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NURS 330


April 16, 2012 NURS 330 Human Reproductive Health * * * * Diagnosis of Testosterone Deficiency Testosterone Level Test Test in the AM when testes produce more ... – PowerPoint PPT presentation

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Title: NURS 330

April 16, 2012
  • NURS 330
  • Human Reproductive Health

  • Office Hours
  • Mondays, 530pm 6pm
  • SH C240
  • Class e-mail list
  • Send your e-mail address by Mon, 4/23/12

Review 4/9/12 In-Class Assignment      

  • Also referred to as conception
  • Occurs in the Fallopian tube
  • Oocyte mature ovum is viable for
  • 12-24 hours
  • Sperm are viable 3 to 5 days in womans body

The zygote
  • Once fertilized, the egg is called a zygote.
  • Zygote travels four days to the uterus
  • Divides rapidly
  • Identical (Monozygotic) Twins
  • One egg fertilized by one sperm but divides into
    two separate masses
  • Fraternal (Dizygotic) Twins
  • Two separate eggs fertilized by two separate

  • The zygote continues to develop and becomes a
  • The blastocyst floats around in the uterus for
    about 3 days before implanting itself in the
    uterine wall
  • Implantation, occurs 7 days after fertilization

Length of Pregnancy
  • 266 days (280 days after last normal menstrual
  • 40 weeks

Embyronic Period
  • From implantation until the 8th week of pregnancy
    (gestation), the blastocyst is now known as an
  • Embryo
  • Prenatal organism from implantation on uterine
    wall to 8th week of pregnancy
  • During this period, internal and external
    structures begin to form

The Embyronic Period (cont)
  • Yolk sac
  • first element seen in the gestational sac during
    pregnancy, usually at 5 weeks gestation
  • Placenta
  • Develops at the site of implantation
  • Secretes human chorionic gonadotropin (hCG)
  • Effect on ovaries
  • Effect on corpus luteum
  • Nourishment, oxygen, elimination of waste
  • Umbilical cord
  • Connects the developing embryo of fetus to the
  • Waste products are removed from the fetus and
    nutrients are transported from the mother through
    the placenta

The Embyronic Period (cont)
  • Amniotic sac
  • Protective membrane around the fetus
  • Amniotic fluid
  • watery liquid surrounding and cushioning a
    growing fetus within the amnion.
  • allows the fetus to move freely without the walls
    of the uterus being too tight against its body.

Fetal Period
  • From the 8th week of gestation to delivery, at
    about 40 weeks.
  • The embryo is now known as a fetus
  • When internal and external structures (organs
    that developed during the embryo period) grow and

Prenatal Sex Differentiation (cont)
  • Nature is predisposed toward female development.
    Female development requires no added hormones.
  • For a male to develop, the testes must produce
    large amounts of testosterone between the 6th and
    the 12th week of the prenatal period.
  • For the vast majority, sex differentiation occurs
    flawlessly and normal genitalia develop. However,
    in rare instances, problems may occur.

Prenatal Care
  • Health care during pregnancy before the baby is
  • Good prenatal care
  • Protects the mothers health
  • Nutrition, diet, exercise
  • Enhance probability of having a healthy baby

Pregnancy Tests
  • All pregnancy tests look for a special hormone in
    the urine or blood that is only present when a
    woman is pregnant.
  • This hormone, human chorionic gonadotropin (hCG),
    is also called the pregnancy hormone.
  • Blood test detects HCG sooner than Urine tests
  • 7 days vs. 2 weeks

  • First 0 13 Weeks
  • Second 14 26 Weeks
  • Third 27 40 Weeks

Early Pregnancy Signs and Symptoms
  • Symptoms missed period, breast tenderness, etc
  • Hegars Sign
  • softening of the uterus just above the cervix,
    purplish hue of labia minora, vagina and cervix

Pregnancy Symptoms
  • First trimester
  • 2/3rds of pregnant women experience nausea,
    vomiting, fatigue and painful swelling of the
  • Second trimester
  • Most nausea and vomiting subside, fetal movements
  • Braxton Hicks - False Labor

Pregnancy Symptoms
  • During the third trimester
  • pressure on the internal organs causes heartburn,
    acid reflux and frequent urination.
  • Edema causes swelling of ankles, face, hands and

Distribution of Weight Gain Pounds
Baby 7.5
Placenta 1.5
Amniotic Fluid 2
Uterus 2.5
Breasts 1.5
Increased blood 3
Increased fluids 4
Maternal fat stores 8
Total 29
Diagnostic Tests during Pregnancy
  • Amniocentesis
  • Genetic test - examination of chromosomes in
    amniotic fluid
  • Done during the 2nd trimester (weeks 14 and 20)
  • Recommended if
  • woman is 35
  • previous child has a chromosomal abnormality
  • Chorionic Villus Sampling
  • Genetic test examination of tissue from the
    chorion of the placenta
  • Done during the 1st trimester (weeks 9 and 12)
  • Recommended if
  • Woman is 35
  • family history of an identifiable inherited
    genetic disorder

Diagnostic Tests during Pregnancy
  • Ultrasound (Sonogram)
  • Picture of the internal structure of the fetus,
    can determine fetal age and location of the
  • Also used as a guide during amniocentesis and CVS
  • Alpha-fetoprotein (AFP)
  • Blood test - examination of the mothers blood
    can detect spinal cord defects (spina bifida
    also used to screen for Downs Syndrome)
  • Done during weeks 15 and 18

Postpartum Period
  • The period consisting of the months or weeks
    immediately after childbirth.
  • It is a time when the woman adjusts, both
    physically and psychologically, to the process of
  • Marker events
  • Postpartum Blues
  • Postpartum Depression
  • Postpartum Psychosis
  • Breastfeeding

Postpartum blues or baby blues
  • Common 50 70 women after pregnancy
  • State of short-term dysphoria that my accompany
    the feelings of happiness and excitement that
    follow the babys birth
  • Only lasts a few days
  • Symptoms include
  • Bouts of crying Memory Lapses
  • Mild Confusion Mood swings
  • Irritability Fatigue

Postpartum Depression (PPD)
  • Not so common 8 20 of women after pregnancy
  • More severe than baby blues.
  • Extreme sadness and feelings of worthlessness and
    inadequacy as a mother
  • May become suicidal
  • Most women improve on their own in 3 - 6 months
  • Others may require psychological intervention
  • Symptoms include
  • Insomnia
  • Digestive problems
  • Unusual weight loss

Postpartum Psychosis
  • Rare
  • Serious disorder that probably has underlying
    psychological causes
  • Requires psychological evaluation and treatment
  • Marked by extreme highs and lows
  • Symptoms
  • Extremely agitated
  • Paranoid
  • Delusions hallucinations

  • Facilitates uterine contractions
  • Colostrum
  • Produced in late pregnancy and for about 48
    hours after birth
  • Contains no milk
  • Contains many nutrients and antibodies that are
    valuable for the newborn

Pregnancy Conditions/Complications
  • Spontaneous Abortion or Miscarriage
  • Ectopic Pregnancy
  • Incompetent Cervix
  • Preterm Labor
  • Low birth weight
  • Preeclampsia/Eclampsia
  • Gestational Diabetes
  • Placenta problems
  • Abruption, previa

Pregnancy Conditions/Complications
  • High Risk Pregnancies
  • Mother's health
  • Mothers Age
  • Teenage mothers (17 and younger)
  • Mothers over 35 years of age
  • Health of the fetus (baby)
  • Complications unique to pregnancy

  • Substances that can be dangerous to the health of
    the baby
  • Cause defects because they cross the placenta
  • Greatest teratogenic effect during the first

  • Active Teratogens
  • Passive Teratogens

Labor DeliveryPreparing for Labor
  • Woman may experience burst of energy
  • Lightening and engagement of fetus
  • descent of fetus into pelvic region
  • Cessation of weight gain
  • Dilation and effacement (thinning) of cervix
  • bloody show (due to bursting capillaries)
  • mucus plug expelled
  • Rupture of amniotic sac (the water breaking)

Stage I
  • Early phase
  • mild-moderate contractions dilate
  • cervix 03 cm
  • Active phase
  • moderate contractions dilate
  • cervix 37 cm
  • Transition
  • intense contractions dilate cervix 710 cm

Stage II
  • Early or Rest phase
  • brief lull with no urge to push
  • Active or Decent phase
  • pushing during contractions
  • Moves baby down the birth canal
  • Transition or Crowning
  • and Birth phase
  • head and body delivered

Stage III Stage IV
  • Stage III
  • Placental phase
  • Placenta is delivered
  • Stage IV
  • Recovery phase
  • Mother and baby checked for complications

  • The cutting of the perineum that allows more room
    for the baby to be delivered

Drugs During Labor
  • Analgesics
  • Tranquilizers or narcotics
  • Help a woman relax and give some pain relief
  • Anesthesia
  • Lumbar epidural
  • Eliminates sensation from the belly down
  • May sometimes prolong or even stop labor
  • Risks associated with drugs
  • Can cross the placental barrier to the baby
  • Temporary side effects
  • Irregular or slowed heart beats
  • Higher rates of jaundice
  • Breathing problems

Cesarean Section
  • Most common when
  • fetus in the breech position
  • labor difficult or abnormal (dystocia)
  • fetus is distressed
  • woman had a previous c-section

Breech Positions
  • By 36 weeks of pregnancy, most fetuses turn into
    a head-down, or vertex position. This is the
    normal and safest fetal position for birth.
  • A fetus with the feet, buttocks, or legs pointing
    down toward the cervix is said to be in breech
  • Types
  • Complete
  • The buttocks are down near the birth canal
  • Frank
  • buttocks are in place to come out first during
  • Footling
  • One leg (single footling) or both legs (double
    footling) are stretched out below the buttocks.
    The leg(s) are in place to come out first during

  • Video Having a Healthy Baby

  • Menopause is the medical term for the end of a
    woman's menstrual periods.
  • Change of life.
  • Average age 51 years
  • As early as 40 years
  • As late as early 60s.

  • Natural
  • Occurs naturally after the womans supply of
    follicles has been depleted and menstruation ends
  • Surgical
  • Can be induced if the ovaries are surgically

  • This period usually begins a few years before the
    last menstrual cycle
  • May last a few years

  • Three stages of transition
  • Early
  • Middle
  • Late

Early Stage
  • Between ages 40 and 44
  • Marker
  • Changes in menstrual flow
  • Changes in length of the cycle
  • Sudden surges in estrogen

Middle Stage
  • Periods become irregular
  • Periods are NOT skipped

Late Stage
  • Women begin missing the periods until they
    finally stop.
  • Estrogen levels drop significantly
  • Triggers menopausal symptoms
  • Puts women at greater risk of certain conditions

Estrogen depletion can lead to
  • Increase in heart disease
  • Loss of bone density
  • Memory loss

Hormonal Changes
  • Ovaries
  • Stop producing estrogen and progesterone
  • Continue to produce small amount of testosterone
  • Can be converted to estrogen (estradiol) in fat

Symptoms of Menopause
  • An array of symptoms, including
  • -Hot flashes -Mood Changes
  • -Night sweats -Sexuality
  • -Heart pounding or racing -Forgetfulness
  • -Insomnia -Urine leakage
  • -Vaginal Dryness -Joint stiffness
  • Can last from six months to more than five years
    after the onset of menopause

Remedies Over-the-counter
  • Non Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Painkillers such as aspirin, ibuprofen (Advil,
  • Relief of menopausal symptoms
  • Lubricants
  • Vaginal dryness
  • Vitamin E
  • Helps with hot flashes

Alternative Therapies
  • Acupuncture, meditation and relaxation techniques
  • Herbal or natural remedies
  • Pros
  • Some women report great benefits with these
  • Cons
  • Not regulated
  • Quality is not controlled
  • Some can contain toxic metals

Dietary and Lifestyle Factors
  • Mineral-rich Fruits and Vegetables
  • High in magnesium and potassium and can help
    preserve bones
  • Many help protect against heart disease and
  • Effects of fiber
  • Important for the heart
  • Phytoestrogens
  • These are plant estrogens found in soy
  • Intake can result in lower risk for diseases
    associated with estrogen
  • Avoid fast foods and Limit salts

Hormone Replacement Therapy (HRT)
  • Standard treatment for preventing many of the
    health problems that develop after menopause
    because of estrogen loss
  • May use estrogen alone or in combination with
    forms of progesterone
  • If hysterectomy estrogen alone
  • If uterus is present estrogen progestin

HRT (cont)
  • Refers to providing a woman who has gone through
    menopause with hormones that her body has stopped
  • Symptom relief in 80 of women
  • Does not prevent certain other problems
    associated with menopause such as thinning hair

How is HRT Administered?
  • 1. Hormone Pills
  • most common form
  • 2. Injections
  • Bypasses the liver
  • 3. An estrogen-filled patch
  • Placed on the buttock or upper arm
  • Bypasses the liver
  • 4. Implants
  • Placed under skin 2X per year common in 1970s
  • 5. Creams (estrogen progesterone)
  • 6. Vaginal Creams (estrogen only)

Oral Contraceptives??
  • Not suitable for replacement therapy
  • May reduce the risk of bone loss and alleviate
    early menopausal symptoms, such as hot flashes
  • Recommended and effective only during early

Benefits of HRT
  • Relief of uncomfortable symptoms that may occur
    with menopause
  • Hot flashes, vaginal dryness, osteoporosis
  • Prevention of bone loss
  • improves balance protects against falling
  • Improve cholesterol levels
  • Increasing blood flow and reducing blood pressure
  • Protects against stroke
  • Reduces risk of heart disease
  • Help prevent mental breakdown after menopause

Risks for HRT
  • Depends on three factors
  • treatment prescribed
  • whether the woman has a uterus
  • how long hormones are taken
  • with short-term therapy of less than 5 years,
    there appear to be few risks of treatment

Risks of HRT
  • Breast cancer
  • Uterine Cancer Other Reproductive Cancers
  • Estrogen alone
  • Heart Attack
  • Within the first two years in women with
    pre-existing conditions
  • Strokes
  • Within the first two years in women with
    pre-existing conditions
  • Blood clots
  • Endometriosis

Side Effects of HRT
  • Not medically serious but bothersome
  • Estrogen
  • breast tenderness, edema, nausea, headache, and
    breakthrough bleeding
  • Progestin
  • Fluid retention, acne, premenstrual-like
    symptoms, anxiety, depression, and irritability

Who gets HRT?
  • Not every menopausal woman
  • First women should consider herbs, nutritional
    support, balanced diet, and exercise
  • HRT should come in second place and not last
    longer than five years

Menopause and Bone Density
  • Osteoporosis
  • Disease of the skeleton in which bones become
    brittle and prone to fracture
  • Bone loses density
  • Major risk factor for fracture in the spine and
  • After menopause
  • Extreme speed-up of bone breakdown (resorption)

Male Climacteric Syndrome
  • Male climacteric
  • Best name
  • Indicates a decline in testosterone
  • Aka Male Menopause
  • May be an inappropriate term as it indicates drop
    in hormones
  • Aka Aging Male Syndrome (AMS) or Andropause
  • Does not cause infertility
  • Occurs when testosterone production fall
  • Occurs in men ages 40 and 55

The role of Testosterone
  • A hormone that helps maintain sex drive, sperm
    production, pubic and body hair, muscle, and
    bone. Testosterone levels decrease over time.
    This decline is normal in healthy males as they

Common Symptoms of Male Climacteric Syndrome
  • Symptoms as a result of a decline in testosterone
  • Depression, nervousness
  • Insomnia
  • Feeling fat/weight gain
  • Decreased libido
  • Erectile Dysfunction
  • Easily fatigued
  • Poor concentration and memory
  • Flushes and sweats

Diagnosis of Testosterone Deficiency
  • Testosterone Level Test
  • Test in the AM when testes produce more
  • Blood test
  • See an Endocrinologist, hormone specialist

Testosterone Replacement Therapy
  • An option for men whose natural testosterone
    level is not within the normal range
  • Becoming increasingly popular but unsure of the
  • If it relieves symptoms of men with low
  • how low testosterone levels affect men's health.
  • if testosterone therapy increases the risk of
    prostate cancer.
  • if testosterone therapy is safe

Testosterone Replacement Therapy
  • Benefits/Risks
  • Still being researched

Reproductive Health Essay
  • Due
  • 5/14/12 (in class AND on
  • Set up Turnitin account
  • Essay Topic/Article Research
  • Sample articles will be sent via e-mail
  • Submit article for approval by 5/7/12
  • In class only. Will not be approved via email.

Essay Points scored as follows
  • Summary (10)
  • Identify and discuss Reproductive Health Issue
  • Strengths/Weaknesses (10)
  • Moral /Ethical Issues (5)
  • Conclusion (7)
  • Grammar/Writing Ability (5)
  • Free of typographical Errors (5)
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