ANATOMY AND PHYSIOLOGY OF THE

REPRODUCTIVE ORGAN
Sheila S. Zate RM,RN | Midterm

FEMALE EXTERNAL STRUCTURES clitoral hood and the frenulum of the

- The structures that form the female external clitoris.
genitalia are termed the vulva (from the 4. CLITORIS
Latin word for “covering”). - The clitoris is a small (approximately
- The term VULVA or PUDENDA refers to the 1 to 2 cm), rounded organ of erectile
entire female external genitalia. tissue at the forward junction of the
1. MONS PUBIS labia minora.
- The mons pubis is a tissue mound - It’s covered by a fold of skin, the
made up of fat located directly prepuce; is sensitive to touch and
anterior to the pubic bones. temperature; and is the center of
- This mound of tissue is prominent in sexual arousal and orgasm in a
females and is usually covered in woman.
pubic hair. The mons pubis functions - composed of two erectile tissues
as a source of cushioning during called corposa cavernosa that are
sexual intercourse. connected to the pubic bone.
- The mons pubis also contains 5. HYMEN
sebaceous glands that secrete - is a tough but elastic semicircle of
pheromones to induce sexual tissue that covers the opening to the
attraction. vagina during childhood.
2. LABIA MAJORA - is often torn during the time of first
- The word "labia majora" is defined sexual intercourse.
as the larger lips. 6. URETHRAL MEATUS
- The labia majora are a prominent - the external opening of the female
pair of cutaneous skin folds that will urethra is located just below the
form the lateral longitudinal borders clitoris.
of the vulval clefts. - The purpose of the urethra is for the
- The labia majora forms the folds that excretion of urine.
cover the labia minora, clitoris, vulva - The urethra in females opens within
vestibule, vestibular bulbs, the vulva vestibule located inferior to
Bartholin's glands, Skene's glands, the clitoris, but superior to the vagina
urethra, and the vaginal opening. opening.
- The labia majora engorges with - the shortness of the female urethra
blood and appears edematous makes a woman more susceptible to
during sexual arousal. urinary tract infection (UTI) than
3. LABIA MINORA men.
- The "labia minora" is defined as the - The urethra in females opens within
smaller lips. the vulva vestibule located inferior to
- The labia minor are a pair of small the clitoris, but superior to the vagina
cutaneous folds that begins at the opening.
clitoris and extends downward. The 7. VAGINAL ORIFICE
anterior folds of the labia minora - is the external opening of the vagina
encircle the clitoris forming the located just below the urethral
meatus.
Type your initials here | 1
 -the Grafenberg or G-spot is a very 4. OVARIES
sensitive area located at the inner - Ovaries are small, oval-shaped
anterior surface of the vagina. glands that are located on either
8. FOURCHETTE side of your uterus. Your ovaries
- -is the ridge of tissue formed by the produce eggs and hormones.
posterior joining of the labia minora 5. FALLOPIAN TUBE
and the labia majora. - These are narrow tubes that are
- the structure that sometimes tears attached to the upper part of your
(laceration) or is cut (episiotomy) uterus and serve as pathways for
during childbirth to enlarge the your egg (ovum) to travel from your
vaginal opening. ovaries to your uterus.
9. PERINEAL MUSCLE - Fertilization of an egg by sperm
- Often called as the perineal body normally occurs in the fallopian
- posterior to the fourchette. tubes. The fertilized egg then moves
- is a muscular area, it stretches to the uterus, where it implants into
during childbirth to allow your uterine lining.
enlargement of the vagina and
passage of the fetal head.
FEMALE INTERNAL STRUCTURES
1. VAGINA
- Your vagina is a muscular canal that
joins the cervix (the lower part of
uterus) to the outside of the body.
- It can widen to accommodate a baby
during delivery and then shrink back
to hold something narrow like a
tampon. It’s lined with mucous
membranes that help keep it moist. Female internal structure
2. CERVIX
- Your cervix is the lowest part of your
uterus. A hole in the middle allows
sperm to enter and menstrual blood
to exit. Your cervix opens (dilates) to
allow a baby to come out during a
vaginal childbirth.
- Your cervix is what prevents things
like tampons from getting lost inside
your body.
3. UTERUS Female external structure
- Your uterus is a hollow, pear-shaped
organ that holds a fetus during MALE REPRODUCTIVE STRUCTURES
pregnancy. Your uUterus is divided 1. SHAFT OR BODY
into two parts: the cervix and the 2. GLANS
corpus. - is a bulging, sensitive ridge of tissue
- Your corpus is the larger part of your at the distal end of the organ
uterus that expands during 3. PREPUCE
pregnancy. - Or the foreskin

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 - a retractable casing of skin; protects bladder and empty into the urethra
the nerve-sensitive glans at birth. In by ejaculatory ducts.
some cases the prepuce is too tight - These glands secrete a viscous
and cannot be retracted over the alkaline liquid with a high sugar,
glans, this condition is called protein, and prostaglandin content.
phimosis - Sperm become increasingly motile
4. URETHRAL MEATUS because this added fluid surrounds
- is the slit like opening located at the them with a more favorable pH
tip of the penis which serves as environment.
passageway of both semen and 10. EJACULATORY DUCT
urine. - pass through the urethra and then,
5. SCROTUM connect the seminal vesicles to the
- is a rugated, skin-covered, muscular urethra carrying the secretions of the
pouch suspended from the perineum said organs; the passageway of the
containing the testes; covered by semen.
sparse hair after puberty. 11. PROSTATE GLANDS
- - is supplied abundantly by sweat - is a chestnut-sized gland that lies
and sebaceous glands; has no just below the bladder and allows
subcutaneous fat because the testes the urethra to pass through the
must be kept cool. center of it, like the hole in a
Its functions are: doughnut.
- To support the testes and help 12. BULBOURETHRAL GLANDS
regulate the temperature of sperm. - Two bulbourethral, or Cowper’s,
6. TESTES glands lie beside the prostate gland
- are two ovoid glands, 2 to 3 cm and empty by short ducts into the
wide, that rest in the scrotum. urethra. They supply one more
- Each testis is encased by a source of alkaline fluid to help
protective white fibrous capsule and ensure the safe passage of
is composed of a number of lobules. spermatozoa.
Each lobule contains interstitial cells 13. URETHRA
(Leydig cells) that produce - The urethra is a hollow tube leading
testosterone and a seminiferous from the base of the bladder, which,
tubule that produces spermatozoa. after passing through the prostate
7. EPIDIDYMIS gland, continues to the outside
- a tightly coiled tube about 6m (20 ft) through the shaft and glans of the
long that caps the superior part of penis.
the testis. - It is about 8 in. (18 to 20 cm) long.
8. VAS DEFERENS (DUCTUS DEFERENS) Like other urinary tract structures, it
- is an additional hollow tube is lined with mucous membrane.
surrounded by arteries and veins
and protected by a thick fibrous
coating, which, altogether, are
referred to as the spermatic cord .
9. SEMINAL VESICLE
- are two convoluted pouches that lie
along the lower portion of the

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FEMALE BREAST ➢ When palpating for breast health, always
- are accessory organs of reproduction meant include the axillary region in the
to provide the infant with the most ideal examination, or this breast tissue can be
nourishment after birth. missed.
- They are situated over the pectoralis major ➢ The nipple on these auxiliary sites may look
muscles, between the second and sixth ribs. like a mole, so adolescents may report this
- The breasts are supported by the cowper’s as a “mole changing in color” or be
ligaments. concerned they have skin cancer.
Gynecomastia INTERNAL STRUCTURES
- boys, especially those who are obese, may 1. LOBES
notice a temporary increase in breast size at - Lobes – 15 to 20 lobes are found in
puberty. the breast that are divided into
EXTERNAL STRUCTURES several lobules.
1.Nipple or Mammary Papillae 2. LOBULES
- located at the center of the anterior - Composed of clusters of acini cells
surface of each breast. 3. ACINI CELLS
- has 15-20 opening connected to - are the milk secreting cells of the
lactiferous ducts and in which milk breasts that are stimulated by
flows out. prolactin hormone.
2. Areola 4. LACTIFEROUS DUCTS
- the pigmented skin that surrounds - ducts that serve as passageway of
the nipple. milk.
3. Montgomery Tubercles 5. LACTIFEROUS SINUS
- Glands in the areola that secrete an - dilated portions of the ducts located
oily substance that keeps the areola behind the nipple that serve as
and nipple lubricated. reservoir of milk.
➢ Breasts are located anterior to the pectoral HORMONES AFFECTING THE DEVELOPMENT
muscle and, in many women, breast tissue OF BREAST
extends well into the axilla. Estrogen
➢ When palpating for breast health, always - stimulates the development of ductile
include the axillary region in the structures of the breast.
examination, or this breast tissue can be Progesterone
missed. - stimulates the development of the acinar
➢ It is not uncommon for women or men to structures of the breast
have supernumerary breast tissue along Human placental lactogen
mammary lines on the front of their body. - promotes breast development during
➢ The nipple on these auxiliary sites may look pregnancy.
like a mole, so adolescents may report this Oxytocin
as a “mole changing in color” or be - let-down reflex. This hormone is inhibited by
concerned they have skin cancer. progesterone.
➢ You can assure them supernumerary breast Prolactin
tissue or nipples are not uncommon and are - stimulates milk production. This hormone is
innocent findingsBreasts are located inhibited by estrogen.
anterior to the pectoral muscle and, in many
women, breast tissue extends well into the
axilla.

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PHYSIOLOGY OF MENSTRUATION about two weeks before the start of the
Menarche menstrual period
- the first menstrual period
- the average age at which it occurs is 12.4
years of age It may occur as early as age 9
years or as late as age 17 years.
- Irregular menstrual periods are the
rule rather than the exception for the
first year or two.
- Menstrual periods do not become
regular until ovulation occurs
consistently and this does not tend
to happen until 1 to 2 years after
menarche.
MENSTRUATION
- A menstrual cycle (the chromosomal female
reproductive cycle) is episodic uterine
bleeding in response to cyclic hormonal
changes. HUMAN SEXUALITY
- Purpose: is to bring an ovum to maturity - is the way people experience and express
and renew a uterine tissue bed that will be themselves sexually
necessary for the ovum’s growth should it - involves biological, psychological, physical,
be fertilized. erotic, emotional, social, or spiritual feelings
- The length of menstrual cycles and behaviors.
differs from woman to woman - Because it is a broad term, which has varied
- the average length is 28 days (from with historical contexts over time, it lacks a
the beginning of one menstrual flow precise definition.
to the beginning of the next). Sexual Identity
- It is not unusual for cycles to be as - Sexual identity describes how a person
short as 23 days or as long as 35 identifies related to their sexual orientation.
days. - Hence a man who exclusively prefers
- The length of the average menstrual women will usually have a straight or
flow termed menses) is 4 to 6 days, heterosexual sexual identity, and a woman
although women may have flows as who exclusively prefers women usually a
short as 2 days or as long as 9 days lesbian or homosexual sexual identity.
(Ledger, 2018). Gender identity
- describes the gender with which a person
Four body structures are involved in the physiology identifies (i.e, whether one perceives
of the menstrual cycle: oneself to be a man, a woman, or describes
● The hypothalamus oneself in some less conventional way.
● The pituitary gland - Gender identity may be affected by a variety
● The ovaries of social structures, including the person's
● The uterus ethnic group, employment status, religion or
Ovulation irreligion, and family.
- is a phase of the female menstrual cycle Gender role
that involves the release of an egg (ovum)
from one of the ovaries. It generally occurs

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a set of perceived behavioral norms associated - enlargement of the testes and tightening of
particularly with males or females, in a given social the scrotal sack in those with testes
group or system. PHASE 2: PLATEAU
If a person continues to receive sexual stimulation
HUMAN SEXUAL RESPONSE after the excitement phase, they move into the
- Sexuality has always been a part of human second stage: plateau.
life, but only in the past few decades has it - In the plateau phase, the responses initiated
been studied scientifically. during the excitement phase intensify.
- One common finding of researchers has - Blood flow, heart rate, muscle tension,
been that feelings and attitudes about sex breathing rate, and sensitivity continue to
vary widely across cultures and individuals. increase.
Although the sexual experience is unique to each - People with a vagina may also experience:
individual, sexual physiology (how the body - darkening of the wall of the vagina, which
responds to sexual arousal) has common features expands, elevating the uterus
(Kimmel & Rogers, 2011). - increasing sensitivity in the clitoris
THE SEXUAL RESPONSE CYCLE - increasing lubrication of the vagina
- Two of the earliest researchers of sexual - People with a penis may release some pre-
response were Masters and Johnson. seminal fluid, also known as pre-ejaculate
- In 1966, they published the results of a or pre-cum, or experience further drawing in
major study based on more than 10,000 of the scrotal sack to the body.
episodes of sexual activity among more - The plateau phase ends when the third
than 600 men and women (Masters et al., stage, orgasm, begins.
1998). PHASE 3: ORGASM
In this study, they described the human sexual - The orgasm phase happens when a person
response as a cycle with four discrete stages: is at the peak of sexual excitement. It is also
excitement, plateau, orgasm, and resolution. known as a “climax.”
PHASE 1: EXCITEMENT - This phase happens when a person
- Sexual excitement, also called arousal, is continues to receive sexual stimulation after
the first phase of the sexual response cycle. the plateau phase. Stimulation that may
This phase happens in response to cause an orgasm includes touching the
thoughts, sensations, or events that make a genitals, breasts, nipples, and other body
person feel aroused. parts.
- Examples of things that can trigger the - Features of orgasm include involuntary
excitement phase include viewing muscle contractions, a feeling of euphoria,
pornography, having sexual fantasies, or and a release of tension.
kissing. - During the orgasm phase, a person with a
During the excitement phase, a person may penis may also experience contraction of
experience: the penile muscles and ejaculation, which is
- increased heart rate, breathing rate, and the release of semen from the urethra.
blood pressure - A person with a vagina may experience
- increased muscle tension contraction of the pelvic muscles and a
- increased blood flow to the genitals release of muscle tension.
- increased sensitivity to touch - As well as these physical changes, the
- nipple hardening brain releases a chemical called oxytocin,
- an erection in those with a penis which results in emotional well-being and
- the start of vaginal lubrication in those with the forming of social bonds following the
a vagina orgasm.

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 - The brain also releases dopamine, which prescription sites carefully to avoid
results in a state of relaxation following purchasing inactive or possibly harmful
intercourse medications advertised as pink Viagra.
PHASE 4: RESOLUTION ERECTILE DYSFUNCTION
- The resolution phase returns the body to its - formerly referred to as impotence, is the
pre-aroused state. In this phase, a person inability of a man to produce or maintain an
“recovers” from sexual intercourse and erection long enough for penetration or
orgasm. partner satisfaction (Ghanem, Salonia, &
- A person’s heartbeat and breathing slow Martin-Morales, 2013).
down, blood pressure and muscle tension - It affects as many as 40% of men by age 40
return to normal, and the genitals become years and 65% of men by age 65 years.
smaller and less engorged. A person may Most causes of ED are physical, such as
feel satisfied and tired. aging, atherosclerosis, or diabetes, all of
- After orgasm, a person enters the refractory which are conditions that limit blood supply
period. to the penis.
- The refractory period refers to a period after - It may also occur as a side effect of certain
an orgasm where a person’s body no longer drugs, such as antidepressants (Burnett,
responds to sexual stimuli. 2011) or after discontinuation of finasteride,
- In people with a penis, the penis becomes a drug for male pattern baldness (Irwig &
flaccid, and the person no longer responds Kolukula, 2011).
to stimulation. PREMATURE EJACULATION
- How long a person’s refractory period lasts - is ejaculation before the sexual partner’s
depends on their age, how often they have satisfaction has been achieved (Mulhall,
sexual intercourse, how intimate they are 2012).
with their partner, and the newness of the - It applies to both same sex and opposite
experience. sex couples.
DISORDERS OF SEXUAL FUNCTIONING - Premature ejaculation can be unsatisfactory
- Disorders involving sexual functioning can and frustrating for both partners.
be lifelong (primary) or acquired - The cause, like that of ED, can be
(secondary). They can have a psychogenic psychological.
origin (produced by psychic rather than - Masturbating to orgasm (in which orgasm is
organic factors), a biogenic origin (produced achieved quickly because of lack of time)
by biologic processes), or both. may play a role.
- They occur in both men and women. - Other reasons suggested are doubt about
FAILURE TO ACHIEVE ORGASM masculinity and fear of impregnating a
- The failure of a woman to achieve orgasm partner, which prevent the man from
can be a result of poor sexual technique, sustaining an erection.
concentrating too hard on achievement, or PERSISTENT SEXUAL AROUSAL SYNDROME
negative attitudes toward sexual - Persistent sexual arousal syndrome (PSAS)
relationships. occurs in women and is the excessive and
- Treatment is aimed at relieving the unrelenting sexual arousal in the absence of
underlying cause. It may include instruction desire (Brotto, Bitzer, Laan, et al., 2010).
and counseling for the couple about sexual - It may be triggered by either medications or
feelings and needs. psychological factors and is associated with
- Female Viagra (often referred to as “pink” restless leg syndrome and overactive
Viagra) is not yet available in the United bladder.
States. Caution women to use online

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 - When assessing someone with the disorder, and ejaculation because these actions are
be certain to ask if the person is taking any governed at the spinal level.
herbal remedies such as ginkgo biloba or a - Manual stimulation of the penis or
partner is using a treatment for male pattern psychological stimulation can, however,
baldness as these can have arousal effects. achieve erection in most men with spinal
PAIN DISORDER cord lesions, allowing the man a satisfying
- Because the reproductive system has a sexual relationship with his partner.
sensitive nerve supply, when pain occurs in
response to sexual activities, it can be acute - Most women with spinal cord injuries cannot
and severe and can impair a person’s ability experience orgasm but are able to conceive
to enjoy this aspect of their life. and have children.
- Vaginismus is involuntary contraction of the THE INDIVIDUAL WITH HYPOACTIVE SEXUAL
muscles at the outlet of the vagina when DESIRE
coitus is attempted, which prohibits penile - Lessened interest in sexual relations is
penetration (Reissing, 2012). normal in some circumstances, such as
- Vaginismus may occur in women who have after the death of a family member, a
been raped. Other causes are unknown, but divorce, or a stressful job change.
it could also be the result of early learning - The support of a caring sexual partner or
patterns in which sexual relations were relief of the tension causing the stress
viewed as bad or sinful. allows a return in sexual interest.
- As with other sexual problems, sexual or
psychological counseling to reduce this
response may be necessary.
DYSPAREUNIA
- pain during coitus.
- Dyspareunia can occur because of
endometriosis (abnormal placement of
endometrial tissue), vestibulitis
(inflammation of the vestibule), vaginal
infection, or hormonal changes such as
those that occur with menopause and cause
vaginal drying.
- A psychological component may be present.
Treatment is aimed at the underlying cause.
- Encouraging open communication between
sexual partners can be instrumental in
resolving the problem.
THE INDIVIDUAL WITH DISABILITY
- Individuals who are physically challenged
have sexual desires and needs the same as
all others (Meaney-Tavares & Gavidia-
Payne, 2012).
- They may, however, have difficulty with
sexual identity or sexual fulfillment because
of their disability.
- Males with upper spinal cord injury, for
example, may have difficulty with erections

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 2. Leads to the creation of new life
(procreation)

PROCREATION, CREATION AND

EVOLUTION
Procreation - is the creation of a new
human person, by the act of sexual
intercourse, by a man and a woman
CONCEPT OF UNITIVE AND
Creation - is the making of all things from
PROCREATIVE HEALTH nothing, by an act of God, at some time in
the past. God’s action could have taken a
second, or 6 days, or a million years.
REPRODUCATIVE HEALTH – is a state of
complete physical, mental and social well being Evolutionary theory - is the theory that all
and not merely the absence of disease of infirmity things came about by the repeated random
in all matters related to the reproducative system actions of natural selection, whereby:
and to its functions and processes. 1. Life came into existence, and then
2. Primitive life evolved into more
SEXUAL HEALTH – means having a responsible, and more complex organism, and
satisfying and sex life, that is free from disease, eventually producing mankind.
injury violence, disability, unnecessary or risk of
death
Family of Orientation– the family to which
one is born, reared and socialized. It
A CONCEPT OF UNITIVE AND PROCREATIVE consists of a father, mother, brothers and
HEALTH sisters.
- UNITIVE - Union of two individuals that is • Family of Procreation– the family
mutually agreed to become one established by the person by his/her
- PROCREATIVE - Create and produce marriage, consists of a husband,
another life. wife, sons and daughters.
-Thus, unitive, and procreative are sacred
Marriage is when a man and woman unite CHARACTERISTICS OF THE FAMILY AS
“as one flesh” Sex is unitive. A CLIENT
- Marriage needs to be open to the possibility • The family is behaving, functioning
of having children. Sex is procreative organism.
- The unitive and procreative aspects of the • The family develops its own lifestyle.
sexual act are inseparable. • The family operated as a group.
- All marital acts must respect both the unitive • The family accommodates to the
and procreative purposes of the marital act. need of the individual.

CHARACTERISTICS OF HEALTHY FAMILIES:

SEXUAL RELATIONSHIP IN MARRIAGE  Communicates and listens
HAS TWO PURPOSES  Supports its members
1. Strengthen the couple and allows them to  Teaches respect for others
express their love in a powerful way  Develops trust
(unitive).  Plays and shares a sense of humor

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  Strong sense of family - Although such a relationship may be
 Seeks help when necessary temporary, it may also be as long-lasting
and as meaningful as a more traditional
alliance. Many couples choose cohabitation
The Concept of Family as a way of getting to know a potential life
• Family is defined by the U.S. Census partner before marriage because of the
Bureau (USCB, 2010) as “a group of people hope this will make their eventual marriage
related by blood, marriage, or adoption stronger.
living together.” - Statistically, however, couples who cohabit
• Allender (2013) defines the family in a much before marriage have a higher divorce rate
broader context as “two or more people who than those who do not (Cherlin, 2012).
live in the same household (usually), share
a common emotional bond, and perform Positive aspects: Companionship, possibly
certain interrelated social tasks.” financial security; encourages a monogamous
relationship
Potential negative aspects: As with dyad
Family Types families, may result in a feeling of loss if only short
term and the breakup isn’t desired by both partners
• For the purposes of assessing families, two
basic family types can be described:
• Family of orientation (the family one is
 The Nuclear Family - is composed of a
born into; or oneself, mother, father, and
husband, wife, and children.
siblings, if any)
- it was the most common family structure
• Family of procreation (a family one
seen worldwide.
establishes; or oneself, spouse or significant
- The biggest advantage of a nuclear family is
other, and children, if any)
its ability to provide support to family
members because, with its small size,
people know each other well and can feel
 The Dyad Family - is two people living together
genuine affection and support for and from
without children.
each other.
- usually refers to single young adults who
Positive aspects: Support for family members;
live together in shared apartments or
sense of security
dormitories for companionship and financial
Possible negative aspects: May lack support
security while completing school or
people in a crisis situation
beginning a career.
- Dyad families are generally viewed as
temporary arrangements, but this could
 The Polygamous Family - Although polygamy
extend into a lifetime arrangement.
(a marriage with multiple wives or husbands)
Positive aspects: Companionship, possibly
has been illegal in the United States since
shared resources
1978, such families are not an unusual
Potential negative aspects: Often a short-
arrangement worldwide, so new immigrants
term arrangement so can result in a sense
may report they have been raised in this type of
of loss when the relationship ends
family (or may still be living in this
arrangement).
- This category can be further divided into
 The Cohabitation Family - are composed of
polygyny (a family with one man and
couples, perhaps with children, who live
several wives) and polyandry (one wife
together but remain unmarried.
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 with more than one husband) (Jacobson & security, and sexual fulfillment, or form the
Burton, 2011). same structure as a nuclear family.
Positive aspects: Companionship; shared
resources  The Foster Family - Children whose parents
Possible negative aspects: Not sanctioned by can no longer care for them may be placed in a
law; disapproval by community; decreased foster or substitute home by a child protection
value of women agency (Kubiak, Kasiborski, Karim, et al.,
2012).
 The Extended (Multigenerational) Family - - Foster parents may have children of their
includes not only a nuclear family but also other own; they receive remuneration for care of
family members such as grandmothers, the foster child.
grandfathers, aunts, uncles, cousins, and - Theoretically, foster home placement is
grandchildren. temporary until children can be returned to
Advantage of such a family is it contains more their own parents.
people to serve as resources during crises and - Unfortunately, if return does not become
provides more role models for behavior or possible, children may be raised to
values (Keene, Prokos, & Held, 2012). adulthood in a series of foster care families.
Positive aspects: Many people for child care
and member support  The Adoptive Family - Families of a great
Possible negative aspects : Resources may many types (nuclear, extended, cohabitation,
be stretched thin because of few wage earners blended, single parent, gay, and lesbian) adopt
children today.
 The Single-Parent Family - single-parent - No matter what the family structure,
families play a large role in childrearing. adopting not only brings unusual joy and
- Unfortunately, low income is often a fulfillment to a family but can also offer a
problem encountered by single-parent number of challenges for both the adopting
families, especially if a woman is the head parents and the child as well as for any
of the household. other children in the family (Jones, 2012).
- Single parents have difficulty working full
time plus taking total care of young children.
- Trying to fulfill several central roles (mother FAMILY FUNCTIONS AND ROLES
and father) is not only time consuming but Family roles
also mentally and physically exhausting • Nurturer Who is the primary caregiver to
and, in many instances, not rewarded. children or a physically or cognitively
challenged member?
 The Blended Family - (a remarriage or • Provider Who brings in the bulk of the
reconstituted family), a divorced or widowed family’s income?
person with children marries someone who also • Decision maker Who makes decisions,
has children. particularly in the area of lifestyle and how
leisure time is spent?
 The Gay or Lesbian Family - Gay is the • Financial manager Who supervises the
socially preferred term to describe men who family fi nances (pays the bills, provides
have sex with men; lesbian is used to denote savings for the future)?
women who have sex with women. • Problem solver Who does the family
- Gay couples or lesbian couples live together depend on to provide a solution to
as partners for companionship, financial problems?

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 • Health manager Who makes health care other families or their community for help as
decisions, ensures family members keep needed.
health appointments, immunizations are 8. Maintenance of motivation and morale:
kept current, and preventive care such as a Healthy families are able to maintain a sense of
mammogram for the mother is scheduled? unity and pride in their family. Assessing
• Culture bearer Who maintains family and whether a feeling of loyalty to other family
community customs so children can develop members is present tells you a lot about the
a sense of where they belong in history? overall health of a family.
• Environmentalist Who is responsible for
recycling and not wasting electricity or
water?
• Gatekeeper Who determines what
information will be released from the family Responsible Parenthood - The Responsible
or what new information can be introduced Parenthood and Reproductive Health Act of
2012, also known as the Reproductive Health
Law or RH Law, and officially designated as
Republic Act No. 10354, is a Philippine law that
Family Tasks provides universal access to methTods of
1. Physical maintenance: A healthy family contraception, fertility control, sexual education,
provides food, shelter, clothing, and health care and maternal care.
for its members.
2. Socialization of family members: This task What is the purpose of Responsible
includes being certain that children feel part of Parenthood?
the family and learning appropriate ways to - Responsible parenting, to put things simply,
interact with people outside the family such as is being able to recognize your child's needs
teachers, neighbors, or police. and wants and being able to support them
3. Allocation of resources: This involves in achieving these things. Responsible
determining which family needs will be met and parenthood also has to do with parents
their order of priority, including not only material aiding their children to becoming happy,
goods but also affection and space. responsible adults.
4. Maintenance of order: This task includes
establishing family values, establishing rules
about expected family responsibilities and roles, Responsibilities in parenthood
and enforcing common regulations for family Parenting;
members such as using “time out” for toddlers.  Promotion and support for the physical,
5. Division of labor: Healthy families not only social, and intellectual development of the
evenly divide the workload among members but offspring from infancy to adulthood.
are also flexible enough to interchange  Activities needed to be done to raise a child
workloads as needed. properly until they become a functional part
6. Reproduction, recruitment, and release of of society.
family members: Often not a great deal of
thought is given to who lives in a family; Family structure and health
membership often happens more by changing  Defining the number of family members
circumstances than by true choice.  Responsibility of the parents to make sure
7. Placement of members into the larger that the family size is just enough to ensure
society: Healthy families realize they do not that all the needs of each member are
have to operate alone but can reach out to sustained appropriately

12
 postpartum depression screening, and
Basic needs immunization adherence.
 Basic needs of their child (proper nutrition - Evidence-based maternity care uses the
by providing food that the child needs to best available research on the safety and
grow) effectiveness of specific practices to help
 Adequate grooming parents must provide guide maternity care decisions and to
goof shelter for their children facilitate optimal outcomes in mothers and
newborns.
Safety
 Provider their children with a good condition
of being protected and away from harm or
any other non-desirable outcomes
 Keeping their family member safe and away
from any danger, accident, or diseases

Self esteem
 Ability of an individual to evaluate their
worth subjectively
 Parents must guide their children on how to
see their worth as an individual

Shaping values and discipline

 Parents must show their children the good
and the bad things concerning following the
rules and laws of society

Education
 Good education to their child (priority of all
parents)
 Needed to train an individual to become a
better person

Maintaining health of the family

 Prepare the body of their children to
different factors that could affect its health
 Provide proper vaccination

Evidence - Based practice in Maternal and Child

Health
- The study found that evidence-based
practices in maternal and child health
nursing have a positive effect on the health
outcomes of women and children. Key
findings included the importance of prenatal
education, breastfeeding support,

13
 pregnant woman as early as 10 days after
conception
2. Chadwick’s sign - bluish discoloration of the
cervix, vagina and labia due to increase blood flow,
observed as early as 6-8 weeks pregnant
3. Hegar’s sign - softening of the lower uterine
segment, signs indicate the body’s adaption to
accomodate the growing embryo.
4. Goddel’s Sign - softening of the cervix, occurs
Care of the Mother and the fetus around 6-8 wks of pregnancy
5. Enlarged uterus - increase size of the uterus,
during Prenatal Period can be felt during Physical examination
6. Braxton Hicks Contarction - irregular, painless
contraction that can begin in the 2nd trimester and
 Earliest indicator that a woman is might be
frequency as pregnancy progress.
pregnant, these signs are primarily
subjective, meaning they are based on what
the woman feels and observed in her life
Positive sign of Pregnancy
 Definitive indicators that a woman is pregnant
1. Missed period- often the first sign that prompts
a woman to consider the possibility of pregnancy.
1. Fetal Heartbeat - most conducive signs of
(hormonal imbalances can cause menstrual
pregnancy
iregularities)
- A doppler device can usually pck up the heartbeat
2. Nausea and vomiting - commonly known as
of the heart between 10-12 weeks pregnancy.
“morning sickness”, can occur anytime of the day
- ultrasound can detect earlier
and typically begin around the 6th week of
2. Visualization of the fetus - provide visual
pregnancy.
confirmation of the pregnancy by showing the
3. Breast changes - tenderness, swelling, and
gestational age, fetal heart rate and fetal
darkening of the areola, common early signs of
movement.
pregnancy these chnges are due to hormonal shifts
3. Fetal Movement - known as the quickening,
as the body prepares for breastfeeding.
occurs between 18 and 25 weeks of pregnancy.
4. Fatigue - feeling of tiredness, caused by an
increase levels of hormone progesterone
5. Frequent urination - can lead to more frequent
tryings to the bathroom
Care of the Mother and the fetus during prenatal
6. Food cravings or aversion - many women
Period
experiences changes in their sense of taste, smell
during early pregnancy.
 Prenatal Care
 Physiologic changes of pregnancy
Probable Sign of Pregnancy
• Assessment
 are more objective, can be observed by health
• Naegele’s Rule
professional, during physical examination or
lab.test • Mcdonald’s Rule
• Johnson’s Rule
1. Pregnancy test (OTC) - detects the presence of • Bartholomew’s Rule
Human Chorionic Gonadotropin (HCG) a • Haase’s Rule
hormone provuce rimarily by synoytiotrophobastic
cells of the placenta,appears in the blood of a
14
PRENATAL/ ANTENAL CARE  To estimate EDD accurately.
- the health care you get while you are  To give the first dose of TT after
pregnant 12weeks.
- Periodic and regular supervision  To help the woman for an early and
including examination and advice of safeabortion (MTP), if it is required for her.
awoman during pregnancy (Antenatal  Medical Termination of Pregnancy.
care)  To start the regular dose of folic

acidduring the first trimester Changes in

Importance of Pre-natal care
 To confirm pregnancy and assess the period of Uterine Measurement:
gestation.· Prenatal services for mothers Antenatal (check
 To prevent maternal and neo natal tetanus.· up)
 To facilitate health education regarding  Health history.
diet,rest, avoidance of unnecessary travel -To diagnose pregnancy
and preparation for delivery - To identify any complications durong previous
pregnancies
- To identify any medical/obstetrics condition that
Goal of prenatal care may complicate the pregnancy
1. To screen the high-risk cases.  Physical examination.
2. To prevent or detect or treat early any  Laboratory
complication. examination.Urinalysis,stoolexam,bloodcount
3. To ensure continued medical surveillance and (serological/ blood group Rh).
prophylaxis.  Papsmear,chestx-ray and STI test (if needed)
4. To educate mother about the physiology of  High risk assessment.
pregnancy and labor by:  Iron folic acid (IFA)and necessary medications.
Demonstrations,charts and  TT immunization. ( 5 doses, 2 doses before
diagrams so that fear is removed,and delivery, 1st dose ASAP during pregnancy, 2nd
psychology is improved. atleast 4wks after the 1st,atleast 2wks before
5. To discuss with couple about the place, time due date, after delivery (6mos.after delivery)
and mode of the delivery and care of the  Health education.
newborn  Home visit.
6. To motivate the couple about the need of  Referral if needed
family planning.
7. To advice the mother about breast-
feeding,post-natal care and immunization
Physiologic Changes of
Objective of prenatal care pregnancy
- To ensure a normal pregnancy with deliveryof a
healthy baby from a healthy mother.

Role of the nurse in prenatal care - The nurse

has to do registration of the prenatal mother
so that to assess the following condition:
 Assess the health status.
 To identify and manage high-risk cases

15
 - About 2 weeks before term (the 38th week)
for a primigravida , a woman in her first
pregnancy, the fetal head settles into the
pelvis and the uterus returns to the height it
was at 36 weeks.

Lightening is settling of the fetus into the

midpelvis.
• the point at which lightening will occur is
not predictable in a multipara (a woman who
has had one or more children).
UTERINE CHANGES In such women, it may not occur until labor begins
Changes in Uterine Measurement:

Uterine height - is measured from the top of the

symphysis pubis to over the top of the uterine
fundus.
• although growth of a uterus implies a
Growth of fundic height: pregnancy is causing the increase in size,
- As the uterus enlarges and the products of because a uterine tumor could also cause
conception grow, the fundic height also uterine growth, uterine growth is only a
increases during the entire duration of presumptive symptom of pregnancy.
pregnancy. The increase of fundic height • exact shape of the expanding uterus can be
is an important sign of fetal growth and influenced by the position of the fetus.
well being. Starting at 12 weeks gestation, • As the uterus grows larger, it pushes the
the fundus can already be palpated as it intestines to the sides of the abdomen,
rises out of the pelvic cavity. elevates the diaphragm and liver,
- 12 weeks: at the level of symphysis pubis compresses the stomach, and puts
- 16 weeks: halfway between symphysis pressure on the bladder.
pubis and umbilicus
- 20 - 22 weeks: at the level of umbilicus
- 24 weeks: two fingers above the umbilicus
- 28 -32 weeks: midway between umbilicus
and xiphoid process
- 32-34 weeks: two fingers below the xiphoid
process
- 36 weeks: it usually touches the xiphoid
process and can make breathing difficult
16
Ballottement - From french word ballotter meaning
“to quake”, the fetus can be felt to browse or rise in
the amniotic fluid up against a hand placed in
abdomen
- felt during the 16th to 20th week of pregnancy

Uterine blood vessels and blood flow:

• From15 to 20 ml/min before pregnancy,
blood flow reaches 500 to 750 ml/min at the
end of pregnancy.
• ¾ or 75% of this blood supply goes to the
placenta CERVIX
• at term the placenta, uterus and blood  Color: Color of cervix change from pinkish
vessels contain about 1/6th or more of the to purplish due to increased blood supply.
total blood volume of the mother.  Leukorrhea: Estrogen causes increase
Shape cervical mucus production. Thick mucus
• The uterus loses its pear shape during accumulates in the cervical canal forming
pregnancy. It becomes spherical around 8 an effective barrier against ascending
weeks gestation and becomes ovoid from infection called mucus plug.
16 weeks until term.  During labor, the mucus plug mixes with
Consistency the blood from ruptured capillaries in the
• The uterus becomes increasingly softer cervix and is dislodged when the cervix
because of the growth of decidua and the dilates. This blood stained mucus is called
presence of amniotic fluid. show and is an important sign of labor.
 A mucous plug, called the operculum ,
Isthmus forms to seal out bacteria and help prevent
- The isthmus is a narrow portion of the infection in the fetus and membranes.
uterus that joins the connective tissue of the  Goodel’s Sign: Increased vascularity and
cervix to the muscle fibers of the body of the edema causes the cervix to soften starting 6
uterus to 8 weeks of pregnancy. Cervical softening
- At about the sixth week of pregnancy (at the is due to the influence of estrogen. Before
time of the second missed menstrual flow), pregnancy, the consistency of the cervix
the lower uterine segment just above the can be likened to that of the nose, during
cervix becomes so soft when it is pregnancy it is as soft as the earlobe and
compressed between examining fingers on during labor it is as soft as butter.
bimanual examination.
- Hegar’s Sign - softening of the lower uterine VAGINAL CHANGES
segment and cervical dilatation in response - Increase blood supply results in:
to pressure from the growing fetus 1. Chadwick Sign – purplish discoloration of the
- first described in 1879, by German vagina.
Gynecoogist Enst Heinrich Georg August 2. Increased sensitivity and heightened sexual
Ludwig Hegar. responsiveness.
- Decreased vaginal pH 4 to 5.
- Vaginal secretions before pregnancy have a pH
value greater than 7 (an alkaline pH). During
pregnancy, the pH level falls to 4 or 5 (an acid pH),

17
which helps make the vagina resistant to bacterial 2. Tingling sensation
invasion for the length of the pregnancy. 3. Darkening of the skin around the areola - and its
- This occurs because of the action of diameter increases from about 3.5 cm (1.5 in.) to 5
Lactobacillus acidophilus, a bacteria that grows cm or 7.5 cm (2 or 3 in.).
freely in the increased glycogen environment, 4. Montgomery glands enlarge and become
which increases the lactic acid content of prominent
secretions. 5. Nipples become more erectile,
6. A clear fluid, called colostrum, can be
expressed from it as early as the fourth month.
OVARIAN CHANGES
• Increased vascularity of the ovaries causes
them to be enlarged especially the one that
contains the corpus luteum.
• Corpus luteum is functional until 12 weeks
gestation and produces primarily
progesterone. It also produces estrogen
relaxin, inhibin and sometimes oxytocin.
• Relaxin is a protein hormone. Its exact role
in pregnancy is unknown but it is thought to
induce softness and effacement of the
cervix. .
• The corpus luteum that was created after
ovulation continues to increase in size on
the surface of the ovary until about the 16th
week of pregnancy, by which time the
placenta takes over as the chief provider of
progesterone and estrogen. The corpus
luteum, no longer essential for the
continuation of the pregnancy, regresses in
size and appears white and fibrous on the
surface of the ovary (a corpus albicans). ENDOCRINE SYSTEM
• THYROID GLAND
CHANGES IN THE BREAST • There is diffuse slight enlargement of the
• Subtle changes in the breasts may be one thyroid gland.
of the first physiologic changes of • Increased activity of the thyroid gland
pregnancy a woman notices (at about 6 results in:
weeks). 1. Increased basal metabolic rate (BMR) by
• Increased breast size is due to alveolar about 30%, - Basal metabolic rate measures the
tissue growth, fat deposition and increased calories needed to perform your body's most
vascularity. basic (basal) functions, like breathing, circulation,
• As vascularity of the breasts increases, blue and cell production
veins may become prominent over the 2. Increased thyroxine-binding globulin
surface of the breasts. (produced by the liver), total T3 (tri-iodothyronine)
and T4 (thyroxine). - Thyroxine binding globulin
Breast changes associated with pregnancy (TBG) is the high-affinity serum binding protein for
include: thyroxine and triiodothyronine. Normally, the thyroid
1. Feeling of fullness adjusts to changing concentrations of TBG by
producing more, or less, thyroid hormone to
18
maintain a constant level of metabolically important • The adrenal gland hypertrophies during
free hormone. pregnancy, particularly the cortex, resulting
3. Increased protein bound iodine (PBI). – in increased hormone production.
protein bound iodine is the amount of iodine • Increased mineralcorticoids production is
expressed in micrograms per 100 milliliters of blood stimulated in part by adrenocorticotrophic
serum that is precipitated with serum proteins and hormone (ACTII) secretion and corticotropin
that serves as a measure of the activity of the releasing hormone (CRIH) from the
thyroid gland. placenta. This result in:
1. Increased secretion of aldosterone which
promotes sodium and water retention, contributing
PANCREAS to edema of pregnancy. Urinary aldosterone
• Pregnancy is potentially diabetogenic increases 10 fold by the third trimester
because of the decreased efficiency of 2. There is increased demand for iron, calcium,
insulin which results in increased blood phosphate and magnesium. The major serum
sugar. electrolytes sodium, potassium and chloride have
• HPL decreases efficiency of insulin, as a almost unchanged concentrations during
compensatory mechanism, elevated pregnancy.
glucocorticoid (cortisol) levels stimulates the • Increased glucocorticoids cortisol stimulates
pancreas to produce more insulin. increased insulin production.
• If all urine samples are tested, most • The dexamethasone suppression test
pregnant women will have glycosuria at response is blunted in pregnancy, although
some time during pregnancy but glucosuria the ACTH challenge test is unchanged in
usually occurs during the second trimester. pregnancy.
This is due to: • Angiotensin Il increases 2-4 times the non-
I. The renal threshold for glucose falls pregnant level.
during pregnancy. • Renin Activity increases 2-3 times The non
2. There is reduced tubular reabsorption of – pregnant level.
glucose.
3. Increased glomerular filtration.
PITUITARY GLAND
• The pituitary gland enlarges but this is not
PARATHYROID GLAND essential to pregnancy.
• Enlargement of Parathyroid gland occurs • The pituitary produces the following
during pregnancy as it produces more hormones:
parathyroid hormone to meet increased 1. Anterior Pituitary - Prolactin (PRL):
needs for calcium needed for the  The amniotic fluid prolactin level is 2-10
development of fetal bones and teeth. times this (probably produced by the
• Relative state of iodine deficiency occurs fetus/endometrium of early pregnancy).
during pregnancy because:  Despite increase prolactin secretion,
1. of active transport of maternal iodine to the fetal lactation itself or milk production will not be
placental unit initiated until after delivery of the placenta
2. Iodine excretion is doubled because of the because of the inhibitory effect of estrogen.
increased glomerular filtration rate (GFR).  In labor there is an acute fall, followed by a
3. Iodine is used to form thyroxine hormone. surge 2 hours post partum. These changes
are not observed in women undergoing
elective caesarian sections
ADRENAL GLAND

19
  Prolactin may act synergistically with
estrogen, progesterone and HPL to provide
prolactational changes during pregnancy
including breastdevelopment.Prolactin
levels approach the normal range in non-
lactating women 2-3 weeks after delivery,
but remain high in women who
breastfeed.Gonadotropins: High estrogen
and progesterone levels inhibit LH and FSH
production.
Effects of Estrogen:
- Growth Hormone (GH): Hyperglycemia
1. Palmar Erythema - There is increased
decreases secretion, unchanged to slight increase
vascularization of the palms of the hands causing
during pregnancy.
redness and itching.
- Adrenocorticotropin Hormone (ACTH):
2. Vascular Spider Nevi: Prominent capillaries
Remains unchanged during pregnancy.
under the skin
- Melanocyte Stimulating Hormone: Increased
3. Activation of sweat and sebaceous glands
during pregnancy.
result in increased perspiration and oily skin.

2. Posterior Pituitary
- Oxytocin: Causes contraction of the breast "let-
down reflex“ and the uterus. Increased production
during pregnancy but does not cause uterine
contraction because of the elevated levels of
progesterone.
- Anti-diuretic Hormone (ADH, Vasopressin): Striae gravidarum:
Unchanged during pregnancy  enlargement of the uterus results in
stretching and tearing of the elastic fibers of
the abdominal skin, thus, the striaes.
 Striaes appear pinkish during pregnancy
INTEGUMENTARY SYSTEM
and turn silvery white after delivery. Pruritus
• Increased melanin production: During
or severe itching of the abdominal skin is
pregnancy, the anterior pituitary gland
due to stretching of the skin. Striaes may
produce more melanotropin stimulating
also appear at the thighs and breasts.
hormone which stimulates the melanocytes
 Increase hair growth and fine lanugo
in the skin to produce more melanin. This
appear on the face and chest, usually
results in darker skin coloration in certain
disappears in the postpartum period.
parts of the body:
 The subcutaneous fat becomes thicker in
1. Melasma/ chloasma: Brownish facial
late pregnancy causing the facial features to
discoloration.
look fuller and softer.
2. Linea Nigra – the line that runs from
umbilicus to symphysis become darker in
coloration.
3. Darker and larger areola.

20
 RESPIRATORY SYSTEM • Increased heart rate: The first change in
Normal findings during pregnancy: the cardio-vascular system is peripheral
Respiratory changes during pregnancy are vasodilatation that is due largely to the
chiefly caused by: effects of hormones. This results in a fall in
1. Increased oxygen requirement as the mother systemic vascular resistance which
must supply not only for herself but for the baby, consequently decreases the amount of
too. blood going to the heart. To compensate for
- Total body consumption of oxygen increase by this, the stroke volume increases and the
15-20%. heart rate increases by about 10 to 20 beats
- To provide for the additional oxygen requirement, per minute in an effort to increase the
tidal volume (amount of air inspired) increases in cardiac output by up to 40% to maintain
early pregnancy and continues to rise to 30-40% adequate blood supply to the uterus.
above the pre- pregnancy state. Usually, this will • Benign Cardiac enlargement: the above
return to normal at 6-8 weeks post-partum. mentioned increase cardiac workload
- Inspiratory capacity increases by about 5% results in slight cardiac enlargement by a
. little more than 10%.
2. Progesterone increases sensitivity to carbon • Displacement of the heart by the uterus:
dioxide resulting in lowered plasma PCO2, from 40 Enlargement of the uterus pushes the
mmHg before pregnancy to 27- 32 mmHg during diaphragm upwards, consequently
pregnancy. This favors transfer of carbon dioxide displacing the apex of the heart to the left
by diffusion from the fetus to the mother as fetal and upward so that it lies in the 4th
PCO2, is higher than the maternal PCO2. intercostal space outside the midclavicular
line. The thoracic pressure caused by the
3. Estrogen causes nasal stuffiness that requires gravid uterus is the cause of palpitations
no medication. late in pregnancy

4. Displacement of the diaphragm by the enlarging

uterus up to 4 cm and resultant chest crowding
produce the following effects:
Dyspnea or shortness of breath that is relieved
after lightening
• Hyperventilation: The mother experience
hyperventilation capacity increasing by 40%
at term, in an effort to blow off the extra
carbon dioxide coming from the fetus,
thereby preventing herself from
experiencing acidosis.
• Respiratory alkalosis: Due to
hyperventilation, a normal pregnant woman
experiences respiratory alkalosis and
diminished pulmonary reserve which is
compensated by increasing renal excretion
of bicarbonate and polyuria as more sodium
and water is lost.

CARDIOVASCULAR SYSTEM HEART

21