NURSING CARE OF THE MOTHER AND

CHILD
 REPRODUCTIVE HEALTH
REVIEW OF THE ANATOMY AND
PHYSIOLOGY ON REPRODUCTION AND
CONCEPTION
SIDE VIEW OF THE MALE REPRODUCTIVE
ORGANS
 MALE REPRODUCTIVE SYSTEM
A. EXTERNAL STRUCTURE
1. PENIS
FUNCTION:
• ORGAN FOR COPULATION
• PASSAGE FOR URINE AND SPERM
CORPORA CAVERNOSA – 2 LATERAL COLUMNS OF ERECTILE TISSUE
CORPUS SPONGIOSUM – COLUMN OF ERECTILE TISSUE ON THE UNDERSIDE OF THE
PENIS THAT INCREASE THE URETHRA
GLANS PENIS – CONE-SHAPED EXPANSION OF THE CORPUS SPONGIOSUM THAT IS
HIGHLY SENSITIVE TO SEXUAL STIMULUS
FRENULUM (PREPUCE OR FORESKIN) – SKIN FLAP THAT COVERS THE GLANS PENIS
IN UNCIRCUMCISED MEN
SMEGMA- CHEESY, NONFOUL WHITISH UNDER THE FORESKIN
2. SCROTUM- POUCH SHAPE; SUPPORTS THE TESTES , INTERNALLY, THE MEDIAL SEPTUM DIVIDES INTO 2 SACS
B INTERNAL STRUCTURE
1. TESTES- COVERED BY TUNICA VAGINALIS, 4 TO 5CM LONG
FXN: PRODUCTION OF TESTOSTERONE AND SITE FOR SPERMATOGENESIS (SPERM FORMATION) 400SPERMS/DAY
• SERTOLI CELLS- WITHIN THE SEMINIFEROUS TUBULES- RESP. FOR SUPPORTING & NURTURING
SPERMATOCYTES.
• SPERMATOZOA- MATURE CELLS
2. EPIDIDYMIS- TUBULAR SAC LOCATED NEXT TO EACH TESTIS (THAT IS A RESERVOIR FOR SPERM STORAGE
AND MATURATION
3.VAS DEFERENS – DUCT EXTENDING FROM THE EPIDIDYMIS TO THE EJACULATORY DUCT WHICH PROVIDES A
PASSAGEWAY FOR SPERMS
4. EJACULATORY DUCT- CANAL FORMED BY THE UNION OF THE VAS DEFERENS AND THE EXCRETORY DUCT
OF THE SEMINAL VESICLE, ENTERS THE URETHRA AT THE PROSTATE GLANDS
5. URETHRA – PASSAGEWAY FOR THE URINE AND SEMEN THAT EXTENDS FROM THE BLADDER TO THE
URETHRAL MEATUS
ACCESSORY GLANDS- PRODUCE SECRETIONS THAT FACILITATE TRANSPORTATION OF
SPERMATOZOA ALONG THE URETHRA DURING EJACULATION AND PROVIDE A TEMPORARY
SAFE FOR THE FRAGILE SPERMS
A) SEMINAL VESICLES – LOCATED BEHIND THE BLADDER AND INFRONT OF THE RECTUM,
DELIVER SECRETIONS TO THE URETHRA THROUGH THE EJACULATORY DUCTS
B) PROSTATE GLAND – SURROUNDS THE BASE OF THE URETHRA AND THE EJACULATORY
DUCT, SECRETES A CLEAR FLUID WITH A SLIGHTLY ACID PH RICH IN ACID PHOSPHATASE,
CITRIC ACID, ZINC AND PROTEOLYTIC ENZYMES
BULBOURETHRAL AND URETHRAL GLAND (COWPER GLANDS) – LIE AT THE BASE OF THE
PROSTATE AND ON EITHER SIDE OF THE MEMBRANOUS URETHRA
 PRODUCE A CLEAR, ALKALINE MUCINOUS SUBSTANCE THAT LUBRICATES THE URETHRA
AND COATS ITS SURFACE:
 THE ALKALINITY ASSISTS IN NEUTRALIZING ACIDIC FEMALE VAGINAL SECRETIONS,
WHICH WOULD DETRIMENTAL TO SPERM SURVIVAL
 MALE REPRODUCTIVE SYSTEM PATHWAY OF
SPERM
• 1.SEMINIFEROUS TUBULES ( TESTES)
• 2.STRAIGHT TUBULES
• 3.BULBOURETHRAL GLAND
• 4.EFFERENT DUCTS
• 5.DUCTUS EPIDIDYMIS (STORAGE OF SPERM; 1 MONTH)
• 6.VAS DEFERENS ( STORAGE OF SPERM; FOR SEVERAL MONTHS)
• 7.PROSTATE GLAND
• 8.MEMBRANOUS URETHRA PASSAGEWAY FOR SPERM AND URINE
• 9.PENILE URETHRA
MALE BREAST
MAMMARY TISSUE REMAINS DORMANT THROUGHOUT LIFE, BUT THE
BREAST ARE A SITE OF SEXUAL EXCITATION AND AROUSAL
NEUROHORMONAL CONTROL OF THE MALE REPRODUCTIVE SYSTEM
A) AT PUBERTY THE HYPOTHALAMUS STIMULATE THE PITUITARY GLAND
TO PRODUCE FOLLICLE STIMULATING HORMONE(FSH )AND
LUTEINIZING HORMONE( LH)
FSH- STIMULATES GERM CELLS WITHIN THE TESTES TO MANUFACTURE
SPERM
LH – STIMULATES THE PRODUCTION OF TESTOSTERONE IN THE TESTES,
ALTHOUGH LH STIMULATES THE LEYDIG CELLS TO PRODUCE
TESTOSTERONE FROM CHOLESTEROL, TESTOSTERONE INHIBITS THE
SECRETION OF LH BY THE ANTERIOR PITUITARY
B) TESTOSTERONE – ONE OF SEVERAL ANDROGEN (THE MOST
POTENT) PRODUCED IN THE TESTES
 RESPONSIBLE FOR THE DEVELOPMENT OF THE SECONDARY SEX
CHARACTERISTIC AT PUBERTY,
 TESTOSTERONE PRODUCTION OCCURS IN THE INTERSTITIAL LEYDIG
CELL IN THE SEMINIFEROUS TUBULES, LEYDIG CELLS ARE
ABUNDANT IN THE NEWBORN AND PUBESCENT AGE AND
TESTOSTERONE IS ABUNDANT DURING THESE PERIOD
 TESTOSTERONE PRODUCTION SLOWS AFTER 40 YRS. OF AGE; BY 80
YRS OF AGE PRODUCTION IS ONLY ABOUT ONE FIFTH PEAK LEVEL
C) SPERMATOGENESIS- OCCURS CONTINUALLY AFTER PUBERTY,
PROVIDING LARGE NO. OF SPERM FOR UNLIMITED EJACULATION DURING
THE MATURE LIFE SPAN
SPERMATOZOA ARE RELEASED FROM THE EPITHELIAL WALL OF THE
SEMINIFEROUS TUBULES, MEIOSIS OCCURS DURING THE PROCESS AND
THE NO. OF CHROMOSOMES IN EACH CELL IS REDUCED BY ONE HALF
(HAPLOID NO.)
SPERMATOGENESIS IS A HEAT-SENSITIVE PROCESS; THE 2 TO 3 F
DIFFERENCE BETWEEN SCROTAL AND ABDOMINAL TEMPERATURE
ALLOWS SPERMATOGENESIS TO PROCEED IN THE COOLER ENVIRONMENT
THE ENTIRE PERIOD OF SPERMATOGENESIS FROM GERMINAL CELL TO
MATURE SPERM TAKES ABOUT 75 DAYS
EXTERNAL FEMALE GENITAL STRUCTURES
 EXTERNAL ORGANS
1. MONS PUBIS- FATTY TISSUE OVER THE SYMPHYSIS PUBIS
2. LABIA MAJORA- PIGMENTED SKIN EXTENDING FROM THE MONS PUBIS TO THE
PERINEUM
3. LABIA MINORA- SMALLER INNER FOLDS OF THE VULVA
4. CLITORIS- ERECTILE TISSUE LOCATED AT THE UPPER END OF THE LABIA MINORA;
PRIMARY SITE OF SEXUAL AROUSAL
5. URETHRAL MEATUS (URETHRAL ORIFICE) – SMALL OPENING OF THE URETHRA
LOCATED BETWEEN THE CLITORIS AND VAGINAL ORIFICE FOR THE PURPOSE OF
URINATION
6. SKENE OR PARA URETHRAL GLANDS- SMALL MUCUS SECRETING GLANDS THAT OPEN
INTO THE POSTERIOR WALL OF THE URINARY MEATUS AND LUBRICATES THE VAGINA
7. VESTIBULE – AN ALMOND SHAPED AREA BETWEEN THE LABIA MINORA CONTAINING
THE VAGINAL INTROITUS, HYMEN, AND BARTHOLIN GLANDS
8. VAGINAL INTROITUS -THE EXTERNAL OPENING OF THE VAGINA
9. HYMEN -MEMBRANOUS TISSUE IN THE VAGINAL INTROITUS
10. BARTHOLIN OR VULVOVAGINAL GLANDS- MUCUS SECRETING
GLANDS LOCATED IN EITHER SIDE OF THE VAGINAL ORIFICE
11. PERINEAL BODY- COMPOSED OF MUSCLE AND FASCIA THAT
SUPPORT PELVIC STRUCTURE
13. PERINEUM – THE AREA OF TISSUE BETWEEN THE ANUS AND
VAGINA;
EPISIOTOMY IS PERFORMED HERE
SIDE VIEW OF FEMALE REPRODUCTIVE
ORGANS
FUNCTIONS OF THE UTERUS
1. MENSTRUATION- THE SLOUGHING AWAY OF SPONGY LAYERS OF THE
ENDOMETRIUM WITH BLEEDING FROM TORN VESSELS
2. ENVIRONMENT FOR PREGNANCY- THE EMBRYO AND FETUS DEVELOP
IN THE UTERUS AFTER FERTILIZATION
3. LABOR , CONSISTING OF POWERFUL CONTRACTION OF THE
MUSCULAR UTERINE WALL THAT RESULT IN EXPULSION OF THE FETUS
UTERINE LIGAMENT-
BROAD AND ROUND LIGAMENTS THAT PROVIDE UPPER SUPPORT FOR
THE UTERUS; CARDINAL, PUBOCERVICAL AND UTEROSACRAL
LIGAMENTS THAT ARE SUSPENSORY AND PROVIDE MIDDLE SUPPORT;
PELVIC MUSCULAR FLOOR LIGAMENT THAT PROVIDE LOWER SUPPORT
FALLOPIAN TUBE – EXTEND FROM THE UPPER OUTER ANGLES OF THE
UTERUS AND END NEAR THE OVARY
TUBES SERVES AS THE PASSAGEWAY FOR THE OVUM TO TRAVEL FROM THE
OVARY TO THE UTERUS AND FOR THE SPERM TO TRAVEL FROM THE UTERUS
TO THE OVARY
OVARIES – FEMALE SEX GLANDS LOCATED ON EACH SIDE OF THE UTERUS

PELVIS- BONY RING IN THE LOWER PORTION OF THE TRUNK, CONSIST OF 3

PARTS ( ILIUM, ISCHIUM, AND PUBIS) AND 4 BONES (2 INNOMINATE BONES
OR HIPBONES, SACRUM, AND COCCYX)
PELVIC BONES ARE HELD TOGETHER BY 4 JOINTS( ARTICULATIONS)
SYMPHYSIS PUBIS, 2 SACRO ILIAC AND SACRO COCCYGEAL,
FIBROCARTILAGE BETWEEN THESE JOINTS PROVIDES MOVABILITY
TYPES OF PELVIS
 TYPES OF PELVIS
• 1. GYNECOID- TYPICAL FEMALE PELVIS WITH ROUNDED INLET
• 2. ANDROID- NORMAL MALE PELVIS WITH HEART SHAPED INLET
• 3. ANTHROPOID- APELIKE PELVIS WITH OVAL INLET
• 4. PLATYPELLIOD- FLAT, FEMALE TYPE PELVIS WITH A TRANSVERSE OVAL

• PELVIMETRY – ASSESSMENT OF THE FEMALE PELVIS IN RELATION TO THE BIRTH

OF A BABY
• OBSTETRICAL SERVICES RELIED HEAVILY ON PELVIMETRY IN CONDUCT OF DELIVERY
IN ORDER TO DECIDE IF NORMAL OR OPERATIONAL VAGINAL DELIVERY OR USE A
CESAREAN SECTION
 FEMALE BREASTS
BREASTS
FUNCTIONS
• LACTATION
• ORGANS FOR SEXUAL AROUSAL IN MATURE ADULT
STRUCTURE
• MAMMARY GLAND COMPOSED OF
15 TO 20 LOBES, DIVIDED INTO LOBULES
• LOBULES ARE CLUSTERS OF ACINI
• ACINUS- IS A SACLIKE TERMINAL PART OF A COMPOUND GLAND EMPTYING
THROUGH A NARROW LUMEN OR DUCT
• ACINI ARE LINED WITH EPITHELIAL CELLS THAT SECRETE COLOSTRUM AND
MILK
INTERNAL STRUCTURE
• 1. GLANDULAR TISSUE – COMPOSED OF ACINI MILK PRODUCING CELLS THAT
CLUSTER IN GROUPS TO FORM THE LOBES
• 2. LACTIFEROUS DUCTS OR SINUSES- FORM PASSAGE WAY FROM THE LOBES TO THE
NIPPLE
• 3. FIBROUS TISSUE (COOPER LIGAMENT) WHICH PROVIDE SUPPORT TO THE
MAMMARY GLAND
• 4. ADIPOSE AND FIBROUS TISSUE ( STOMA) WHICH PROVIDE THE RELATIVE SIZE
AND CONSISTENCY OF THE BREAST
EXTERNAL STRUCTURE
1. NIPPLE
2. 2. AREOLA
3. 3. MONTGOMERY TUBERCLE
BREASTS
• CHANGE IN SIZE AND NODULARITY IN RESPONSE TO CYCLIC
OVARIAN HORMONAL CHANGES
• ESTROGEN STIMULATION WHICH PRODUCE TENDERNESS
• PROGESTERONE (POST OVULATION) WHICH CAUSES
INCREASED TENDERNESS AND BREAST ENLARGEMENT
• PHYSIOLOGIC ALTERATIONS IN BREAST SIZE REACH MINIMAL
LEVEL ABOUT 5 TO 7 DAYS AFTER MENSTRUATION STOPS
• BREAST SELF-EXAMINATION (BSE) BEST CARRIED OUT DURING
THIS PHASE OF MENSTRUAL CYCLE
PHYSIOLOGY OF MENSTRUAL CYCLE
MENSTRUAL CYCLE AND HORMONES
• MENARCHE – THE FIRST MENSTRUAL CYCLE OR FIRST MENSTRUAL
BLEEDING
• IT IS OFTEN CONSIDERED THE CENTRAL EVENT OF FEMALE
PUBERTY AS IT SIGNALS THE POSSIBILITY OF FERTILITY
• OCCURS BETWEEN 9 TO 17 YRS OF AGE WITH AVERAGE AGE OF
ONSET AT 11 OR 14 YRS OLD
MENSTRUAL CYCLE
1. OVULATION – THE DISCHARGE OF MATURE OVUM FROM THE
OVARY
2. MENSTRUATION – PERIODIC SHEDDING OF BLOOD, MUCUS,
AND EPITHELIAL CELLS FROM THE UTERUS, AVERAGE BLOOD
OVARIES PRODUCE MATURE GAMETES AND SECRETE HORMONES
• 1. ESTROGEN – CONTRIBUTES TO FEMALE CHARACTERISTICS (BREAST
GROWTH, AND FEMALE BODY BUILD)
• 2. PROGESTERONE – (HORMONE OF PREGNANCY) DECREASES THE
CONTRACTILITY OF THE UTERUS
• 3. PROSTAGLANDINS- REGULATES THE REPRODUCTIVE PROCESS BY
STIMULATING THE CONTRACTILITY OF THE UTERINE AND SMOOTH
MUSCLE
MENSTRUAL CYCLE OCCURS ON 4 LEVER RESPONSE
1. CENTRAL NERVOUS SYSTEM OR HYPOTHALAMIC- PITUITARY
2. OVARIAN
3. ENDOMETRIAL (MENSTRUAL)
CENTRAL NERVOUS SYSTEM
 HYPOTHALAMUS STIMULATES THE ANTERIOR PITUITARY GLAND BY
SECRETING GONADOTROPIN RELEASING HORMONE (GNRH)
 ANTERIOR PITUITARY SECRETES 2 GONADOTROPINS – FOLLICLE
STIMULATING HORMONE (FSH) AND LUTEINIZING HORMONE (LH)
 FOLLICLE STIMULATING HORMONE PROMPTS THE OVARY TO DEVELOP
OVARIAN FOLLICLES. THE DEVELOPING FOLLICLE SECRETE ESTROGEN
WHICH FEEDS BACK TO THE ANTERIOR PITUITARY TO SUPPRESS FOLLICLE
STIMULATING HORMONE (FSH) AND TRIGGER A SURGE OF LH
 LUTEINIZING HORMONE ACTS WITH FSH TO CAUSE OVULATION AND
ENHANCE CORPUS LUTEUM FORMATION
OVARIAN RESPONSE
2 PHASES
1. FOLLICULAR PHASE (DAY1 TO 14) –FOLLICLE MATURES
AS A RESULT OF FOLLICLE STIMULATING HORMONE(FSH)
2. LUTEAL PHASE (DAY 15 TO 22) THE CORPUS LUTEUM
DEVELOPS FROM A RUPTURED FOLLICLE
 ENDOMETRIAL RESPONSE
4 PHASES
1. MENSTRUAL PHASE (DAY 1 TO 5) THE ESTROGEN LEVELS IS LOW AND
CERVICAL MUCUS IS SCANTY
2. PROLIFERATIVE PHASE(DAY 6 TO 14)THE ESTROGEN LEVEL IS HIGH, THE
ENDOMETRIUM AND MYOMETRIUM THICKEN, CHANGES IN CERVICAL MUCOSA
OCCURS, BEGINS WITH THE END OF MENSTRUATION, WHEN THE EGG IS
RELEASED INTO THE FALLOPIAN TUBE
3. SECRETORY PHASE (DAY 15 TO 26)AFTER RELEASE OF THE OVUM, THE
ESTROGEN LEVEL DROPS, THE PROGESTERONE LEVEL IS HIGH, INCREASED
UTERINE VASCULARITY OCCURS AND TISSUE GLYCOGEN LEVEL INCREASE, AFTER
OVULATION, ENDOMETRIUM CONTINUES TO PREPARE FOR A FERTILIZED EGG
4. ISCHEMIC PHASE (DAY 27 TO 28) ESTROGEN AND PROGESTERONE LEVEL
RECEDE, ARTERIAL VESSELS CONSTRICT, THE ENDOMETRIUM PREPARES TO SHED,
THE BLOOD VESSELS RAPTURE AND MENSTRUATION BEGINS
CERVIX AND CERVICAL MUCUS RESPONSE
 BEFORE OVULATION, ESTROGEN LEVELS RISE, CAUSING CERVICAL
OS DILATATION, ABUNDANT LIQUID MUCUS, HIGH SPINNBARKEIT,
AND EXCELLENT SPERM PENETRATION
 AFTER OVULATION, PROGESTERONE LEVELS RISE, RESULTING IN
CERVICAL OS CONSTRICTION, SCANT VISCOUS MUCUS, LOW
SPIINBARKEIT, NO FERNING, AND POOR SPERM PENETRATION
 DURING PREGNANCY, CERVICAL CIRCULATION (BLOOD SUPPLY)
INCREASES AND A PROTECTIVE MUCUS PLUG FORMS
CLIMACTERIC PERIOD AND MENOPAUSE
 CLIMACTERIC IS A TRANSITIONAL PERIOD DURING WHICH OVARIAN
FUNCTION AND HORMONAL PRODUCTION DECLINE
 MENOPAUSE REFERS TO A WOMAN ‘S LAST MENSTRUAL PERIOD;
THE AVERAGE AGE RANGE OF 40 TO 55 YEARS. IT IS IMPORTANT TO
NOTE THAT WOMEN MAY OVULATE AFTER MENOPAUSE AND THUS
CAN BECOME PREGNANT
 THE EARLIER THE AGE OF MENARCHE THE EARLIER MENOPAUSE
TENDS TO OCCUR
 MENSTRUAL IRREGULARITIES
• 1. AMENORRHEA – ABSENCE OF MENSTRUAL FLOW WHEN
NORMALLY EXPECTED
• 2. OLIGOMENORRHEA -SCANTY FLOW
• 3. MENORRHAGIA – EXCESSIVE FLOW
• 4. DYSMENORRHEA – PAINFUL MENSTRUATION
• MENOPAUSE CESSATION OF MENSES AND FERTILITY
 FEMALE AND MALE REPRODUCTIVE
POTENTIALS
FEMALE REPRODUCTIVE POTENTIAL
 WOMAN’S REPRODUCTIVE LIFE SPAN IS FINITE; IT BEGINS SHORTLY
AFTER MENARCHE ( 9 TO 17 YRS OLD) DECLINES SOMEWHAT DURING
THE LATE REPRODUCTIVE YEARS, AND TERMINATES WITH MENOPAUSE.
 THE LARGE INITIAL STORE OF GERM CELLS (PRIMORDIAL OVA) PRESENT
AT BIRTH REPRESENTS THE TOTAL OVA FORMED DURING THE LIFE SPAN.
BY WAY OF ATRESIA, THE GERM CELLS DECREASE IN NUMBER; BY
PUBERTY, 6 TO 7 MILLION FETAL GERM CELLS REMAIN. A WOMAN
RELEASES NO MORE THAN 500 OVA DURING OVULATION THROUGHOUT
HER LIFE TIME
 WOMAN’S CAPACITY TO REPRODUCE MAYBE DISASSOCIATED FROM
SEXUAL EXCITEMENT OR RECEPTIVITY
MALE REPRODUCTIVE POTENTIAL
 REPRODUCTIVE ACTIVITY IN MEN BEGINS WITH SPERM
PRODUCTION AT THE ONSET OF PUBERTY AND CONTINUES
THROUGHOUT HIS LIFE TIME
 NEW SPERM CELLS ARE GENERATED ABOUT EVERY 75 DAYS, AND
BILLIONS OF MATURE SPERM ARE PRODUCED DURING A MAN’S
NORMAL LIFETIME
 A MAN’S CAPACITY TO REPRODUCE IS ASSOCIATED WITH SEXUAL
EXCITEMENT, PENILE ERECTION AND EJACULATION
 SEXUALITY, GENDER IDENTITY, AND SEXUAL
ORIENTATION
A. SEXUALITY
1. PERSON’S SEXUALITY ENCOMPASSES COMPLEX EMOTIONS, ATTITUDES,
PREFERENCES, AND BEHAVIORS RELATED TO EXPRESSION OF THE SEXUAL
SELF AND EROTICISM
2. SEXUAL RELATIONSHIPS ARE A DYNAMIC ASPECT OF LIFE AND ARE
INTERTWINED WITH BIOLOGICAL AND PSYCHOSOCIAL COMPONENTS
3. NURSE COMMONLY ARE RESOURCES PEOPLE FOR CLIENTS SEEKING
INFORMATION RELATED TO HUMAN SEXUALITY AND FUNCTIONING
DURING THE REPRODUCTIVE YEARS
4. RESPONSIBLE SEXUALITY INVOLVES COMMITMENT TO A RELATIONSHIP,
RESPONSIBLE REPRODUCTIVE HEALTH CARE, AND RATIONAL DECISIONS
 SEXUALITY, GENDER IDENTITY, AND SEXUAL
ORIENTATION
B. GENDER IDENTITY AND GENDER ROLES
1. GENDER IDENTITY- A PERSON’S SENSE OF HIS OR HER OWN MUSCULARITY OF
FEMININITY , THIS IS THOUGHT TO BE ESTABLISHED IN PART BY HOW THE
INDIVIDUAL WAS TREATED BY HISS OR HER PARENTS AS A CHILD, BY HORMONAL
INFLUENCES IN UTERO, AND BY PSYCHOSOCIAL FACTORS
2. GENDER ROLE – COMPOSED OF BEHAVIORS, ATTRIBUTES AND ATTITUDES AN
INDIVIDUAL CONVEYS ABOUT BEING MALE OF FEMALE
3. BORN A SEXUAL BEING, A CHILD’S GENDER IDENTITY AND GENDER ROLE
BEHAVIOR USUALLY DEVELOP FROM, AND CONFORM TO, CULTURAL NORMS AND
EXPECTATIONS
4. BIOLOGIC GENDER – USED TO DENOTE CHROMOSOMAL SEXUAL DEVELOPMENT
 SEXUALITY, GENDER IDENTITY, AND SEXUAL
ORIENTATION
C. SEXUAL ORIENTATION AND EXPRESSION
1. SEXUAL ORIENTATION – A PERSON’S PREFERENCE FOR HETEROSEXUAL, HOMOSEXUAL, OR BISEXUAL
RELATIONSHIPS. PREFERENCE MAY VARY DURING A PERSON’S LIFETIME AND IS PROBABLY SHAPED BY
COMPLEX INTERACTION OF SEVERAL FACTORS, INCLUDING PRENATAL HORMONE ENVIRONMENT,
EARLY PARENTAL INTERACTIONS, SOCIAL MORES AND VALUES, FAMILY DYNAMICS AND IMITATION OF
THE MOST VALUED PARENT
2. SEXUAL EXPRESSION – THE ACTIVITIES THAT THE INDIVIDUAL CHOOSE TO GIVE AND RECEIVE
PHYSICAL LOVE AND GRATIFICATION
a) THERE ARE MANY WAYS TO EXPERIENCE SEXUAL GRATIFICATION, SUCH AS COITUS, MASTURBATION,
CELIBACY AND FETISHISM
b) ONE’S CULTURE DETERMINES ACCEPTABLE FORMS OF SEXUAL EXPRESSION. WHAT IS CONSIDERED
NORMAL MAY VARY GREATLY AMONG CULTURES
c) ACCEPTABLE SEXUAL ACTIVITY INCLUDES THE ELEMENTS OF PRIVACY, CONSENT, AND LACK OF
FORCE. ADOLESCENCE IS AN ESPECIALLY CONFUSING AND DIFFICULT TIME BECAUSE ADOLESCENTS
NEED TO FEEL COMFORTABLE WITH THEIR OWN SEXUALITY BEFORE THEY CAN REACH OUT TO
OTHERS
 PROCESS RELATED TO HUMAN
REPRODUCTION
SEXUAL RESPONSE CYCLE
PHYSIOLOGIC RESPONSES TO SEXUAL STIMULATION

1. VASOCONGESTION
- OCCURS IN THE PELVIC ORGANS DURING SEXUAL EXCITEMENT BECAUSE THE
ARTERIES DILATE.
- LEADS TO ERECTION OF THE PENIS AND CLITORIS, VAGINAL LUBRICATION AND
ENGORGEMENT OF THE LABIA AND TESTICLES.
 
2. MYOTONIA( MUSCULAR TENSION)
- PRESENT THROUGHOUT THE BODY DURING SEXUAL AROUSAL AND ORGASM.
- EVIDENT IN VOLUNTARY AND INVOLUNTARY CONTRACTIONS.
 HUMAN SEXUAL FUNCTION
FOUR PHASES:
1. EXCITEMENT – OCCURS AS A RESULT OF PHYSICAL OR MENTAL
EROTIC STIMULI SUCH AS KISSING, PETTING OR VIEWING EROTIC
IMAGE THAT LEADS TO SEXUAL AROUSAL
2. PLATEAU- AN INCREASED CIRCULATION AND HEART RATE INCREASE,
BOTH SEXES, INCREASED SEXUAL PLEASURE WITH INCREASED
STIMULATION AND FURTHER INCREASED MUSCLE TENSION
3. ORGASMIC- FEELING OF THE INEVITABILITY OF EJACULATION IN MEN
AND CONTRACTIONS OF THE LOWER THIRD OF THE VAGINA
4. RESOLUTION- ALL THE CHANGES IN THE BODY ARE REVERSED BACK
TO NORMAL
COMPARISON OF MALE AND FEMALE SEXUAL
RESPONSE
SEXUAL CONCERNS RELATED TO PREGNANCY
1. DURING PREGNANCY, THE WOMAN’S DESIRE FOR SEX MAY BE ALTERED DUE TO
FATIGUE, NAUSEA, AND OTHER DISCOMFORTS OF PREGNANCY
2. BREASTS MAYBE PAINFUL TO TOUCH, ESPECIALLY DURING THE FIRST TRIMESTER
3. SOME MEN FIND THE NORMAL INCREASE IN THE AMOUNT AND ODOR OF VAGINAL
DISCHARGE DURING PREGNANCY A “TURN OFF”, OTHERS DO NOT
4. OTHER SEXUAL CONCERNS DURING PREGNANCY INCLUDE DYSPAREUNIA AND
MALE ERECTILE DYSFUNCTION
5. FOR COUPLE WHO CANNOT HAVE OR WHO CHOOSE NOT TO HAVE INTERCOURSE
DURING PREGNANCY, KISSING, HUGGING AND ORAL OR MANUAL GENITAL
STIMULATION CAN BE SATISFYING EXPRESSIONS OF CLOSENESS AND INTIMACY
 NURSING PROCESS
A. ASSESSMENT
1. BEFORE INTERACTING WITH ANY CLIENT REGARDING SEXUALITY AND
REPRODUCTION, THE NURSE MUST PERFORM A SELF-ASSESSMENT; PERSONAL
ATTITUDES AND VALUES WILL GREATLY INFLUENCE THE NURSING CARE
PROVIDER
2. A SEXUAL HISTORY INVOLVES GATHERING INFORMATION ABOUT THE CLIENT OR
COUPLE;
 PAST AND CURRENT EXPERIENCES WITH SEXUAL ACTIVITY
 SEXUAL KNOWLEDGE AND HOW IT WAS OBTAINED
 ATTITUDES TOWARD SEXUALITY
 CURRENT PROBLEMS, IF ANY
 NUMBER OF SEXUAL PARTNERS IN THE LAST 6 MONTHS
 KNOWLEDGE AND USE OF “SAFER” SEX PRACTICES
 MENSTRUAL AND OBSTETRIC HISTORY
 METHOD OF BIRTH CONTROL USED
 SPECIFIC CONCERNS RELATED TO SEX AND SEXUALITY
B. NURSING DIAGNOSES
1. KNOWLEDGE DEFICIT
2. SEXUAL DYSFUNCTION
3. ALTERED SEXUAL FUNCTION
4. ANXIETY
C. PLANNING AND OUTCOME IDENTIFICATION
1. THE CLIENT AND HER PARTNER WILL BE KNOWLEDGEABLE ABOUT
REPRODUCTION AND SEXUALITY.
2. THE CLIENT AND HER PARTNER WILL RESUME A MUTUALLY SATISFYING
RELATIONSHIP
3. THE CLIENT AND HER PARTNER WILL EXPERIENCE REDUCED ANXIETY RELATED
TO THEIR SEXUAL RELATIONSHIP
D. IMPLEMENTATION
4. PROVIDE EDUCATION REGARDING REPRODUCTION AND SEXUALITY
 PROVIDE THE CLIENT OR COUPLE WITH SPECIFIC INFORMATION ABOUT THE
REPRODUCTIVE SYSTEM’S STRUCTURE AND FUNCTION
 SUGGEST WAYS TO ALLEVIATE REPRODUCTIVE SYSTEM DISCOMFORTS AND TO
PREVENT REPRODUCTIVE DISEASE
 DISCUSS RISK AND POTENTIAL EFFECTS OF SEXUAL ACTIVITY
2. PROMOTE OPTIMAL SEXUAL FUNCTIONING

 PLAN INTERVENTIONS TO STRENGTHEN GENDER IDENTITY OR ROLE

BEHAVIOR
 DESIGN CARE THAT DEMONSTRATES EQUAL ACCEPTANCE OF ALL
LIFESTYLE CHOICES
 PROVIDE INFORMATION ABOUT ALTERNATIVE MEANS OF SEXUAL
EXPRESSION
 DISCUSS PERCEPTIONS AND EXPECTATIONS OF SEXUAL FUNCTIONING
 REFER CLIENTS WITH COMPLEX PROBLEMS TO PROFESSIONAL
SPECIALIZING SEXUALITY ISSUES
3. PROVIDE SUPPORT TO RELIEVE ANXIETY. ALLOW THE CLIENT OR
COUPLE TO DISCUSS SEXUAL FEELINGS AND CONCERNS OPENLY
E. OUTCOME EVALUATION
1. THE CLIENT OR COUPLE REPORTS DECREASED ANXIETY RELATED
TO THEIR SEXUAL RELATIONSHIP
2. THE CLIENT OR COUPLE VERBALIZES POSITIVE SEXUAL CONTACT
3. THE CLIENT OR COUPLE REPORTS ENGAGING IN SEXUAL
INTERCOURSE AND PLEASURABLE NONCOITAL ACTIVITIES
 RISK FACTORS THAT LEADS TO GENETIC
DISORDERS
• BEFORE WOMEN BECOME PREGNANT, THEY AND THEIR PARTNER
SHOULD SPEAK WITH THEIR HEALTH CARE PRACTITIONER ABOUT
THEIR RISK OF HAVING A BABY WITH A GENETIC DISORDER.
• RISK FACTORS INCLUDE OLDER AGE IN THE WOMAN, A FAMILY HISTORY
OF GENETIC ABNORMALITIES, A PREVIOUS BABY WITH A BIRTH DEFECT
OR MISCARRIAGE, AND A CHROMOSOMAL ABNORMALITY IN ONE OF
THE PROSPECTIVE PARENTS.
• TESTING FOR GENETIC DISORDERS IS OFFERED TO ALL WOMEN BUT IS
PARTICULARLY IMPORTANT IF A COUPLE’S RISK IS HIGHER THAN
NORMAL.
• IF YOU OR PARTNER ARE OF MEDITERRANEAN OR ASIAN DESCENT, OR ANYBODY
OF THE FAMILY HAS THALASSEMIA. ANY OF A GROUP OF HEREDITARY
HEMOLYTIC DISEASES CAUSED BY FAULTY HEMOGLOBIN SYNTHESIS,
WIDESPREAD IN MEDITERRANEAN, AFRICAN, AND ASIAN COUNTRIES.
• HX OF NEURAL TUBE DEFECT- A CHILD WITH NEURAL TUBE DEFECT
• FAMILY HX OF CONGENITAL HEART DEFECT –
• FAMILY HX OF DOWN SYNDROME - A CHILD WITH DOWN SYNDROME
• ANY OF THE PARTNER’S FAMILY HAS MENTAL RETARDED, WAS IT TESTED FOR
FRAGILE X SYNDROME.
• A METABOLIC DISORDER SUCH AS DIABETES OR PHENYLKETONURIA. (AN
INHERITED INABILITY TO METABOLIZE PHENYLALANINE THAT CAUSES BRAIN
AND NERVE DAMAGE IF UNTREATED.
 COMMON TEST DETERMINATION OF
GENETIC ABNORMALITIES
• TESTS FOR SINGLE-GENE DISORDERS IN PATIENTS WITH CLINICAL SYMPTOMS OR WHO HAVE A
FAMILY HISTORY OF GENETIC DISEASE.
1.MATERNAL SERUM SCREENING- A BLOOD TEST USED TO SEE IF A PREGNANT WOMAN IS AT
INCREASED RISK FOR CARRYING A FETUS WITH NEURAL TUBE DEFECT OR CHROMOSOMAL
ABNORMALITY
• THE AFP TEST IS MEASURING HIGH AND LOW LEVELS OF ALPHA-FETOPROTEIN.
• THE RESULTS ARE COMBINED WITH THE MOTHER’S AGE AND ETHNICITY IN ORDER TO ASSESS
PROBABILITIES OF POTENTIAL GENETIC DISORDERS.
• HIGH LEVELS OF AFP MAY SUGGEST THAT THE DEVELOPING BABY HAS A NEURAL TUBE DEFECT SUCH AS
SPINA BIFIDA OR ANENCEPHALY.
• HIGH LEVELS OF AFP MAY ALSO SUGGEST DEFECTS WITH THE ESOPHAGUS OR A FAILURE OF YOUR BABY'S
ABDOMEN TO CLOSE.
• HOWEVER, THE MOST COMMON REASON FOR ELEVATED AFP LEVELS IS INACCURATE DATING OF THE
PREGNANCY.
TESTS THAT CAN HELP ASSESS THOSE RISKS MORE PRECISELY (
GENETIC SCREENING) CAN BE DONE. IF THESE TESTS SHOW A HIGH
RISK OF PASSING ON A SERIOUS GENETIC ABNORMALITY, THE COUPLE
CAN CONSIDER THE FOLLOWING:
• CONTRACEPTION
• ARTIFICIAL INSEMINATION IF THE MAN HAS AN ABNORMAL GENE
• USE OF AN EGG FROM ANOTHER WOMAN IF THE WOMAN HAS AN
ABNORMAL GENE
• IN VITRO (TEST TUBE) FERTILIZATION WITH ANALYSIS OF THE
EMBRYO'S GENES BEFORE THE EMBRYO IS TRANSFERRED TO THE
WOMAN’S UTERUS (CALLED PREIMPLANTATION GENETIC
DIAGNOSIS)
DURING PREGNANCY, THE FETUS IS SURROUNDED BY AMNIOTIC FLUID,
A SUBSTANCE MUCH LIKE WATER. AMNIOTIC FLUID CONTAINS LIVE
FETAL SKIN CELLS AND OTHER SUBSTANCES, SUCH AS ALPHA-
FETOPROTEIN (AFP). THESE SUBSTANCES PROVIDE IMPORTANT
INFORMATION ABOUT YOUR BABY'S HEALTH BEFORE BIRTH
2. AMNIOCENTESIS
AMNIOCENTESIS IS A PRENATAL TEST IN WHICH A SMALL AMOUNT OF
AMNIOTIC FLUID IS REMOVED FROM THE SAC SURROUNDING THE
FETUS FOR TESTING.
THE SAMPLE OF AMNIOTIC FLUID (LESS THAN ONE OUNCE) IS REMOVED
THROUGH A FINE NEEDLE INSERTED INTO THE UTERUS THROUGH THE
ABDOMEN, UNDER ULTRASOUND GUIDANCE.