuit of
continuing education; involvement in professional
image; positive attitude towards change and
criticism.
7. Quality Improvement - data gathering for
quality improvement; participation in nursing
rounds; identification and reporting of solutions to
identifies problems related to client care.
8. Research - research-based formulation of
solutions to problems in client care and
dissemination and application of research findings
Nursing Administration Administrator: 9. Records Management - accurate and updated
- a person in authority to supervise his levels of documentation of client care while observing legal
subordinates Nursing Service in Hospital (Nurse imperatives and record keeping
Practitioner). 10. Communication - uses therapeutic
communication techniques, identifies verbal and
nonverbal cues, responds to client needs while
using formal and informal channels of
communication and appropriate information
technology .
11. Collaboration and Teamwork - establishment
of collaborative relationship with colleagues and
other members of health team.
OTHER AREAS / FIELDS OF NURSING:
1. NURSING EDUCATION History of Public Health and Public Health
• To be in college of Nursing Nursing in the Philippines.
• Goal: Preparing students to become professional
nurse 1577 - Franciscan FriarJuan Clemente opened
• Dean→ Asst. Dean→ Secretary→ Coordinators→ medical dispensary in Intramuros for the indigent.
Faculty→ Clinical Instructor.
1690 – Dominican Father Juan de Pergero worked
COMPETENCY STANDARDS IN CHN toward installing a water system in San Juan del
Monte and Manila .
1. Safe and Quality Nursing Care -knowledge of
health/illness status of the client, sound decision 1805 – smallpox vaccination was introduced by
making; safety, comfort, privacy, administration of Francisco de Balmis , the personal physician of
meds and health therapeutics and nursing process. King Charles IV of Spain .
2. Management of resources and environment -
organization of workload; use of financial resources 1876 – first medicos titulares were appointed by
for client care; mechanism to ensure proper the Spanish government.
functioning of equipment and maintenance of a
safe environment. 1888 - 2-year courses consisting of fundamental
3. Health Education - assessement of client’s medical and dental subjects was first offered in the
learning needs; development of health education University of Santo Tomas. Graduated were known
plan and learning materials and implementation as “cirujanos ministrantes” and serve as male
and evaluation of health education plan nurses and sanitation inspector.
4. Legal Responsibility - adherence to the nursing
laws as well as to national, local and organizational 1901 – United States Philippines Commission,
policies including documentation of care given to through Act 157, created the Board of Health of the
clients. Philippine Islands with a Commissioner of the
5. Ethicomoral Responsibility - respect for the Public Health ,as its chief executive officer (now the
rights of the client; responsibility and accountability Department of Health.
for own decisions and actions; and adherence to
the international and national codes of ethics for
nurses.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
Fajardo Act of 1912 – created sanitary divisions
made up of one to four municipalities. Each
sanitary division had a president who had to be a
physician.

1915 - the Philippine General hospital began to

extend public health nursing services in the homes
of patients by organizing a unit called Social and
Home Care services .

Asociacion Feminista Filipina (1905) – Lagota de

Leche was the first center dedicated to the service
of the mothers and babies.

1947 – the Department of Health was reorganized

into bureaus: quarantine, hospitals that took charge
of the municipal and charity clinics and health with
the sanitary divisions under it.

1954 – Congress passed RA 1082 or the Rural

Health Act that provided the creation of RHU in
every municipality .

RA 1891 – enacted in 1957 amend certain

provisions in the Rural Health Act; Created 8
categories of rural health units corresponding to the
population size of the municipalities.

RA 7160 (Local Government Code) – enacted in

1991, amended that devolution of basic health
services including health services, to local
government units and the establishment of a local
health board in every province and city of
municipality.

Millennium Development Goals – adopted during

the world summit in September 2000
FOURmula One (F1) for health, 2005 and
Universal Health Care in 2010 – agenda launched
in 1999 .

Universal Health Care – aims to achieve the

health system goals of better health outcomes,
sustained health financing, and responsive health
system that will provide equitable access to health
care.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
Overview of Public Health Nursing in the 5 GOALS STRATEGY ON RESEARCH FOR
Philippines. HEALTH
(CARE DELIVERY SYSTEM) A. Capacity - to strengthen the national health
research system
B. Priorities - focus research in priority health need
LESSON 3: C. Standards - promote good research practice
INTRODUCTION TO HEALTH CARE DELIVERY D. Translation - quality evidence is turned into
SYSTEM products and policy
 A nation’s health care delivery system has a E. Organization - strengthen the research culture.
tremendous impact not only the health of its
people but also on their total development 3. Setting norms and standards
including their socioeconomic status. 4. Articulating ethical and evidence-based policy
options
FACTORS THAT INFLEUNCES THE HEALTH 5. Providing technical support, catalyzing change,
CARE DELIVERY SYSTEM: and building sustainable institutional capacity.
1. Health care ‘reforms”
2. Demographics
3. Globalization 17 SUSTAINABLE DEVELOPMENT GOALS
4. Poverty and growing disparities
5. Social disintegration 1. End poverty in all its forms everywhere
2. End hunger, achieve food security and improved
HEALTH SYSTEM - Primary intent is to promote, nutrition and promote sustainable agriculture
restore or maintain health. 3. Ensure healthy lives and promote well-being for
6 Health System Components: all ages.
1. Service Delivery 4. Ensure inclusive and equitable quality education
2. Health work face and promote life-long learning opportunities for all
3. Information 5. Achieve gender equality and empower all women
4. Medical products, vaccines and technologies and girls
5. Financing 6. Ensure availability and sustainable management
6. Leadership and governance or stewardship of water and sanitation for all
7. Ensure access to affordable, reliable, sustainable
HEALTH ORGANIZATIONS and modern energy for all.
WHO = Provides global leadership on health 8. Promote sustained, inclusive and sustainable
matters. economic growth, full and productive employment
DOH = Operating mechanism to meet the priority and decent work for all.
needs and service requirements of their 9. Build resilient infrastructure, promote inclusive
communities. Primary responsibility is Basic Health and sustainable industrialization and foster
Services. innovation.
10. Reduce inequality within and among countries.
WORLD HEALTH ORGANIZATION (WHO) 11. Make cities and human settlements inclusive,
Established: April 7, 1948 safe, resilient and sustainable
Objective: The attainment of all peoples of the 12. Ensure sustainable consumption and
highest possible level of health. production patterns
13. Take urgent action to comb at climate change
5 CORE FUNCTIONS: and its impacts
1. Providing leadership on matters critical to health 14. Conserve and sustainably use the oceans, seas
and engaging partnerships where joint action is and marine resources for sustainable development
needed. 15. Protect, restore and promote sustainable use of
terrestrial ecosystem, sustainably manage forests,
2. Shaping the research agenda and stimulating the comb at desertification and halt and reverse land
generation, translation, and disseminating valuable degradation and halt biodiversity loss.
knowledge.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
16. Promote to peaceful and inclusive societies for Provincial governments responsible for
sustainable development, provide access to justice administration of provincial and district hospitals.
for all and build effective, accountable and inclusive Municipal and City government in charge of
institutions at all levels. primary care through rural health unites or health
17. Strengthen the means of implementation and centers.
revitalize the global partnership for sustainable dev. Satellite Outposts known as barangay health
stations provide health services in the periphery of
MILLENIUM DEVELOPMENT GOALS the municipality or city.
Unites Nations Millennium Declaration - The
world leaders recognized their collective 3 Major Groups Financing Health Services
responsibility to uphold the principles of human 1. The government (National and Local)
dignity, equality and equity at the global level. 2. Private Sources
3. Social Health Insurance
8 MDG’s”
1. Eradicate extreme poverty and hunger DOH MAJOR ROLES
2. Achieve universal primary education 1. Leader in health
3. Promote gender equality and empower women 2. Enabler and capacity builder
4. Reduce child mortality, target: reduce by 2/3 3. Administrator of specific services
between 1990 and 2015 the under-five mortality
rate. DOH CORE VALUES
5. Improve maternal health. Target: 1. Integrity
- reduce by three quarters the maternal mortality 2. Excellence
ratio 3. Compassion and respect for human dignity
- achieve universal access to reproductive health 4. Commitment
6. Combat HIV/AIDS malaria and other diseases. 5. Professionalism
Target: 6. Stewardship
- have halted by 2015 and begun to reverse the
spread of HIV/AIDS
- Achieve by 2010, universal access to treatment LEVELS OF HEALTH CARE DELIVERY
for all those who need it (Other Health Facilities Categories)
- Have halted by 2015, and begun to reverse the
incidence of malaria and other major disease.  CATEGORY A: Primary Health Care Facility
7. Ensure environmental sustainability  Offers basic service.
8. Develop a global partnership for development.  Without in-patient beds - example health
centers, out-patient clinics and dental clinic
PHILIPPINES HEALTH CARE DELIVERY  With in patient beds - a short facility where
SYSTEM the patient spends n the average of one to two
DOH = DEPARTMENT OF HEALTH days before discharge. Example: infirmaries
 The main governing body of health services in and birthing (lying-in) facilities.
the country.
 Provides guidance and technical assistance to  CATEGORY B: Custodial Care Facility
LGUs through the center for health  Provides long-term care.
development in each of the 17 regions  Example: custodial health care facilities,
 DOH VISION is to be a global leader for substance/drug abuse treatment and
attaining better health outcomes, competitive rehabilitation centers, sanitaria, leprosaria and
and responsive health care system, and nursing homes.
equitable health financing.
 DOH MISSION to guarantee equitable,  CATEGORY C: Diagnostic/ Therapeutic
sustainable and quality health for all filipinos, Facility
especially the poor, and to lead the quest for  Examination of the human body, specimens
excellence in health. from the human body for the diagnosis.

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 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
 CATEGORY D: Specialized Outpatient Facility HEALTH REFERRAL SYSTEM
 A facility that performs highly specialized -A referral is a set of activities undertaken by a
procedures on a outpatient basis. health care provider or facility in response to its
 Example: dialysis clinic, ambulatory surgical inability to provide the necessary health
clinic, cancer chemotherapeutic center/clinic. intervention to satisfy patient’s need.
-A functional referral system is one that ensures
RURAL HEALTH UNIT the continuity and complementation of health and
 A.k.a Health Center medical services.
 A primary level health facility in the municipality -It usually involves movement of a patient from
 Preventive and promotive health services the health center of first contact and the hospital
 Supervision of BHS’s. 20,000 populations. at first referral level.

Two-way Referral System

RURAL HEALTH UNIT PERSONNEL • Internal referrals – occur within the health
MUNICIPAL HEALTH OFFICER (MHO) OR facility; may be made to request for an opinion or
RURAL HEALTH PHYSICIAN suggestion, co-management, or further
“heads the health services at the municipal level” management or specialty care.
• External referral – is a movement of a patient
ROLES AND FUNCTIONS OF MHO from one health facility to another. It may be
1. Administrator of the RHU vertical, where the patient referral may be from a
2. Prepares the municipal health plan and budget lower to a higher level of health facility or the other
3. Monitors the implementation of basic health way round.
services
4. Management of the RHU staff INTER-LOCAL HEALTH ZONE (ILHZ)
5. Community physician  an integrated health management & delivery
6. Conducts epidemiological studies system based on a defined administrative &
7. Formulates health education campaigns on geographical area.
disease prevention  has a defined catchment population within a
8. Prepares and implements control measures or defined geographical area, it has a central or
rehabilitation plan core referral hospital and a number of primary
9. Medico-legal officer f the municipality. level facilities such as RHUs and BHSs.

LOCAL HEALTH BOARDS

“Code A 7160 provided for the creation of the ILHZ COMPONENTS
Provincial Health Board and the City/Municipal  People , the number of people may vary from
Health boards, or Local Health Boards“ “enable zone to zone
local governments to attain their fullest  Boundaries boundaries between ILHZs
development as self-reliant communities and establish accountability and responsibility of
make them more effective partners in the health service providers.
attainment of national goals“  Health facilities an integrated health system.
 Health workers To deliver comprehensive
FUNCTIONS services.
1. Proposing to the Sanggunian annual budgetary
allocations for the operation and maintenance of
health facilities and services within the HEALTH SECTOR REFORM: UNIVERSAL
province/city/municipality; HEALTH CARE“a.k.a. Aquino Health Agenda”
2. Serving as an advisory committee to the  Health Sector Reforms are intended to bring
Sanggunian on health matters; and about equity in health service delivery.
3. Creating committees that shall advise local
health agencies on various matters related to
health service operations

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
GOALS AND OBJECTIVES: 5 KEY ELEMENTS
1. Better health outcomes 1. Reducing exclusion and social disparities in
2. Sustained health financing, and health (universal coverage).
3. A responsive health system by ensuring that all 2. Organizing health services around people’s
Filipinos, especially the disadvantaged group, have needs and expectations (health service reforms).
equitable access to affordable health care. 3. Integrating health into all sectors (public policy
reforms).
Strategic Thrusts 4. Pursuing collaborative models of policy dialogue
1. Financial risk protection through expansion in (leadership reforms).
NHIP enrollment and benefit delivery 5. Increasing stakeholder participation.
2. Improved access to quality hospitals and health
care facilities 8 Essential Health Services
3. attainment of the health-related MDG E - Education for health
L - Locally endemic disease control
E - Expanded program for immunization
Six Strategic Instruments M - Maternal and child health including responsible
1. Health Financing - to increase resources for parenthood
health. E - Essential drugs
2. Service delivery - to transform the health N - Nutrition
service delivery structure. T - Treatment of communicable and
3. Policy, standards and regulation - to ensure noncommunicable diseases
equitable access to health. S - Safe water and sanitation
4. Governance for heath - to ensure that all
Filipinos have access. Key Principles
5. Health information - to establish a modern 4 A’s:
information system. Accessibility - distance/travel time required to get
to a health care facility/services.
PUBLIC HEALTH PROGRAM
1. Reproductive and maternal health: Affordability - consideration of the individual,
prepregnancy services and care during pregnancy, family, community and government can afford the
delivery, and postpartum period services.
2. Expanded Garantisadong Pambata (child
health): advocacy for exclusive breastfeeding in Acceptability -compatible with the culture and
the first 6 months of life, newborn screening traditions.
program, immunization, nutrition services, and
integrated management of childhood illness. Availability -provided on a regular and organized
3. Control of communicable disease such as manner.
tuberculosis, mosquito-borne diseases, rabies,
schistosomiasis, and sexually transmitted infections EQUITABLE DISTRIBUTION OF HEALTH
4. Control of noncommunicable or lifestyle diseases RESOURCES
5. Environmental health. 2 DOH programs to ensure equitable
distribution:
PRIMARY HEALTH CARE 1. Doctor to the Barrio (DTTB) Program
 the essential care made universally accessible • the deployment of doctors to municipalities that
to individuals and families in the community are w/o doctors.
through their full preparation. • deployed to unserved, economically depressed
UNIVERSAL GOAL 5th or 6th class municipalities for 2 years.
-“Health For All by the Year 2000”
- ”this is achieved through community and 2. Registered Nurses Health Enhancement and
individual self-reliance” Local Service (RN HEALS)
ATTAINMENT OF BETTER HEALTH SERVICES • training and program for unemployed nurse
FOR ALL • deployed to unserved, economically depressed
municipalities for 1 year.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023

R. A 8423 | Traditional and Alternative Medicine

Act of 1997:

TEN (10) HERBAL PLANTS APPROVED BY THE

DEPARTMENT OF HEALTH (DOH)
 Use of plants or derivatives from plants for the
treatment of specific conditions.
 One of the considered as one of the most
popular modalities of complementary medicine.

TIPS ON HANDLING MEDICINAL PLANTS /

Medicinal Plant Preparation HERBS.
1. DECOCTION - boiling the plant material in  Buy herbs that are grown organically – without
water for 20 min. pesticides.
2. INFUSION - plant material is soaked in hot  Medicinal parts of plants are best harvested on
water for 10 - 15 minutes. sunny mornings.
3. POULTRICE - directly apply plant material on  Leaves, fruits, flowers or nuts must be mature
the affected part, usually in bruises, wounds and before harvesting.
rashes.  If drying is required, it is advisable to dry the
4. TINCTURE - mix the plant material in alcohol. plant parts either in the oven or air-dried on
screens above ground and never on concrete
ALTERNATIVE HEALTH CARE MODALITIES floors.
 Store plant parts in sealed plastic bags or
brown bottles in a cool dry place without
sunlight preferably with a moisture absorbent
material like charcoal.

TIPS ON PREPARATION FOR INTAKE OF

HERBAL MEDICINES:
 Use only half the dosage prescribed for fresh
parts like leaves when using dried parts.
 Do not use stainless steel utensils when boiling
decoctions.
PRIMARY CARE  As a rule of thumb, when boiling leaves and
 “includes health promotion, disease prevention, other plant parts, do not cover the pot, and boil
health maintenance, counseling, patient in low flame.
education and diagnosis and treatment of  Decoctions loose potency after some time.
acute and chronic illness in different health Dispose of decoctions after one day.
settings.  Always consult with a doctor if symptoms
 refers to the first contact of a person with a persist or if any sign of allergic reaction
professionals. develop.
 a model of nursing care that emphasizes
continuity of care.
 nursing care is directed towards meeting all the
patient’s need.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
LAGUNDI
 Asthma, Cough & Fever.
 Skin diseases (dermatitis, scabies, ulcer,
eczema)
 Headache
 Rheumatism, sprain, contusions, insect bites

ULASIMANG BATO
 Indications: Infusion, decoction or salad for
gout and rheumatic pains; pounded plant warm
poultice for boils and abscesses. TSAANG GUBAT
 Diarrhea
GUAVA  Stomachache
 For washing wounds
 Indications: antidiarrheal and antiseptic AMPLAYA
 Diarrhea – May be taken 3-4 times a day As  DiabetesMellitus (Mild non-insulin dependent)
gargle and for toothache

BAWANG (ALIUM SATIVUM L.)

 Hypertension
 Toothache REMINDERS ON THE USE OF HERBAL
 Indications: Fresh cloves, capsules for lowering MEDICINE
blood cholesterol levels ;antiseptic. 1. Avoid the use of insecticide as these may leave
poison on plants.
YERBA BUENA 2. In the preparation of herbal medicine, use a clay
 Indications and preparations: for muscle pain, pot and remove cover while boiling at low heat.
arthritis, rheumatism, cough, colds, nausea, 3. Use only part of the plant being advocated.
dizziness. 4. Follow accurate dose of suggested preparation.
 Pain (headache, stomachache) 5. Use only one kind of herbal plant for each type of
 Rheumatism, arthritis and headache symptoms or sickness.
 Cough & Cold 6. Stop giving the herbal medication in case
 Menstrual & gas pain untoward reaction such as allergy occurs.
 Insect bites 7. If signs and symptoms are not relieved after 2 to
 Pruritis 3 doses of herbal medication, consult a doctor.
SAMBONG
 Indications: Diuretic in hypertension; dissolves
kidney stones
 Anti-edema, diuretic, anti-urolithiasis
 Diarrhea

AKAPULKO
 Anti-fungal (tinea flava, ringworm, athlete’s foot
and scabies.
 Anti-fungal (tinea flava, ringworm, athlete’s foot
and scabies) – Fresh, matured leaves are
pounded. Apply soap to the affected area 1-2
times a day

NIYOG-NIYOGAN
 Anti-helmintic – The seeds are taken 2 hours
after supper.
 Anti-helmintic
 Dosage:

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
LESSON 4: FAMILY HEALTH NURSING FAMILY AS A CLIENT
“Community health nursing has long viewed the family
“The basic unit so strongly influences asan important unit of health care, with awareness that
thedevelopment of an individual that it may the individual can be best understood within the social
determine the success or failure of that person’s life.” context of the family “
DEFINITION
FAMILY AS A SYSTEM
• The family is a group of persons usually living
General System Theory -It is way to explain how the
together
family as a unit interacts with larger units outside the
• The family is a social unit interacting with the larger
family and with smaller units inside the family.
society
• A family is characterized by people Three Subsystem of the Family (Parke 2002)
togetherbecause of birth, marriage, adoption or • Parent-Child Subsystem
choice. • Marital Subsystem
• A family is a two or more persons who are joined • Sibling-sibling Subsystem
together by bonds of sharing and
emotionalcloseness and who identify themselves as
being part of the family. DEVELOPMENTAL STAGES OF THE FAMILY
FAMILY LIFE CYCLE
TYPES OF FAMILY
1.Beginning
1. Nuclear Family –husband, wife, and family through 1.Living with
1.Parenting
theirimmediate childrennatural, adopted or both marriage or the first child Adolescent
2. Dyad Family -husband and wife commitment (s)
3. Extended Family- consist of threegenerations— as a couple
relationship
married sibling, or grandparents
4. Blended Family- one or both spouses brings a
child or children from previous marriage into one
living arrangement 1.Aging family 1.Middle- 1.Launching
5. Compound Family- where a man has more (fromretiremen aged family family
thanone spouse t to death of (remaining (youngest
6. Cohabiting Family – live-in arrangement between both marital child leaves
spouses) dyadto home)
an unmarried couple
retirement)
7. Single Parent – results from a death of
spouse,separation or pregnancy outside of wedlock
8. The Gay or Lesbian Family – cohabiting couple STAGES AND TASKS OF THE FAMILY LIFE CYCLE
ofthe same sex
1. Marriage: joining of families
FUNCTIONS a. Formation of identity as a couple
1. PROCREATION- means that even though families b. Inclusion of spouse in realignment of relationships with
can look different today, most people still see them extended families
as the primary way to have children and raise them. c. Parenthood: making decisions
2. SOCIALIZATION OF FAMILY MEMBERS - the 2. Families with young children
way we learn to fit into our community and adopt its a. Integration of children into family unit
values and behaviors. b. Adjustment of tasks: child rearing, financial
3. STATUS PLACEMENT- Hierarchy, social classes, andhousehold
societal rank c. Accommodation of new parenting and grandparenting
4. ECONOMIC FUNCTION- Unit of production, roles
farming, consumption, salaries, wages 3. Families with adolescents
5. PHYSICAL MAINTENANCE- Survival needs, a. Development of increasing autonomy for adolescents
food, shelter, clothing b. Midlife reexamination of marital and career issues
6. WELFARE AND PROTECTION- Companionship, c. Initial shift towards concern for the older generation
emotional gratification, psychological security
4. Families as launching centers
REASONS IT IS IMPORTANT FOR THE NURSES a. Establishment of independent identities for parents and
TO WORK WITH FAMILIES: grown children
 The family is a critical resource b. Renegotiations of marital relationship
 Improving nursing caredysfunctions that affects c. Readjustment of relationships to include in-lawsand
one or more family members will affect the grandchildren
members and unit as a whole d. Dealing with disabilities and death of older generation
 “Case finding”

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 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
5. Aging Families TRADITIONAL HEALTH CARE PRACTICES
a. Maintaining couple and individual functioning while IN THE PHILIPPINES
adapting to the aging process HILOT “Healing”
b. Support role of middle generation "Hilot or massage incorporates popular and beneficial
c. Support and autonomy of older generation herbs like tanglad, lagundi, sambong, and other
d. Preparation for own death and dealing with loss of nativeplants known for their healing and therapeutic
spouse and/or siblings and other peers properties."

FAMILY HEALTH TASKS TYPES OF MANGHIHILOT

• Health Tasks according to Freeman and • Comadrona – expert in post-natal massage.
Heinrich(1981) • Acupressurist – aligns nerves and balances electrical
• Recognizing interruptions of health or development. energy.
• Seeking health care. • Reflexologist – drains excess energy.
• Managing health and nonhealthy crisis. • Herbalist – uses herbal in healing.
• Providing nursing care to sick, disabled or
dependent family members of the family CUPPING THERAPY (Bentosa)
• Maintaining a home environment conducive to “a form of alternative medication that uses “cups” on the
goodhealth and personal development. skin to create suction. This suction is trusted to help in
• Maintaining a reciprocal relationship with mobilizing blood flow and promote the healing of a broad
thecommunity and it’s health institutions. range of medical ailments”

CHARACTERISTICS OF A HEALTHY FAMILY LESSON 5: NURSING PROCESS

 Members Interact
 Establish Priorities Family Nursing Process
“the blueprint of the care that the nursedesigns to
 Affirm, Support, and Respect Each Other.
systematically minimize or eliminate the identified
 Flexible Role Relationships health and family nursing problems through
 Family Teaches Family explicitly formulated outcomes of care and
 The Ability to Cope With Stress and Crisis deliberately chosen set “
 A Sense of Play and Humor
 Foster Responsibility and Value Service to This approach helps nurses give organized and scientific
Others care to individuals, families, or communities at any health
level, in any practice setting, using its components in any
TRADITIONAL FILIPINO FAMILY order.
VALUES AND TRAITS
PAGGALANG (RESPECT) PHASES OF NURSING PROCESS
 to give respect to a person 1. Assessment 2. Diagnosis
In the Philippines, using "po,""opo," and "ho" when 3. Planning 4. Implementation
speaking to older people or those in positions of 5. Evaluation
authority is a common sign of respect.
PAKIKISAMA (HELPING OTHERS) NURSING ASSESSMENT PHASE
 connotation of getting along with people in DATA COLLECTION
general METHODS OF GATHERING
This trait usually fosters general cooperation and DATA Three Sources Of Data
performing good or helpful deeds. 1. DIRECT OBSERVATION First source -
UTANG NA LOOB (DEBT OF GRATITUDE) o involves using all your Healthstatus of the
family Second Source -
 Utang na Loob means to pay your debt with senses to observe and gather Family’s status as a
gratitude information about a family's functioning unit
PAGPAPAHALAGA SA PAMILYA well-being and how they Third Source - Family's
(PRIORITIZING FAMILY) behave. environment
 Valuing and prioritizing your family above all oPresence of S/S
else. to understanding how each person in a group looks,
HIYA (SHAME) talks, acts, and makes decisions, while also considering
 It is the value that drives a Filipino be obedient the conditions in their home and surroundings.
and respectful to their parents, older siblings, 2. INTERVIEWING
and other authorities. To make interviews more productive, use good
communication to help people express their thoughts and
feelings while providing support and reassurance when
needed.

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 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
3. PHYSICAL EXAMINATION o Dietary history indicating quality and quantity offood
Done through inspection, palpation, percussion, intake per day
auscultation measurement of specific body parts and o Eating/feeding habits and practices
reviewing the body systems c. Current health status indicating presence of
4. REVIEW OF RECORDS illnessstates (diagnosed/undiagnosed by
Reviewing existing records and reports pertinent to medicalpractitioner)
the client
5. LABORATORY/DIAGNOSTIC TESTS 5. VALUE PLACED ON PREVENTIVE DISEASE
To tests and procedures conducted by a nurse or a. Immunization status of children
healthcare professionals to assess the health and b. Use of other preventive services
functionality of a patient.
DATA ANALYSIS
5 TYPES OF DATA USE AS INITIAL DATA BASE “Comparison of the gathered DATA to the STANDARDS
FOR FAMILY NURSING PRACTICE OR NORMS”
1. FAMILY STRUCTURE AND CHARACTERISTICS THREE TYPES OF STANDARDS OR NORMS
a. Household members and family head relationship 1. Normal health of individual members
b. Demographic data: age, gender, marital status, 2. Home and environment conditions conducive to family
family position development
c. Member residence status: cohabiting or 3. Family characteristics, dynamic and level of functioning
elsewhere conducive to family development.
d. Family structure type: matriarchal, patriarchal,
nuclear, extended
e. Dominant family decision-makers in healthcare
f. Family dynamics: conflicts, communication HEALTH PROBLEM
patterns “A health problem is considered a nursing problem when it
can be improved or managed with nursing care, and it's
2. SOCIO-ECONOMIC AND CULTURAL FACTORS any situation that gets in the way of someone staying
a. How much money each working family healthy or recovering from illness or injury.”
membermakes, if they can cover basic needs, who
manages the money, and how it's spent. HEALTH NEED
b. The education level of family members. “Exist when there is a health problem that can
c. The family's ethnic and religious background. bealleviated with medical or social technology.”
d. The important roles of other people in the family.
e. How the family interacts with the community and NURSING DIAGNOSIS PHASE
gets involved in community activities. FIRST LEVEL OF
ASSESSMENT
3. ENVIRONMENTAL FACTORS I. Presence of health deficit, health threats, and
a. Housing foreseeable crisis/ stress points in the family.
o Adequacy of living space
o Sleeping arrangement. A. HEALTH DEFICITS
o Presence of insects and rodents. Failure in health maintenance and development refers
o Adequacy of the furniture to situations where people's actual health and well-being
o Food storage and cooking facilities fall short of what they could reasonably achieve,
o Presence of accidents hazards oftenresulting from illnesses, unexpected deaths,
o Water supply-source, ownership, potability emotional struggles, or challenges in personal growth and
o Toilet facility-type, ownership, sanitary condition mental health.
o Garbage/refuse disposal- type, sanitary Ex.
condition o Illness regardless whether it is diagnosed
o Drainage system- type and sanitary condition o Failure to thrive or inability to develop according
b. Kind of neighborhood- congested, slum, etc. tonormal rate.
c. Social and health facilities available o Disability arising from illness,
d. Communication and transportation whethertransient/temporary
TEMPORARY
4. HEALTH ASSESSMENT OF EACH MEMBER Aphasia or temporary paralysis after CVA
a. Medical and Nursing History indicating PERMANENT
pastsignificant illness, beliefs and practices Leg amputation secondary to DM, blindness from
conducive to illness. measles, paralysis from polio.
b. Nutritional assessment (specifically for
vulnerableor at risk members)
o Anthropometric data- weight, height.

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 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
B. STRESS POINTS/ FORESEEABLE CRISIS 11. Health history which may precipitate theoccurrence of
SITUATION health deficit-previous history of difficult labor.
• Anticipated periods of unusual demand on the 12. Improper role assumption-child assumingmother’s
individual or family in terms of adjustments/family role, father not assuming his role.
resources. 13. Lack of/ inadequate immunization status ofchildren
Ex. 14. Family disunity
o Marriage o Parenthood a. Self-oriented behaviour of members
o Pregnancy, labor, puerperium o Abortion b. Unresolved conflicts among members
o Additional member-newborn, lodger. c. Intolerable disagreements
o Entrance at school o Adolescence
o Loss of job o Death of a member I. Presence of health deficit, health threats,
o Resettlement in new community andforeseeable crisis/ stress points in the family. (Started
o Illegitimacy in slide #19)
II. Inability to recognize presence of problem
C. HEALTH THREATS III. Inability to make decisions with respect to
• Condition that are conducive to diseases, accidents takingappropriate health action
orfailure to realize one’s health potential. IV. Inability to provide adequate nursing care to thesick,
Ex. disabled, dependent or vulnerable/at riskmember of the
1. Health history of specific condition/disease family.
a. family history of DM V. Inability to provide a home which is conducive tohealth
2. Threat of dross infection of CD case maintenance and personal development due to:
3. Family size beyond what resources can VI. Failure to utilize community resources for healthcare
adequatelyprovide
4. Accident Hazards NURSING DIAGNOSIS
a. Broken stairs 1. General
b. Fire hazards • the statement of the unhealthful response
d. Fall hazards. 2. Specific
5. Inadequate food intake both in quantity and quality • the statement of factors which are maintaining the
a. Excessive intake of certain nutrients undesirable response and preventing the desired change
b. Faulty eating habits
6. Stress Provoking Factors Ex:
a. Strained marital relationship GENERAL
b. Strain parent-sibling relationship • Inability to utilized the community resources for
c. Interpersonal conflicts between family healthcare due to
members. SPECIFIC
7. Poor Environmental Sanitation • Lack of adequate family resources, specifically,
a. Inadequate living space a. Financial
b. Inadequate personal belongings/utensils b. Manpower
c. Lack of food storage facilities c. Time
d. Polluted water supply
e. Presence of breeding places of insects and NURSING PLANNING PHASE
rodents
Typology of Nursing Practice Family Nursing Care Plan
f. Improper garbage/refuse disposal “the study or systematic “A Family Nursing Care Plan is
g. Unsanitary waste disposal classification of types.” the set of actions the nurse
h. Improper drainage system “A tool or classification of a family decides to implement to be
i. Noise pollution nursing problems that reflects the able to resolve identified family
family status and capabilities as a health and nursing
j. Air pollution functioning unit.” problems.”
8. Unsanitary Food Handling and Preparation
9. Personal Habits/ Practices Characteristics Family Nursing Care Plan
a. Frequent drinking of alcohol 1. The nursing care plan focuses on actions which
b. Excessive smoking aredesigned to solve or minimize existing problem.
c. Walking barefooted 2. The nursing care plan is a product of
d. Eating raw meat/fish deliberatesystematic process.
e. Poor personal hygiene 3. The nursing care plan, as with all other plans, relates to
f. Self-medication the future.
g.Use of dangerous drugs or narcotics 4. The nursing care plan is based upon identified
h. Sexual promiscuity healthand nursing problems.
i. Engaging in dangerous sports 5. The nursing care is a means to an end, not an end
10. Inherent personal characteristics- short temper initself.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
6. Nursing care plan is a continuous process not a
one-shot deal SCORING
a. Decide on a score for each of the criteria.
Desirable Qualities a Nursing Care Plan b. Divide the score by the highest possible score
1. It should be based on a clear definition of the andmultiply by the weight.
problems. SCORE/HIGHEST SCORE X WEIGHT
2. A good plan is realistic. c. Sum up the scores for all the criteria. The highest score
3. The nursing care plan should be consistent with is 5, is equivalent to the total weight.
the goals and philosophy of the health agency.
4. The nursing care plan is drawn with the family. EXAMPLE CASE SCABIES
5. The nursing care plan is best kept in a written
form.

Importance of Planning Care

1. They individualized care to clients
2. The nursing care plan helps in setting priorities by
providing information about the client as well as the
nature if his problem.
3. The Nursing care plan promotes
systematiccommunication among those involve in
the health care effort.
4. Continuity of care is facilitated through the use of
nursing care
5. Nursing care plans facilitate the coordination of
care bymaking known to other members of the health EXAMPLE CASE IMPROPER REFUSE DISPOSAL
team what the nurse is doing.

Four Criteria for Determining Priorities

1. Nature of condition or problem
• Categorized into wellness state/ potential, health
threat,health deficit of foreseeable crisis.
2. Modifiability of the Problem
• Refers to the probability of success in
minimizing,alleviation or totally eradicating the
problem through nursing intervention
3. Preventive Potential
• Refers to the nature and magnitude of future
problemsthat can be minimized or totally prevented if
intervention is done on the problem under
consideration. EXAMPLE CASE MALNUTRITION

4. Salience
• Refers to the family’s perception and evaluation of
the problem in terms of seriousness an urgency
attention needed.

Scale for Ranking Family Health Problems

according to Priorities

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
EXAMPLE SUMMARY
The list of health problems ranked according to Formulation Objectives of Nursing Care
priorities is presented: “Objectives -refer to more specific statements of the
MALNUTRITION -- 5 desired results or outcomes of care."
SCABIES -- 4
IMPROPER REFUSE DISPOSAL -- 3.67 “It can either be nurse-oriented based on activities of
thenurse or client-oriented stated in terms of outcomes.”
Formulation of Goals and Objectives of Nursing
Care NURSE ORIENTED VS. CLIENT ORIENTED
Establishment of Goals
Goals
• Is a general statement of condition or state to be
brought about by specific courses of action.
• It is the end towards which all efforts are directed.
Example:
o After nursing intervention, the family will be able
to takecare of the premature infant competently.
• Goals relate to health mater
o specifically the alleviation of disease conditions.
o And health problems that intertwined with
otherproblems like socio-economic ones.
Example 1:
o at the end of nursing intervention, the family will be
able to start a piggery business.
Example 2:
o at the end of nursing intervention, the family will be
ableto start litigation proceedings against landlord.

• A cardinal principle in goal setting states that goals

GENERAL VS. SPECIFIC OBJECTIVE
must be set mutually with the family.
• Basic to the establishment of mutually acceptable
goals is the family’s recognition and acceptance
of existing health needs and problems.
• Goals set by the nurse and the family should be
realistic or attainable.
• Goals are best stated in terms of client’s outcomes,
whether at the individual, family, or community
levels

Barriers to Joint Goal Setting Between the Nurse

and the Family
1. Failure on the part of the family to perceive
theexistence of the problem.
2. The family may realize the existence of the
healthcondition or problem but is too busy at the OBJECTIVE TIME FRAME
moment.
3. Sometimes the family perceives the existence of
theproblem but does not see it as serious enough to
warrant attention.
4. The family may perceive the presence of the
problemand the need to take action. It may however
refuse to faceand do something about the situation.
a. Reasons to this kind of behavior:
• Fear of consequences of taking actions.
• Respect for tradition.
• Failure to perceive the benefits of action.
• Failure to relate the proposed action to the
family’s goals.
5. A big barrier to collaborative goal setting between
thenurse and the family is the working relationship.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
Example of Nursing Goal / Objective
The family will cope effectively with the TYPES OF RESOURCES
threat of pulmonary tuberculosis. 1. FAMILY RESOURCES- physical and psycho-social
Short Term -The infant and preschool members of strengths and assets of individual members,
the family will be immunized with BCG. financialcapabilities, physical facilities and the presence of
Medium Term -All members of the family will have a supportsystem provided by relatives and significant
complete physical check-up to rule out pulmonary others.
tuberculosis. 2. NURSE RESOURCES- knowledge about family
Long Term -All members of the family will participate healthand her skills in helping family manage them. These
in the care of the sick members and apply preventive skillsmay range from simple nursing procedure to
measures against the spread of infection. complicatedbehavioral problems such as marital
disharmony.Availability of time and logistical support are
NURSING IMPLEMENTATION PHASE also part ofresources of the nurse.
Selecting Appropriate Nursing Actions 3. COMMUNITY RESOURCES- include existing
The choice of nursing intervention is highly agencies,programs or activities for health and
dependent on two major variables: relatedneeds/problems and community organization for
1. The nature of the problem healthactions
• resolve around the family’s assumption of the
health tasks. METHODS OF INTERVENTION
2. Resource available to solve the problem Family-Nurse Contact
• aimed at minimizing or eliminating the • Home-Visit
possiblereasons for or causes of the family’s inability o Home visit is a professional, purposeful interaction
to do these tasks. thattakes place in the family’s residence aimed at
GOALS AND OBJECTICVES promoting,maintaining and restoring the health of the
S – Specific family or itsmembers.
M – Measurable • Clinic- Visit
A – Attainable o takes place in a private clinic health center,
R – Realistic barangayhealth station.
T – Time Bound o Major advantage is the fact that a family member
takesthe initiative of visiting the professional health
worker,usually indicating the family readiness to
PRINCIPLES OF NURSING ACTIONS participate in the health care process.
• To stimulate recognition and acceptance of health o Because the nurse has greater control over
needs and problems theenvironment, distraction are lessened and the family
• The nurse can work on the family’s failure to decide mayfeel less confident to discuss family health concerns.
ontaking appropriate health actions • Group Approach
• The nurse can increase the family’s confidence o appropriate for developing cooperation,leadership,
inproviding nursing care to its sick, disabled and self-reliance and or community awareness among group
dependentmember through demonstrations on members.
nursing proceduresutilizing supplies and equipment’s o The opportunity to share experiences andpractical
available in the home. solutions to common health concerns is astrength of this
• The nurse should involve the patient and family in type of family-nurse contact.
orderto motivate them to assume responsibility for • Telephone Conference
their own care. • Written Communication
• The nurse also explains and clarifies doubts thus o used to give specific information to families, suchas
the roleof the nurse shifts direct care giver to that of instructions given to parents through school children.
a teacher. • School Visit or Conference
• She can explore the ways to minimize or prevent • Industrial or Job Site Visit
threatsto the maintenance of health and personal
development among family members THE NURSING BAG
• She can utilize intervention measures • Frequently called the PHN bag is a tool used by
involvingenvironmental manipulations through thenurse during home or community visits to be able
improvements on the physical facilities in the home toprovide care safely and efficiently.
either by construction ofneeded ones or modifying • Serves as a reminder of the need for hand hygieneand
existing ones. other measures to prevent the spread of infection.
• To minimize or eliminate psychological threats in • Nursing bag usually has the ff. contents:
thehome environment, the nurse can work closely o Articles for infection control
with the family to improve its communication o Articles for assessment of family members
patterns, roleassumptions and relationships and o Note that the stethoscope andsphygmomanometer
interaction patterns. are carried separately.

By: Torres & Belmonte

 BACHELOR OF SCIENCE IN NURSING 2YA-11
CHNN211 LECTURE: BSN SECOND YEAR – 1ST SEMESTER PRELIM 2023
o Articles for nursing care ACTIVITY AND OUTCOME
o Sterile items • ACTIVITIES - are actions performed to accomplish
o Clean articles anobjective. They are the things the nurse does in order to
o Pieces of paper achieved a desired result or outcome. Activities
• Bag technique helps the nurse in infection control. consumetime and resources. Examples are health
• Bag technique allows the nurse to give teachings,demonstration and referrals.
careefficiently. • OUTCOME - is the results produced by activities. Where
• It saves time and effort by ensuring that the activity is the cause, outcome is the effect. They can also
articlesneeded for nursing care are available. be immediate, immediate or ultimate outcomes.
• Bag technique should not take away the Patientcare outcomes can be measured along three broad
nurse’sfocus on the patient and the family. lines:
• Bag technique may be performed in different • PHYSICAL CONDITION - decreased temperature
ways,principles of asepsis are of the essence and orweight and change in clinical manifestations
shouldbe practiced at all times. • PSYCHOLOGICAL OR ATTITUDINAL STATUS -
decreased anxiety and favourable attitude towards health
NURSING EVALUATION PHASE care personnel.
“The determination of whether the objectives set • KNOWLEDGE ON LEARNING BEHAVIOR -
wereattained or to what degree they were attained.” complianceof the patient with instructions given by the
“Evaluation is always related to objectives.” nurse.
“Evaluation when address to the result or outcome
ofcare answers the question {did the intended results
occur?}”
“There is always an element of subjectivity
inevaluation; the process involves value judgement
which is subjective”
“Evaluation also involves decision-making”

DIMENSIONS OF EVALUATION
• EFFECTIVENESS- focus is attainment of the
objectives
• EFFICIENCY- relates to cost whether in terms
ofmoney, time, effort, or materials
• APPROPRIATENESS- ability to solve or
correctexisting problem situation, a question that
involvesprofessional judgement.
• ADEQUACY- pertains to its comprehensiveness
whether all necessary activities were performed
inorder to realize the intended results.

CRITERIA AND STANDARD

• CRITERIA- refer to the signs or indicators that tell
us if the objective has been achieved. They are
names and description of variables that are relevant
indicators ofhaving attained the objectives. They are
free from anyvalue judgement and are independent
to time frame.
• STANDARD- once a value judgement is applied to
acriterion; it acquires the status of a standard. It
refers to thedesired level of performance
corresponding with a criterionagainst which actual
performance is compared. It tells uswhat the
acceptable level of performance or state of
affairsshould be for us to say that the intervention
wassuccessful.

By: Torres & Belmonte