MCN

FAMILY
● "A group of people related by blood, marriage, or adoption living together." (US Census Bureau, 2009)
● "Two or more people who live in the same household (usually), share a common emotional bond, and perform certain
interrelated social tasks. (Allender & Spradley, 2008)

Types of Family
NUCLEAR FAMILY
● Composed of 2 parents and children.
● Advantage: financial and emotional support, genuine affection for each other
Extended (multigenerational) family
● Nuclear family plus grandparents, uncles, aunties, cousins and grandchildren.
● Contains more people to serve as resources during crises and models for behavior and values.

Single-parent family
● PROS: family can offer the child a special parent-child relationship & increased opportunities for self-reliance &
independence.
● CONS: limited resources

Blended family/Remarriage/Reconstituted
Family a divorced or widowed person with children marries someone
who also has children;
● PROS: increased security and resources, exposure to different customs or culture;
● CONS: rivalry, each spouse may experience difficulty helping rear the other's children, financial problems

DYAD FAMILY
● 2 people living together, usually man & woman (e.g. newly-married couple)
● single, young, same-sex adults who live together as a dyad for companionship & financial security

BINUCLEAR FAMILY
• A family that is created by divorce or separation when the child is raised in two families

COMMUNAL FAMILY
● group of people who choose to live together as an extended family
● make decisions together regarding household matters, finances, and other family affairs, fostering a strong sense of
interdependece and support among all members
● communal families may also include non-blood-related members who are considered part of the family unit due to close
relationships or shared living arrangements

Gay or Lesbian (LGBT) Families

● individuals of the same sex live together as partners for companionship, financial security and sexual fulfilment
● some include children from previous heterosexual relationships, artificial insemination, adoption or surrogate
motherhood
● Pros: advantages of a nuclear family
● CONS: discrimination

FOSTER FAMILY
● foster parents may or may not have children of their own and receive remuneration for their care of the foster child;
theoretically temporary until the kids can be returned to their own parents
● PROS: prevents kids from being raised in large orphanage settings
● CONS: insecurity & inability to establish meaningful relationships due to frequent moves
ADOPTIVE FAMILY
• type of family structure in which a person from the family assumes the parenting of a child from his/her biological parents
through adoption agencies, international adoption and private adoption

Polygamous Family
● marriage with multiple spouses
● polygyny- (1 man with several wives)
● polyandry (1 woman with several husbands)

FEMALE ANATOMY
● External genitalia (collectively known as vulva or pudenda)
● There are seven (7) openings in the female external genitalia (V.A.B.U.S.)
● Vagina
● DAnus
● Bartholin's duct (2)
● Urethra
● Oskene's duct (2)

Mons pubis / Mons veneris - pad of adipose tissues, which lines over the symphysis pubis, which protects the surrounding
delicate tissues from trauma.

Glans clitoris - Erectile tissue located at the upper end of Labia minora; primary site of sexual arousal

● Labia minora - soft longitudinal skin folds between the Labla majora
Clinical Significance: Serves as landmark when inserting urinary catheter
● Labia majora - longitudinal folds of pigmented skin extending from the mons pubis to the perineum. Contains the
Bartholin's gland that secretes yellowish mucus that acts a lubricant during sexual activity.
● Vestibule - a narrow space seen when labia minora are separated that also contains the vaginal introitus, Bartholin's
gland and urethral meatus.
● Vaginal orifice/introitus/opening- external opening of the vagina that contains the hymen.
● Hymen - a membranous tissue ringing the vaginal introitus
● Urethral meatus - small opening between the clitoris and vaginal orifice for the purpose of
urination
● The external genitalia's blood supply:
Arteries: a. Pudendal artery
b. Inferior rectus artery
Vein: Pudendal Vein
● Perineum - tissue between the anus and vagina. Site of episiotomy

c) Secondary sex characteristics of girls

• Occur in order: (GOGO GIRL!)
Growth spurt
Onset of menstruation (Menarche 12.5 y/o average)
Growth of pubic hair (Adrenarche)
Ovulation occurs 1-2 years after menarche Growth of axillary hair (Adrenarche)
Increase in the transverse diameter of the pelvis
Rapid breast development (Thelarche: The hallmark)
Lumalabas: Secretion from vagina

d. Internal Organs (PaPa DiNa Fo nagCR)

• Vagina
PH 4-5
pH from infancy to prepubertal and menopause is 7.5
Divided into 3 parts: upper, middle, lower Female organ for copulation
Normal bacterial flora cells bacilli due to Doderlein bacillus and the vaginal epithelial
environment
Cells contain glycogen
Rugae - permits stretching without tearing

• Cervix (HINT)
Highly elastic due to its high fibrous and collagenous content
It is lined with ciliated columnar epithelium and near the internal os, it is abruptly changed
into stratified squamous epithelium
Narrow neck of the uterus
Iransition point where cancers in the cervix begin - squamocolumnar junction
Clinical significance: (1) For Pap smear; (2) landmark to determine cervical dilatation

Uterus
Functions:
. To receive the ova to fallopian tube
. Place for implantation and nourishment during fetal growth
. Furnish protection to a growing fetus
. Aids in labor and delivery through myometrial contraction
Shape:
● Non-pregnant - pear-shaped
● Pregnant - ovoid
● Multiparous - globular
Weight:
● Non-pregnant - 50-60g
● Pregnant - 1, 000g
Pregnancy to Involution of Uterus:
4th stage of labor - 1, 000g
2 weeks postpartum - 500g
3 weeks postpartum - 300g
5-6 weeks postpartum - 50-60g (non-pregnant weight)

UTERINE ANATOMY
Fundus Upper cylindrical layer
• Portion that can be palpated at the
abdomen to determine the amount of uterine
growth occurring during pregnancy
Isthmus • Short segment between the body and the
cervix
• Portion of the uterus that is most commonly
cut when a fetus is born by a Cesarean
section
Corpus (Body) • Portion of the structure that expands to
contain the growing fetus
Cervix Lower uterine segment
 • Lowest portion of the uterus
Approximately half of it lies above the vagina
and half extends to the vagina
Layers of the Uterus:
● Endometrium - glandular layer
● Myometrium - muscular layer
● Perimetrium - outmost layer
Decidua - Latin word for "falling off"

3 Types of Decidua
Decidua basalis Endometrium that lies directly under the
embryo
Decidua capsularis Portion of the endometrium that stretches or
encapsulates the surface of the trophoblast
Decidua vera Remaining portion of the uterine lining
● Fallopian tubes
● Otherwise known as oviducts or uterine tubes
● Parts of the fallopian tube (medial to lateral)
"In-ls-A-If
Interstitium - uterine portion
Isthmus - narrow and straight, site of sterilization (tubal ligation)
Ampulla - central portion, site of fertilization, common site of ectopic pregnancy (80%)
Infundibulum or the fimbriae
Finger-like projection to the ovaries
• Longest of which is the fimbriae ovaria
Site of ectopic pregnancy

Functions:
● Provide transport for the ovum
● Provide site for fertilization
● Nourishes the zygote
● Ovaries (SHANT)
Source of primary hormones - estrogen and progesterone
Held in place by infundibulopelvic ligaments
Almond shape
No peritoneal covering - easy spread of malignant cells Three (3) to 4 cm long, 2 to 3 cm wide and 1 to 3 cm thick

3 Principal divisions
● A protective layer of surface epithelium
● The cortex filled with the ovarian and Graafian follicle
● The central medulla containing nerves, blood vessels, lymphatic tissue and some smooth muscle tissue

Bony pelvis
Support and protect the pelvic contents
vegnan
Made up of 4 bones
Innominate bones (2)
Sacrum
Соссух

Lined with fibrocartilage and held together by ligaments

 Lined with fibrocartilage and held together by ligaments

Muscular floor of the bony pelvis

•Provides stability and support for surrounding tissues
Levator ani muscle makes up most of the major portion of the floor and comprised by: lliococcygeous
PuboÇoccygeous
PuboRectalis
PuboVaginalis

Pelvic types (Cladwell-Moloy Classification)

1. Gynecoid
– Normal female pelvis
– Transversely rounded or blunt to
– Most favorable for vaginal birth
2. Android
– Wedge shaped or angulated
– Usually seen in males
– Not favorable for vaginal birth
3. Platypelloid
– Flat with an oval inlet
– Wide transverse diameter but short anteroposterior diameter making the inlet
4. Anthropoid
– Oval shape
– Adequate outlet
– Normal or moderately narrow pubic arch

Divisions of the Pelvis

.False Pelvis - situated above the pelvic brim and formed by the ileum
Function: Supports the growing uterus during pregnancy and direct the fetus into the true pelvis near end of gestation
. True Pelvis - inferior half formed by the pubis in front, the ileum and the ischium on the sides and the sacrum and the
coccyx behind It is made up of 3 parts (ICO):
● Pelvic Inlet - entrance way to the true pelvis
● Pelvic Cavity
● Pelvic Outlet
Pelvic Measurements
. True conjugate (Conjugate Vera) - from upper margin of symphysis pubis to sacral promontory (11 cm)
. Diagonal conjugate - from lower border of symphysis pubis to sacral promontory (12.5 - 13 cm)
3. Obstetric conjugate - from inner surface of symphysis pubis, slightly below upper border, to sacral promontory (estimated
by subtracting 1.5-2cm to diagonal conjugate)

Physiology of Menstruation
● Average menstrual cycle -28 days (22-35 days)
● Average blood loss - 50cc (30 to 80 cc)
● Duration - 4-6 days
● Menarche - first menstruation
● Amenorrhea - absence of menses
● Dysmenorrhea - painful menstruation
● Menometrorrhagia - prolonged uterine bleeding at irregular intervals
● Menorrhagia (Hypermenorrhea) - prolonged menses at/regular intervals
● Metrorrhagia - irregular but frequent menses
● Polymenorrhea - regular intervals of less than 21 days
● Menopause - cessation of menstruation within 12 months
● Mean age: 45-55 y/o/
● Premature menopause may occur before age 45 y/o
● Perimenopause or the climacterium - gradual decline of ovary function
 ● May occur 8-10 years before menopause

Ovulation Day
● Occurs 14 days before the start of the next menstruation
● Phases of menstruation by the Uterine cycle (Refer to table on next page)
● Ischemic Phase
● Menstrual Phase
● Proliferative Phase
● Secretory Phase
• Remember: The 1st day of menstruation Is always the 1st day of menstrual cycle

AVERAGE CYCLE: 28 days (23-35days)

Duration of menstrual flow
● 4-6days (normal)
● 1-9 days (abnormal)
Normal blood loss: 30-80 cc, ⅙ cup
Interplay of 4 major organs:
● Hypothalamus
● Anterior pituitary gland
● Ovaries
● Uterus
● Hypothalamus
● Produces GRH or gonadotropin-releasing hormone to stimulate the anterior pituitary gland for the release of hormones
● Anterior pituitary gland
● Also termed as adenohypophysis
● Secretes Gonadtropins (hormones that stimulates the Gonads or Ovaries)
● Stimulates the ovaries to secrete estrogen and progesterone

Gonadotropins
● Follicle-stimulating Hormone (FSH)
● Hormone that is active early in the cycle and is responsible for maturation of the primordial follicle.
● Luteinizing Hormone (LH)
● Hormone most active at the midpoint of the cycle and is responsible for ovulation
● Ovary
● Release of the ovum (egg cell)
● Uterus
● Stimulation from the hormones
● Develops stratum functionalis in preparation for pregnancy - sheds of as menstruation if ovum not fertilized

PHASES OF THE MENSTRUAL CYCLE

Proliferative Phase
• Other terms: follicular phase/ estrogenic phase / post-menstrual phase
• 6 to 14 days
● First phase of menstrual cycle
Always variable in length
● Immediately after the menstrual flow, the endometrium is very thin, approximately once cell layer in depth
Endometrium begins to proliferate as the ovary begins to produce estrogen
● Levels of estrogen will increase in this phase
Graafian follicle
● Most mature of all follicles
● With cavity and ovum ready to be extruded
● With cer fuid rich in etroen
● Only 1 follicle matures per menstrual cycle
● Primordial Follicles
 ● Immature Follicles
● ESTROGEN: secretion effect in Uterus
● • Thickens the uterine lining approximately eight-fold
● LH Surge
● Coincides with ovulation
● Extrusion of ovum from the Graafian follicle signals OVULATION

Luteal Phase
● Other terms: Secretory Phase / Progestational Phase / Premenstrual Phase
● Second phase of menstrual cycle
● Remains constant: always 14 days in length
● Production of corpus luteum occurs
Secretion of luteinizing hormone (LH) peaks in this phase
Cavity is left inside the follicle
● Stimulates change in fluid in Graafian follicle (yellowish, milky white fluid high in progesterone)

PROGESTERONE Effect
● Maintains and organizes uterine lining
● If estrogen is present, the uterine lining would continue to thicken
● Under the influence of luteinizing hormone, the progesterone in the corpus luteum causes the glands of the uterine
endometrium to become corkscrew or twisted in appearance.
● Depo Pro-Vera - this drug contains progesterone and used for dysfunctional uterine bleeding.

Ischemic Phase
● If fertilization does not occur, the corpus luteum in the ovary begins to regress after 8 to 10 days.
● Production of progesterone and estrogen in this phase also decreases
● The decrease in these hormones makes the endometrium to degenerate
● Capillaries rupture with minute hemorrhages and the endometrium sloughs off

Menstrual Phase
● Low levels of Estrogen & Progesterone
● Passage of menstrual flow

B. MALE ANATOMY
a) Secondary sex characteristics of boys
• Occur in order: (P.I.C.H.A.S)
– Penile growth
– Increase in height and weight
– Changes in voice quality
– Hallmark: Growth of testes
– Axillary, face, and pubic hair grow
– Spermatogenesis
b)External
● Penis
– Male organ of copulation
– Elongated cylindrical structure
– Body and shaft
– Composed of
– 2 corpora cavernosa
– Central bulbous spongiosa
– Erection is a parasympathetic response
● Scrotum
Pouch-like structure hanging in front of the anus
Highly pigmented and with scattered hairs Less than 2°C than the body temperature
Composed of the skin and the Dartos muscle
 Contains 2 compartments
● Testes
Two solid ovoid organs 4-5cm long and 2-3cm wide

c)Internal
● Urethra
● Passageway for both urine and semen, extending from the bladder to the urethral
Meatus
● Epididymis
● Responsible for conducting sperm from the tests to the vas deferens
● Site of maturation of the sperm
● Vas Deferens
● Carries sperm from the epididymis through the inguinal canal into the abdominal cavity
● Sperm matures as it passes the vas deferens.
● Seminal vesicle
● Two convoluted pouches that lie along the lower portion of the bladder and empty into the urethra by the way of
ejaculatory ducts.
● Bulbourethral glands or Cowper's glands Adds alkaline fluid to the semen
● Prostate gland
● Located just below the urinary bladder
● Secretes alkaline and most of the seminal fluid
● Gonads
● Ejaculatory ducts
– The canal formed by the union of vas deferens and seminal vesicle which enters the urethra and prostate gland.
● Semen
● Thick, whitish fluid ejaculated by the male during orgasm, contains spermatozoa and fructose-rich nutrients.
● During ejaculation, semen receives contributions of fluid from
● Prostate gland (60%)
● Seminal vesicle (30%) |
● Epididymis (5%)
● Bulbourethral gland (5%)
● Average pH = 7.5

INFERTILITY PROBLEMS
Infertility - couple unable to achieve pregnancy for 1 year of engaging in unprotected coitus
Types:
. Primary infertility - no history of previous conception
. Secondary infertility - with history of previous conception regardless of outcome, but unable to conceive for present
. Idiopathic infertility - unable to conceive to unknown cause

a) Male Infertility factors (SOAP)

– Spermatogenesis disturbance
– Obstruction of duct e.g. seminiferous tubules, vas deferens thus preventing mobilization of sperm
– A qualitative and quantitative change in the seminal fluid Preventing sperm mobility
– Problem with ejaculation and deposition of spermatozoa
– Average amount released during ejaculation: 3-5mL (400 million sperm cells/ ejaculation)
– Lives within the female reproductive tract for 24 to 72 hours
Sperm
● A total of 64 days before they reach maturity.
● Head made up of acrosomes and nucleus, carries the haploid chromosome of the male, enters the ovum during
fertilization
● Tail or flagellum is for motility
● Aspermia - absence of sperm
● Oligospermia - if <20 million sperm / mL
● 90 seconds to reach cervix
● 5 minutes to reach end of fallopian tube
b) Associated Risk Factors in Male Fertility (CHEAPEVE)
– Cryptorchidism (One or both testes failed to descend)
– History of sexually transmitted infection, e.g. gonorrhea
– Exposure to diethylstilbestrol (DES) in utero
– Ascending urethral infections
– Penile anomalies (epispadias & hypospadias)
– Epididymitis Dorsal/ventral
– Varicocele (Enlargement of veins that transport oxygen depleted blood away from the testicle) & history of mumps and
orchitis(Inflammation of the testicles)
– Erectile dysfunction and premature ejaculations

c) Female Infertility Factors (VATUC)

– Vaginal problems
– Anovulation
– Iubal transport problems
– Uterine problems
– Cervical problems

d) Associated Risk Factors in Female Fertility (PETECH)

● P - olycystic ovaries - resence of uterine tumors (Myomas)
● Excessive exposure to radiation
● T- urner's syndrome - 0o much acidity of vagina
● Endometriosis
● Cervical stenosis and polyps
● H - istory of pelvic inflammatory disease (PID) - istory of sexually transmitted infections

HEALTH PROMOTION ACTIVITIES

.Breast Self-examination (BSE) (Every Morning Be Prayerful Not Chatting)
Early detection and prompt treatment of breast cancer under secondary level of prevention monthly examination
Menopause women: same day each month
Beginning at the age of 20
Premenopausal women: 7 days after menstruation Note for any changes from previous BSE
Can be done in front of the mirror or in supine position
. Clinical Breast Examination
● Done by healthcare professionals (MD, Nurse, Midwife)
● Every 3 years from ages 20-40 and yearly after the age of 40 and up
3. Papanicolaou (Pap) smear
● Sexually active women 18 years old above should have annual examination
● High risk women should have yearly examination
Smoking
Having multiple sexual partners and history of HPV infection
Exposed to DES (diethylstilbestrol) in uterus
● Low risk women will have every 3 years after 2 consecutive negative smears of 1 year apart

Interpretation
● Class 1: Normal
● Class 2: Slightly - SUSpICIOUS of malignancy
● Class 3: Moderatel - SuSpicious of malignancy
● Class 4: Probably malignant
● Class 5: Possibly malignant
4. Testicular examination
● Performed same day each month starting adolescent period
● Procedure done after a warm shower when the scrotal skin is most relaxed
● Report for any changes in consistency or difference in size
FERTILIZATION
● Union of Sperm and ova
● Ovum - from ovulation to fertilization
● Zygote - from fertilization to implantation
● Blastocyst - 32-cell zygote
● Embryo - from implantation to end of 7 weeks
● Fetus - from 8 weeks until term
● Conceptus - developing embryo or fetus and placental structures throughout pregnancy

a) Signs of Implantation
● Hartman's sign - vaginal bleeding on implantation
● Process of implantation
● Apposition
● Adhesion
Invasion
Decidua - Endometrium of pregnancy
Decidua basalis -part under the embryo; communicates with maternal blood vessels
Decidua capsularis - encapsulates the surface of the trophoblast
Decidua vera
● Remaining portion
● Trophoblast
● Finger-like projections
● Serves to attach the blastocyst in the walls of the endometrium
● Provides nutrition and maintenance of pregnancy
2 layers:
● Amnion - Funis/Umbilical cord
● Chorion - Secundines/Placenta
Chorionic villi
● Trophoblastic layer of the blastocyst forming miniature villi at 11-12th day with the following areas:
● Central core - fetal capillaries
● Syncytiotrophoblast (HCG, HPL, Estrogen and Progesterone)
● Cytotrophoblast (protects from viral infection, disappears at 20-24th week)
Ectoderm Mesoderm Endoderm
CNS (brain/spinal cord) -Supporting structures Lining of pericardial, pleural,
Peripheral nervous system (bones, muscle, tendons) peritoneal cavities
Skin, hair, nails Dentin of teeth Lining of GIT, respiratory
Sebaceous glands Kidneys and ureters tract, tonsils, parathyroid,
- Sense organs Reproductive system and thyroid glands, thymus
Mucous membranes of anus, Circulatory and lymphatic - Lower GUT (bladder,
mouth, nose, tooth enamel, systems urethra)
mammary glands

PREGNANCY
● A normal physiologic process. It is not a disease but a wellness state.
● Nursing responsibility: Help mothers maintain state of wellness throughout the periods of pregnancy and parenthood.
Divided into trimesters:
● 1st- missed period to 12 weeks
● 2nd - 13th to 24th weeks
● 3rd - 25th week onwards
a) Length of Pregnancy
● 266 days - 294 days
● 38 weeks - 42 weeks (average of 40 weeks)
● 9 calendar months and 10 lunar months
● Start of the period of viability - 24 weeks
● Abortus - an embryo or fetus expelled less than 20 weeks
● Gestation age - number of completed weeks based on the last menstrual period

DURATION OF PREGNANCY
● EDB or EDD vs EDC
● 280 days (263-294 days)
● 40 wks (38-42wks )
● 9 Calendar months
● 10 Lunar months from time of ovulation-

Nagele's Rule
month 01 to 03
+9+7
month 04 to 12
-3 + 7 + 1

Bartholomew's Rule
To determine age of gestation by dividing the abdomen from the symphysis pubis to the xyphoid process into the area of
fourths
● 3 months - ½ from umbilicus to symphysis pubis
● 4 months - ¾ from umbilicus to symphysis pubis
● 5 months - level of umbilicus
● 6 months - ¼ from umbilicus to xiphoid
● 7 months - ½ from umbilicus to xiphoid
● 8 months - ¾ from umbilicus to xiphoid
● 9 months - just below the xiphoid process
● 10 months - level of 8 months due to lightening

McDonald's Rule
Fundic Height is equal to weeks of gestation from 20-32 weeks
20 cm = 20 weeks
32 cm = 32 weeks
Measuring fundal height from the superior aspect of the pubis to the fundal crest.

HAASE'S RULE
– determines length of fetus in cm
– 1st half (1-5 months) = month?
– Age in months=square root of crown heel length(in cm)
– 2nd half = month X 5
– Age in months=crown heel length (in cm)divided by 5