Maternal Child Health Nursing Module 1

1. Maternal Child Health NursingModule 1

2. Objectives – Day 1 • Discuss the female reproductive system anatomy/physiology, disorders, medical treatment, nursing care.

3. Female Anatomy and Physiology • Female reproductive system • Ovaries-produce estrogen and progesterone – and eggs or ova • Fallopian tubes, sometimes called oviducts or uterine tubes - where fertilization takes place • Uterus-3 layers (endo-, myo-, peri- metrium) fundus, corpus, cervix • Vagina

5. AccessoryOrgans • In females • Oviducts • Uterus • Vagina • Greater vestibular glands (Bartholin's) • Vulva and perineum

6. Female reproductive system. The enlargement (right) shows ovulation. 

7. Female Anatomy and Physiology • External genitalia-mons pubis, labia majora/minora, clitoris, and vestibule (a recess which contains the opening to the urethra) • Accessory glands • Skene’s glands-similar to prostate gland • Bartholin’s glands-provide lubrication • Perineum • Mammary glands (breasts)

9. Female: superior inlet

10. Female: inferior outlet

13. The Ovaries • Located in pelvic abdomen • Held by ligaments • Attached to uterus and body wall • Contain and release eggs during ovulation

15. The Ova and Ovulation • Ovarian follicle (Graafian follicle) • Holds ripening ova • Secretes estrogen • Ruptures to discharge egg cell (ovulation) • Oviduct (aka Fallopian Tube) • Tube that leads to uterus

16. The Corpus Luteum • Formed from remains of follicle after ovum is expelled • Secretes estrogen and progesterone • Usually shrinks and is replaced by scar tissue unless pregnancy initiated • Remains active during early pregnancy

17. The Oviducts: Fallopian Tubes • Extend from near ovary to uterus • Not directly connected to ovary • Fimbriae produce current that sweeps ova into oviduct • Cilia in tube lining and peristalsis of tube move ova

18. The Uterus • Organ where fetus develops to maturity • Myometrium • Muscular wall • Endometrium • Specialized epithelium lining • Corpus • Body • Cervix • Neck • Fundus • Supporting ligaments

19. The Cervix

20. The Vagina • Distal part of birth canal that opens to outside of body • Fornix • Posterior fornix • Cul-de-sac (rectouterine pouch or pouch of Douglas) • Hymen • Greater vestibular (Bartholin's) glands

21. Female reproductive system (sagittal section). This view shows the relationship of the reproductive organs to each other and to other structures in the pelvic cavity.  

22. The Vulva and the Perineum Vulva: external parts of female reproductive system - Labia - Clitoris - Related structures - Obstetrical perineum

23. The Menstrual Cycle • Controlled by pituitary hormones regulated by hypothalamus • Cyclic pattern • Regulated by hormonal feedback • Averages 28 days

24. Beginning of the Cycle • Several follicles in ovary begin to develop • Increased production of estrogen • Thickens endometrium • Elongates uterine secretion glands • Inhibits release of FSH • Stimulates pituitary to release LH

25. Ovulation • Luteinizing Hormone (LH) surge in blood • Causes ovulation • Transforms ruptured follicle into corpus luteum that produces estrogen and progesterone • Endometrium thickens • Glands and blood vessels increase in size • Follicle Stimulating Hormone (FSH) and LH are inhibited

26. TheMenstrualPhase • If ovum is not fertilized, corpus luteumdegenerates • Estrogen, progesterone levels decrease • Endometrium degenerates, produces menstrual flow • Endometrium begins to repair itself • FSH released from anterior pituitary

28. Menopause • Menstruation ceases • Normal ovarian function declines • Follicles stop ripening • No appreciable amounts of estrogen produced • Uterus, oviducts, vagina, vulva become somewhat atrophied • Vaginal mucosa becomes thinner, dryer, more sensitive

29. HormoneReplacement Therapy • Combination of estrogen with synthetic progesterone prescribed to relieve menopause discomfort • Increases breast cancer risk • Increases thrombosis and embolism risk • Risks increase with duration of therapy

30. Common Diagnostic Tests • Laboratory Tests • Radiologic Tests • Surgical Tests • Other Tests

31. Reproductive Lab Tests • Triple or Quad screen • Cultures • HCG • Pap Smear • Serum Alkaline Phosphatase • Serum Calcium • Segmented Bacteriologic Localization Culture

32. More lab tests • Rubella immunity • HIV antibody • Tests for sexually transmitted diseases • Hepatitis B screen • Varicella zoster viral screen • TORCH panel • Group B strep

33. Lab tests (cont’d) • Glucose challenge test • Platelet count, H&H, Rh antibody screen • Fetal fibronectin (fFN) • Lecithin-sphingomyelin ratio • Triple and Quad screens

34. Cultures • Cultures and ‘smears’ are collected from exudates of the breast, vagina, rectum and urethra • They can be used to examine and identify: • Infectious processes • Presence of abnormal cells • Hormonal changes • Spread the collected specimen on a slide with aseptic technique

35. Clean catch urine • Frequently used to measure protein, glucose, WBCs and other elements in urine • Have patient clean area around urethral opening with antiseptic wipe • Have patient void some urine, stop stream and void urine into specimen cup and then finish urinating • Nurse uses standard precautions

36. Human Chorionic Gonadotropin (HCG) in other contexts • Confirms pregnancy, threatened or incomplete abortion • Produced by embryo to prompt corpus luteum to increase estrogen and progesterone • Assists in the diagnostic of HCG – producing tumors, such as choriocarcinoma or hydatidiform moles

37. Papanicolaou (Pap) Test (Smear) • Used to screen for early detection of cervical cancer and/or infections (such as HPV) • Examines scrapings of secretions and cells taken from the cervix • Label slides with date and time of collection, LMP, and whether the woman is taking estrogens or BCP • Women should have yearly Pap smears beginning at age 21 or three years after first sexual intercourse every 2-3 years. More frequent exams may be required for high risk factors.

38. Radiology: Hysterosalpingogram • Study for visualizing the uterine cavity to confirm: • Tubal abnormalities (adhesions and occlusions) • The presence of foreign bodies • Congenital malformation and leiomyomas (fibroids) • Traumatic injuries

39. Hysterosalpingogram • Lithotomy position • Insertion of speculum into the vagina • Cannula inserted through the speculum into cervical cavity • Contrast medium injected through the cannula • Uterus and oviducts then viewed by a fluoroscope and films taken

41. Radiology: Mammography • soft tissue of the breast • identification of various benign and neoplastic processes, especially those not palpable on exam • Mammograms should be performed yearly after age 40 (American Cancer Society). High-risk women should also get an annual breast MRI

42. Surgery: Breast Biopsy • Used to differentiate benign or malignant tumors • Needle biopsy ~ local anesthetic, biopsy taken from the breast. Pressure applied to site to stop bleeding. • Open biopsy ~ general or local anesthetic, incision into breast to expose suspicious tissue and then specimens obtained. Sutures and dressing applied to incision.

43. Surgery: D & C • Dilation and Curettage – scraping of material from the wall of a cavity or other surface; performed to remove tumors or other abnormal tissue for microscopic study • General anesthesia, the cervix is dilated, and the walls of the uterus scraped with a curette

44. Modern speculum Used for dilation of cervix

45. Surgery: Endometrial biopsy • Tissue collection: diagnosis of endometrial cancer and analysis for infertility studies. • Performed at time of menstruation, as cervix is partially dilated and cells are more easily obtained • Cervix is locally anesthetized, a curette (loop) is inserted and tissue is obtained

46. Surgery: Laparoscopy • Visualizes abdominal cavity • Uterus, adnexa • small incision beneath the umbilicus • Foley Catheter inserted to keep bladder decompressed • General anesthesia • C02 to inflate abdomen • Gas, referred pain to shoulder

47. Nursing care: surgery • Ensure urinary elimination • Foley catheter may be needed until patient able to void • Discharge instructions should include safety • No lifting more than 10 lbs until cleared by physician • Teach s/s infection, how to clear any drains and monitor dressings and sites

49. Colposcopy • Mounted, lighted instrument • exams cervix, vagina • Indications: • Follow-up of abnormal Pap • abnormal bleeding or pain during intercourse • sores on the vulva