Nursing Notes
Nursing Notes
Nursing Notes
• FSH and LH are termed gonadotropin (gonad= • When triggered at puberty by FSH,
"ovary"; tropin = "growth") hormones not only ovarian follicles in females begin to
because they begin the production of androgen and excrete a high level of the hormone
estrogen, which in turn initiate secondary sex estrogen.
characteristics, but also because they continue to • This increase influences the following:
cause the production of eggs and influence • development of the uterus, fallopian
menstrual cycles throughout women's lives (Eggers, tubes, and vagina;
Ohnesorg, & Sinclair, 2014). • typical female fat distribution;
• hair patterns; and
THE ROLE OF ANDROGEN
• breast development.
• Androgenic hormones are the hormones • It also closes the epiphyses of long
responsible for: bones in girls the same way testosterone
1. muscular development closes the growth plate in boys.
2. physical growth • The beginning of breast development is
3. increase in sebaceous gland secretions that termed thelarche, which usually starts 1
cause typical acne in both boys and girls to 2 years before menstruation.
during adolescence.
• The level of the primary androgenic • menstrual cycle (the female reproductive
hormone, testosterone, is low in males until cycle) is episodic uterine bleeding in
puberty (between ages 12 and 14 years) response to cyclic hormonal changes.
when it rises to influence pubertal changes • The purpose of a menstrual cycle is to
in the testes, scrotum, penis, prostate, and bring an ovum to maturity and renew a
seminal vesicles; uterine tissue bed that will be necessary
for the ova's growth should it be • inactivity of any part results in an
fertilized. incomplete r ineffective cycle
MENARCHE
2. The Anterior lobe of the Pituitary Gland
• First menstruation
(the adenohypophysis)
• May occur as early as 9 years of age
• It is good to include health teaching • Under the influence of GRH, produces
information on menstruation to both two hormones:
school age children and their parents as 1. FSH, a hormone active early in the cycle
early as fourth grade as part of routine that is responsible for maturation of the
care. ovum
2. LH, a hormone that becomes most active at
THE LENGTH OF MENSTRUAL CYCLE
the midpoint of the cycle and is responsible
• differs from woman to woman. for ovulation, or release of the mature egg
• average length is 28 days (from the cell from the ovary.
beginning of one menstrual flow to the • It also stimulates growth of the uterine
beginning of the next). linin during the second half of the
• It is not unusual for cycles to be as short menstrual cycle.
as 23 days or as long as 35 days. 3. THE OVARIES
• Every month during the fertile period of
THE LENGTH OF MENSTRUAL FLOW
a woman’s life (from menarche to
(termed menses)
menopause), one of the ovary’s oocytes
• 4 to 6 days is activated by FSH to begin to grow and
• although women may have flows as mature.
short as 2 days or as long as 9 • As the oocyte grows, its cells produce a
• days (Ledger, 2012). clear fluid (follicular fluid) that contains
a high degree of estrogen and some
progesterone.
• As the follicle surrounding the oocyte
PHYSIOLOGY OF grows, it is propelled toward the surface
of the ovary.
MENSTRUATION • At full maturity, the follicle is visible on
the surface of the ovary as a clear water
blister approximately 0.25 to 0.5 in.
across.
1. Four body structures are involved: • At this stage of maturation, the small
1.hypothalamus ovum (barely visible to the naked eye,
2.Anterior pituitary gland about the size of a printed period) with
3.ovaries its surrounding follicular membrane and
4.uterus fluid is termed a graafian follicle.
• For a menstrual cycle to be complete, all • By day 14 or the midpoint of a typical
four organs must contribute their part; 28-day cycle, the ovum has divided by
mitotic division into two separate • With lutein production, the follicle is
bodies: renamed a corpus luteum (yellow body).
• a primary oocyte, which contains the • The basal body temperature of a woman
bulk of the cytoplasm, and drops slightly (by 0.5° to 1°F) just
• secondary oocyte, which contains so before the day of ovulation because of
little cytoplasm that it is not the extremely low level of progesterone
functional. that is present at that time.
• The structure also has accomplished its • It rises by 1°F on the day after ovulation
meiotic division, reducing its number of because of the concentration of
chromosomes to the haploid (having progesterone, which is thermogenic.
only one member of a pair) number of • The woman’s temperature remains at
23. this elevated level until approximately
• After an upsurge of LH from the day 24 of the menstrual cycle, when the
pituitary at about day 14, prostaglandins progesterone level again decreases
are released and the graafian follicle (Huether & McCance, 2012).
ruptures. • If conception (fertilization by a
• The ovum is set free from the surface of spermatozoon) occurs as the ovum
the ovary, a process termed ovulation. It proceeds down a fallopian tube and the
is swept into the open end of a fallopian fertilized ovum implants on the
tube. endometrium of the uterus, the corpus
• It is important to teach women that luteum remains throughout the major
ovulation does not necessarily occur on portion of the pregnancy (to about 16 to
the 14th day of their cycle; 20 weeks).
• it occurs 14 days before the end of their • If conception does not occur, the
cycle. unfertilized ovum atrophies after 4 or 5
• If their menstrual cycle is only 20 days days, and the corpus luteum (now called
long, for example, their day of ovulation a “false” corpus luteum) remains for
would be day 6 (14 days before the end only 8 to 10 days.
of the cycle). • As the corpus luteum regresses, it is
• If their cycle is 44 days long, ovulation gradually replaced by white fibrous
would occur on day 30, not at the tissue, and the resulting structure is
halfway point—day 22. termed a corpus albicans (white body).
• After the ovum and the follicular fluid
have been discharged from the ovary, the
cells of the follicle remain in the form of 4. THE UTERUS
a hollow, empty pit. • Uterine changes that occur monthly as a
• The FSH has done its work at this point result of stimulation from the estrogen
and now decreases in amount. and progesterone produced by the
• The second pituitary hormone, LH, ovaries.
continues to rise in amount and directs
the follicle cells left behind in the ovary
to produce lutein, a bright yellow fluid
high in progesterone.
•
PHASES OF If fertilization does not occur, the
corpus luteum in the ovary begins to
MENSTRUATION regress after 8 to 10 days, and therefore,
the production of progesterone
decreases.
• With the withdrawal of progesterone,
1. The First Phase of the Menstrual Cycle the endometrium of the uterus begins to
(Proliferative) degenerate (at about day 24 or day 25
• Immediately after a menstrual flow of the cycle).
(which occurs during the first 4 or 5 • The capillaries rupture, with minute
days of a cycle) hemorrhages, and the endometrium
• the endometrium, or lining of the sloughs off.
uterus, is very thin, approximately one
cell layer in depth.
• As the ovary begins to produce estrogen 4. The Fourth Phase of the Menstrual Cycle
(in the follicular fluid, under the (Menses)
direction of the pituitary FSH), the • Menses, or a menstrual flow, is
endometrium begins to proliferate so composed of:
rapidly the thickness of the 1) a mixture of blood from the ruptured
endometrium increases as much as capillaries;
eightfold from day 5 to day 14 2) mucin;
• ALSO CALLED the proliferative, 3) fragments of endometrial tissue; and
estrogenic, follicular, or postmenstrual 4) the microscopic, atrophied, and unfertilized
phase. 5. ovum.
• Because it is the only external marker
2. The Second Phase of the Menstrual Cycle of the cycle, however, the first day of
(Secretory) menstrual flow is used to mark the
• After ovulation, the formation of beginning day of a new menstrual
progesterone in the corpus luteum cycle.
(under the direction of LH) causes the • Contrary to common belief, a menstrual
glands of the uterine endometrium to flow contains only 30 to 80 ml of
become corkscrew or twisted in blood;
appearance and dilated with quantities • if it seems to be more, it is because of
of glycogen (an elementary sugar) and the accompanying mucus and
mucin (a protein). endometrial shreds. The iron loss in a
• It takes on the appearance of rich, typical menstrual flow is approximately
spongy velvet. 11 mg.
• Is termed the progestational, luteal, • This is enough loss that many
premenstrual, or secretory phase. adolescent women could benefit from a
daily iron supplement to prevent iron
depletion during their menstruating
3. The Third Phase of the Menstrual Cycle years (Bitzer, Sultan, Creatsas, et al.,
(Ischemic) 2014).
HEALTH ASSESSMENT DURING PRENATAL
PRENATAL VISITS VISITS
Gynecology Care