2. OVERVIEW
• The functions of the human reproductive system
are multifold.
• The male's reproductive role is to manufacture
male gametes called sperm and deliver them to
the female reproductive tract.
• The female produces female gametes called ova
or eggs. The female also provides an
environment for a fertilized ovum, a zygote, to
develop.
• Both the male and the female produce sex
hormones that affect sexual behavior, drive,
development and function.
6. A. Mons pubis or Mons
Veneris – a pad of fat which
lies over the symphysis pubis
covered by skin and at puberty
by short hairs; protects the
surrounding delicate tissues
from trauma
Stages of Pubic Hair
Development (Tanner Scale)
Stage 1 Pre Adolescence – No
pubic hair except for fine body
hair
Stage 2 Occurs b/w ages 11 and
12 – Sparse, long, lightly
pigmented and curly hair
develops along labia
7. • Stage 3 Occurs between ages 12 and 13 –
hair becomes darker and curlier that
develops along pubic symphysis
• Stage 4 Occurs between ages 13 and 14 –
assumes the normal appearance of an
adult but is not so thick and does not
appear to the inner aspect of the upper
thigh
• Stage 5 Sexual Maturity – assumes the
normal appearance of an adult and appear
to the inner aspect of the upper thigh
8. B. Labia majora – Two folds of skin with
fat underneath; contains bartholins’s
glands which are believed to secrete a
yellowish mucus which acts as a lubricant
during sexual intercourse. The openings of
bartholin’s glands are located posteriorly
on either side of the vaginal orifice.
9. • C. Labia minora – two thin
folds of delicate tissues; form
an upper fold encircling the
clitoris ( called the prepuce)
and unite posteriorly (called the
fourchette) which is highly
sensitive to manipulation and
trauma that is why it is often
torn during a woman’s delivery.
10.
11. • D. Glans clitoris – small erectile
structure at the anterior junction of the
labia minora, which is comparable to
the penis in its being extremely
sensitive.
12. • E. Vestibule – narrow
space seen when the labia
minora are separated.
Almond shape area that
contains the hymen, vaginal
orifice and bartholin’s
glands.
a. Urinary Meatus – external
opening of the urethra;
serves for urination
b. Skene’s glands – 2 small
mucus secreting substances
that serves for lubrication
13. c. Hymen – membranous tissue that covers
the vaginal orifice (* Carumculae
Mestiformes – healing of torn hymen)
d.Bartholin’s glands/ Para vaginal gland –
secretes alkaline substance, which
neutralizes the acidity of the vagina.
(doderleins bacillus – controls the acidity of
vagina)
14. • F. Urethral Meatus –
External opening of the
urethra; slightly behind and
to the side are the openings
of the Skene’s glands (which
are often involved in
infections of the external
genitalia) STD.
• G. Vaginal orifice or
Introitus – external
opening of the vagina
covered by a thin membrane
(called hymen) in virgins.
15. • h. Perineum _ area from the lower
border of the vaginal orifice to the anus;
contains the muscles (pubococcygeal and
levator ani muscles) which support the
pelvic organs, the arteries that supply
blood to the external genitalia and the
pudendal nerves which are important
during delivery under anesthesia.
17. A. Vagina –
a 3 – 4 inch long dilatable
canal located between the
bladder and the rectum;
contains rugae (which
permit considerable
stretching without tearing);
organ of copulation;
passageway for menstrual
discharges and fetus.
19. – Hollow pear shaped fibromuscular organ 3
inches long 2 inches wide 1 inch thick and
weighing 50 – 60 grams in a non-pregnant
woman
– Held in place by broad ligaments ( from the
sides of uterus to pelvic walls; also hold
fallopian tubes and ovaries in place) and
round ligaments (from the sides of uterus to
the mons pubis)
– Abundant blood supply from uterine and
ovarian arteries
20.
21.
22.
23. Composed of 3 muscle layers: which
makes expansion possible in every
direction.
• Endometrium – in lines the non pregnant
uterus (inner), muscle layer for menstruation
( * Endometriosis – ectopic endometrium
abnormal growth of endometrial lining outside
the uterus….common site ovaries. s/sx.
Persistent dysmenorrheal and lowback pain)
• Myometrium – the largest part of the
uterus; the muscle layer for pregnancy; its
smooth muscles is considered to be the living
ligature of the body
• Perimetrium – protect the entire uterus
24.
25.
26. – Consist of three parts
– Corpus (body) – upper portion with
a triangular part called fundus
– Isthmus – area between corpus
and cervix which forms part of the
lower uterine segment
– Cervix – lower cylindrical portion
27. –organ of menstruation; site of
implantation; retainment and
nourishment of the products of
conception.
28. C. Fallopian Tubes – 2-3 inches long
that serves as a passageway of the
sperm from the uterus to the ampulla or
the passageway of the mature ovum or
fertilized ovum from the ampulla to the
uterus
29.
30. 4 significant segments
• 1. Infundubulum – most distal part of fallopian
tube (tunnel or trumphet shape)
• 2. Ampulla – outer 3rd and half; site of
fertilization; common site of ectopic pregnancy;
widest part spreads into fingerlike projections
called Fimbrae.
• 3. Isthmus – common site of fertilization; site for
BTL
• 4. Interstitial – the most dangerous site of
ectopic pregnancy
31.
32. D. Ovaries – almond – shaped,
dull white sex glands near
the fimbrae, kept in place
by ligaments.
• - produce mature ovum
and expel ova and
manufacture estrogen and
progesterone
• - for ovulation
33. • Blood supply to the ovaries is primarily from
the ovarian arteries, which are branches of
the abdominal aorta. Blood is drained from the
ovaries via the ovarian veins.
• An ovary is surrounded externally by a tunica
albuginea, similar to that found upon the testis.
• The ovary has an outer cortex, which contains
the forming gametes, and an inner medulla,
which contains large blood vessels and nerves.
• The ovarian cortex is quite vascular and contains
multiple tiny ovarian follicles. Each follicle
contains an immature egg, an oocyte, surrounded
by one or more layers of cells.
34.
35.
36.
37.
38. Anatomy of the Vagina and
Vulva
• The vagina is a thin-walled tube, 3-4 inches
long, that extends from the cervix to the
body exterior.
• It lies between the bladder and the rectum.
• The vaginal wall has three tunics: an outer
fibroelastic adventitia, a smooth muscle
muscularis, and a rugae-containing
stratified squamous mucosa.
39.
40.
41. • The vaginal orifice is the external opening
of the vagina.
• In virgins, the mucosa near the orifice
forms an incomplete partition called the
hymen.
• The upper portion of the vaginal canal
surrounds the cervix of the uterus,
producing a recess called the vaginal
fornix.
• The vaginal orifice is adjacent to many
structures of the external genitalia.
44. • The mammary glands are present in both
sexes, but normally only function in
females.
• The mammary glands sit within the
breasts, within the superficial fascia and
anterior to the pectorals.
• Slightly below the center of each breast is
a ring of pigmented skin, the areola, which
surrounds the central protruding nipple.
45. • Internally, each mammary gland consists of
15-25 lobes that radiate around and open
up at the nipple. The lobes are separated
from one another by connective tissue and
fat.
46. • This connective tissue forms suspensory
ligaments that attach the breast to the
underlying muscle and overlying dermis.
• Within the lobes are smaller units called
lobules, which contain glandular alveoli that
produce milk during lactation.
• The alveolar glands pass the milk into the
lactiferous ducts, which open at the nipple.
Just deep to the areola, each duct contains
a dilated region called the lactiferous sinus,
where milk accumulates during nursing.
49. II. Male Reproductive System
• includes the penis, scrotum and
testes (encased in the scrotal
sac)
• spermatozoa are produced in
the testes and reached maturity,
surrounded by semen, in the
external structures.
51. • Semen is derived
from the prostate
gland (60%), seminal
vesicle (30%), the
epedidymis (5%) and
the bulbourethral
glands (5%)
• Semen is alkaline
and contains a basic
sugar and mucin
(protein)
52.
53.
54.
55. Male External
Structures
1. Penis – the male organ of
copulation and urination. It
contains of a body or a shaft
consisting of 3 cylindrical
layers and erectile tissues. At
its tip is the most sensitive
area comparable to that of the
clitoris in the female – the
Glans Penis.
56. • The penis and the scrotum collectively
make up the external genitalia.
• The function of the penis is to deliver
sperm into the female reproductive tract
during copulation. The penis consists of an
attached root, a shaft, and an enlarged tip
called the glans penis.
• The skin covering the penis is loose, and at
the glans there is a cuff called the prepuce,
or foreskin, which is typically removed at
circumcision.
57. • The penis contains three erectile bodies:
the corpus spongiosum and two corpora
cavernosa.
• The corpus spongiosum is ventral and
surrounds the urethra. The corpora
cavernosa are dorsal.
• Each of these erectile tissues consists of a
network of connective tissue and smooth
muscle filled with vascular sinuses.
60. 2. Scrotum – a pouch hanging
below the pendulous penis, with
a medial septum dividing into
two sacs, each of which contains
a testes
• - it contains the testes,
epididymis and the lower portion
of the spermatic cord.
• - it support the testes and
help regulate the temperature of
sperm it requires 2 degrees
celcius for spermatogenesis
61. 3. Testes – 2 ovoid glands 2
– 3 cm wide that lie in the
scrotum
- encased by a protective white
fibrous capsule
- composed of a number of
lobules
- each lobule containing
interstitial cells (Leydig’s cell)
and Semeniferous Tubules
- Semeniferous tubules
produced spermatozoa
- Leydig’s cell produce male
hormone testosterone
65. The process of Spermatogenesis
1.Hypothalamus
2.GnRH
3.APG
4.FSH – stimulate the release of
androgen Binding Protein for sperm
maturation
LH – stimulate Leydig’s cell which
responsible for the release of
testosterone
ABP binding testosterone promotes
spermatogenesis
70. Epididymis – a tightly coiled
tube, approximately 20 ft.
long
• responsible for conducting
sperm from the testis to the
vas deferens
• sperm are immobile and
incapable of fertilization as
they pass or are stored at
the epididymis level.
• It takes at least 12 -20
days for them to travel the
length of the epididymis
and a total of 64 days for
them to reach maturity
71. Vas Deferens (Ductus deferens) – it carries
sperm from the epididymis through the
inguinal canal into the abdominal cavity,
where it ends at the seminal vesicles and
the ejaculatory ducts.
• sperm matures as they pass thru the vas
deferens
72. Bulbourethral Gland – lies
beside the prostate gland
and by short ducts empty
into the urethra
• Secretes alkaline fluid
that helps counteract the
acid secretion of the
urethra and ensure the
safe passage of
spermatozoa.
73. Urethra - a hollow tube leading from the
base of the bladde, which after passing
through the prostate gland, continues to
the outside through the shaft and glans
penis.
• 8 inches long, lined with mucous
membrane.
74. Seminal vesicles – two
convoluted pouches that lie
along the lower portion of the
bladder
• empty into the urethra by
way of ejaculatory ducts
• secretes a viscous portion of
the semen, with high content
of a basic sugar, protein, and
prostaglandins and is
alkaline.
• Sperm become increasingly
motile
75. Ejaculatory Ducts – pass through the
prostate gland and join the seminal
vesicles with the urethra
Prostate Gland – chestnut – sized gland
that lies just below the bladder.
• the urethra passes through the center of it.
• Secretes a thin alkaline fluid
78. Basic Knowledge on Genetics
and Obstetrics
• DNA carries genetic information
• Chromosomes thread like strands
composed of hereditary materials
composed of DNA.
• Normal amount of ejaculated
sperm is 5 -3 cc
• ovum is capable of being fertilized
within 24 – 36 hours after ovulation
• Sperm is viable within 48 – 72
hours / 2-3 days
79. • Reproductive cells divides
by the process of meosis
1.spermatogenesis –
maturation of sperm
2.Oogenesis – maturation of
ovum
3.Gametogenesis – process
of maturation of haploid to
diploid
• Age of Reproductivity is 15 –
44y/o
• Ideal age for child bearing 20 - 30
• With risk 18 –2 0
• With high risk 31 – 35
80. Menstruation
• Mestrual cycle – beginning of menstruation to beginning of the next
menstruation
• Average Mestrual Cycle – 28 days
• Normal Blood loss - 50 cc
• Related terminologies:
• Menarche – Ist menstruation
• Dysmenorrhea – painful menstruation
• Metrorrhagia – bleeding in between menstruation
• Menorhagia – excessive bleding during menstruation
• Amenorrhea – absence of menstruation
• Menopaus – cessation of menstruation
• Oligomenorrhea – markedly diminished menstrual flow,
nearing amenorrhea
• Polymenorrhea – frequent menstruation occurring at intervals
of less than 3 weeks.
81. Functions of Estrogen and
Progesterone
ESTROGEN “hormone of the woman”
– Primary functions: development of secondary sex
characteristics/ inhibits FSH production/ Hypertrophy of
myometrium
– Others:
• early closure of the epiphysis of long bones
• Inhibits FHS production
• hypertrophy of myometrium
• increases quantity and PH of cervical mucus, causing it to become
thin and watery and can be stretched to a distance of 10 – 13 cm. (
spinbarkheit test of ovulation)
• Ductile structure of the breast
• Na retention
• increase sexual desire
• vaginal lubrication
82. – PROGESTIN/ PROGESTERONE
• “hormone of the Mother”
• Primary function: prepares the endomertium for
implantation of ovum
• Secondary function: Inhibits uterine contractility
• Others:
• Inhibits LH production ( for ovulation)
• Decrease GIT motility, increase reabsorption
(causes constipation)
• increase permeability of kidneys to lactose and
dextrose causing positive 1 sugar.
• Mammary gland dvlopment
• Increase Basal Body Temperature
83. Female pelvis and
measurements
The Pelvis- although not a part of the female
reproductive system but of skeletal system. It is a
very important body part of pregnant women.
A. Structure
1.Two os coxae/ innominate bones – made up of :
– Ilium – upper extended part; curved upper border is the
iliac crest
– Ischium – under part; the body rsts on the ischial
tuberosities; ischial spines are important landmarks
– Pubes – front part; join to form an articulation of the
pelvis called the symphysis pubis
84.
85. 2.Sacrum – wedge – shaped, forms
the back part of the pelvis. Consist
of 5 fused vertebrae, the first
having a prominent upper margin
called the sacral promontory. The
sacroiliac joint is the articulation
between the sacrum and the ilium.
3.Coccyx – lowest part of the spine;
degree of movement between
sacrum and coccyx made possible
by the third articulation of the
pelvis sacroccyeal joint which
allows room for delivery of the fetal
head.
86. B. Divisions – set apart by the linea terminals, an
imaginary line from the sacral promontory to the
ilia on both sides to the superior portion of the
symphysis pubis.
1.False Pelvis – superior half formed by ilia; offers
landmarks for pelvic measurements; supports the
growing uterus during pregnancy; and directs the
fetus into the true pelvis near the end of gestation. It
also supports the abdominal viscera.
2.True Pelvis – Inferior half formed by the pubes in front;
the iliac and ischia on the sides and the sacrum and
coccyx behind. Made up of 3 parts:
87. 2.1 Inlet – entrance way to the true pelvis. Its
transverse diameter is wider than its
anteroposterior diameter.
• - transverse diameter = 13.5 cm
• - anteroposterior diameter (AP) = 11 cm
• - Right and Left oblique diameter = 12.75 cm
2.2 Cavity – space between the inlet and the
outlet. Contains the bladder and the rectum,
with the uterus between them in an anteflexed
position towards the bladder
2.3 Outlet – inferior portion of the pelvis bounded
on the back by the coccyx on the sides by the
ischial tuberosities and in front by the inferior
aspect of the symphysis pubis and the pubic
arch. Its AP diameter is wider than its
transverse diameter.
88. C. Types / Variation
1.Gynecoid – normal female pelvis. Inlet is well
rounded forward and back. Most ideal for
child birth.
2.Anthropoid – transverse diameter is narrow AP
diameter is larger than normal. Oval shaped.
3.Platypelloid – inlet is oval, AP diameter is
shallow, wide transverse diameter but short
AP diameter, making the outlet inadequate.
4.Android – Male Pelvis; not favorable for labor.
Inlet has a narrow, shallow posterior portion
and pointed anterior portion
89.
90. D. Measurements
1. External – suggestive only of pelvic size.
1.1 Intercristal diameter – distance between the middle
points of the iliac crest. Average = 28 cm.
1.2 Interspinous diameter – distance between the
anterosuperior spines. Average = 25 cm
1.3 Intertrochanteric diameter – distance between the
trochanters of the femur. Average = 31 cm
1.4 External conjugate / baudelocques diameter –
distance between the anterior aspect of the symphysis
pubis and depression below L5. average = 18 – 20 cm
91.
92. 2. Internal - give the actual diameters of the inlet and outlet
2.1 Diagonal Conjugate – distance between the sacral
promontory and inferior margin of the symphysis pubis.
Average = 12.5 cm
2.2 True conjugate / conjugate vera – distance between
the anterior surface of sacral promontory and the superior
margin of the symphysis pubis. Very important
measurement because it is the diameter of the pelvic
inlet. Average = 10.5 – 11 cm
2.3 Bi – ischial diameter/tuberischii – transverse diameter
of the pelvic outlet is measured at the level of the anus.
Average = 11 cm.
93. Feedback Mechanism of Mestruation
A. General considerations
• 300,000 – 400,000 immature oocytes per ovary
are present at birth ( were formed during the
first 5 months of intrauterine life, a process
called oogenesis); many of these oocytes,
however, degenerates and atrophy ( a process
called atresia). Only about 300 – 400 mature
during the entire reproductive cycle of women.
• .
94. • Ushered in by the menarch (very first
menstruation in girls) and ends with
menopause (permanent cessation of
menstruation); age of onset and
termination vary widely depending on
heredity, racial background, nutrition
and even climate
95. • Normal period (days when there is menstrual
flow) last for 3 – 6 days; menstrual cycle (from
first day of menstrual period up to the first day
of the next menstruation period) may be
anywhere from 25-35 days, but accepted
average length is 28 days.
• Anovulatory states after menarche are not
unusual because of immaturity of feedback
mechanism. Anovulatory states also occur in
pregnancy, lactation and related disease
conditions.
97. sequential steps in the menstrual
Cycle
4 phases of the menstrual cycle
• 1. Proliferative Phase (6-14 days)
• 2. Secretory Phase (15 – 26 days)
• 3. Ischemic Phase (27 28 days)
• 4. Menses (1 – 5 days)
98.
99.
100. A. On the third day of the menstrual cycle,
serum estrogen level is at its lowest. This
low estrogen level serves as the stimulus for
the hypothalamus to produce the follicle
stimulating hormone releasing factor
(FSHRF).
B.FSHRF is the one responsible for stimulating
the Anterior Pituitary Gland to produce the
first of two hormones which regulate cyclic
activities, the FSH.
101.
102. C. FSH in turn, will stimulate the
growth of an immature oocyte
inside a primordial follicle by
stimulating production of estrogen
by the ovary. Once estrogen is
produced, the primordial follicle is
now termed as Graafian follicle
( the Graafian follicle, is the
structure which contains high
amounts of estrogen)
103. D. Estrogen in the graafian follicle will
cause the cell in the uterine endothelium
to proliferate (grow very rapidly), thereby
increasing its thickness to about
eightfold. This particular phase in the
uterine cycle therefore, is called
Proliferative phase.
104. In view of the change from
primordial to graafian follicle, it
is also called follicular phase.
Because of the predominance of
estrogen it is also called the
estrogenic phase. And since it
comes right after the menstrual
period, it is also called
postmenstrual phase. It is
also called Pre-ovulatory
105. E. On the 13th day of the menstrual
cycle, there is now a very low level of
progesterone in the blood. This low
serum progesterone level is the
stimulus for the hypothalamus to
produce the Leutenizing hormone
releasing factor (LHRF).
F. LHRF is responsible for stimulating the
APG to produce the second hormone
which regulates cyclic activity, the
Leutenizing Hormone.
106. G. The Lh, in turn is
responsible for stimulating
the ovary to produce the
second hormone produced by
the ovaries, Progesterone.
107. H. The increase amounts of
both estrogen and
progesterone push the new
mature ovum to the surface
of the ovary until, on the
following day (14th day of
the menstrual cycle) the
graafian follicle ruptures
and releases the mature
ovum, a process called
Ovulation
108. I. Once ovulation has taken place, the
graafian follicle, because it now contains
increasing amounts of progesterone,
giving it its yellowish appearance, is
termed Corpus Luteum. ( Therefore the
structure which contains high amounts of
progesterone is the corpus luteum)
109. A. Progesterone causes the glands of the
uterine endothelium to become corkscrew or
twisted in appearance because of the
increasing amount of capillaries.
Progesterone therefore, is said to be the
hormone designed to promote pregnancy
because it makes the uterus nutritionally
abundant with blood in order for the
fertilized zygote to survive should
conception take place, that is why this
phase in the uterine cycle is what we call
Progestational phase.
110. Also called Secretory Phase because
it secretes most important hormone in
pregnancy. In view of the change from
Graafian follicle to corpus luteum, it is
also called luteal phase. And also
called the pre-menstrual phase.
111. K Up until the 24th
day of the menstrual
cycle, if the mature
ovum is not
fertilized by a
sperm, the amounts
of hormones in the
corpus luteum will
start to decrease.
112. The corpus luteum turning white is
now called the corpus albicans
and in 3 – 4 days the thickened
lining of the uterus produced by
estrogen starts to degenerate and
slough off and capillaries rupture.
And thus begins another menstrual
period.
113. Stages of Sexual Response
• Initial Responses
– VASOCONSTRICTION – congestion of blood vessel
– Myotonia – Increase muscle tension
• EXCITEMENT PHASE
– Increase muscle tension
– Moderate increase in HR, RR, BP
– Nipple erection
– Penile erection
– During this phase erotic stimuli cause an
increase in sexual tension
– May last from minutes to hours
114. • PLATEAU PHASE
–Accelerated vital sign
–Increasing and sustained tension
nearing orgasm
–Lasting from 30 seconds – 3
minutes
115. • ORGASM
– diminished sensory assessment ( peak VS)
– Involuntary release of sexual tension
accompanied by physiologic and psychologic
release of
– Known as the immesurable peak of sexual
experience
– Last for 2 – 3 seconds
– Pelvic area is the most affected area
116. • RESOLUTION
– Vital sign may return to normal
– The most critical part
– Cardiac problem may occur
• Refractory period – the only period present in
males, wherein he cannot be restimulated for
about 10 – 15 minutes
118. OBJECTIVES:
A. To identify and learn the different vital
structures and functions of the Heart
B. To define and better understand the
mechanism of Congestive Heart Failure
119. C. To enumerate and learn the risk factors
and etiologic processes leading to Right
and Left Congestive Heart Failure.
D. To identify and integrate preventive -
curative measures by applying Medical and
Nursing Interventions in the management
of patient with CHF.
120.
121. FUNCTIONS OF THE
HEART
1. To pump oxygenated blood to the
arterial system, which carries it to
the cells.
2. To collect deoxygenated blood
from the venous system and
deliver it to the lungs for
reoxygenation.
129. Congestive Heart Failure:
Defined
(Cardiac Decompensation, Ventricular Failure,
Cardiac Insufficiency)
The Inability of the Heart to
pump enough blood to meet
the metabolic needs of the
body at rest or during
exercise
130. CAUSES OF HEART
FAILURE
• ABNORMAL MUSCLE FUNCTION
• ABNORMAL LOADING
CONDITION
• CONDITIONS OR DISEASES
THAT PRECIPITATE HEART
FAILURE
132. Forms of CHF
1. LEFT VERSUS RIGHT
VENTRICULAR FAILURE
2. BACKWARD VERSUS
FORWARD FAILURE
3. HIGH VERSUS LOW
OUTPUT FAILURE
133. FAILURE OF RIGHT VENTRICLE
BACKWARD EFFECTS
Increased volume in systemic venous
circulation
Increased volume in distensible organ
Hepatomegaly and splenomegaly
Dependent edema and serous effusion
FORWARD EFFECTS
Expansion of blood volume
Decreased volume to lungs
134. FAILURE OF THE LEFT
VENTRICLE
BACKWARD EFFECTS
Increased volume and pressure in L ventricle
and atrium
Increased volume in pulmonary veins
Pulmonary edema
FORWARD EFFECTS
Decreased cardiac output
Decreased perfusion of body tissues
Decreased blood flow to kidneys and glands
Increased secretion of sodium and water
retaining hormones
Increase reabsorption of sodium and water
135. ASSESMENT OF CHF
LEFT VENTRICULAR FAILURE
A. Dyspnea or shortness of breath
B. Orthopnea
C. Paroxysmal Nocturnal Dyspnea
D. Cheyne-Stokes respiration
E. Pulmonary edema
F. Cough
G. Cerebral Hypoxia
H. Fatigue and Muscular weakness
I. Cardiovascular sign ( pulsus alternans, S3
heart sound)
J. Renal Changes ( oliguria)
136. Right Ventricular Failure
• Peripheral edema and venous
congestion
• Cardiac Cirrhosis (ascites, jaundice,
symptoms of liver damage)
• Anorexia, nausea, and bloating
(abominal Distention)
• Cyanosis of the nail beds
• Jugular vein distention
• Hepatomegaly
• Weight gain
137. Goals and major intervention
in the management of CHF
1. Improve ventricular pump performance.
a. Administer Inotropic agent (digitalis)
b. Administer oxygen therapy
2. Reduce myocardial workload
a. Reduce Preload
1. Administer diuretics
2. Restrict fluid and sodium intake
3. Place person in upright position
4. Reduce blood volume with phlebotomy
b. Reduce Afterload
1. Administer vasodilators
2. Reduce Physical and emotional stress
138. Nursing Diagnosis and
Intervention in Patient with
CHF
A. Alteration in cardiac output; decreased due to
mechanical and structural defects of the heart.
Interventions
Assess BP, Pulse, CVP every 2 to 4 hours
Weigh daily
Monitor intake and output carefully
Monitor electrolytes specially potassium and
Na
Avoid extracirculatory overload through
excessive oral or IV fluid intake
Allay thirst from fluid restriction with good oral
care and hard candies
139. Interventions
Promote bed rest
Provide a bedside commode
Administer stool softener and give
instructions not to strain with defecation
Give frequent small meals instead of three
large meals daily
Space Nursing Activities
Create a relaxing environment
140. PROGNOSIS
THE PROGNOSIS CAN GENERALLY BE
PREDICTED BY THE PERSON’S RESPONSE
TO THE THERAPEUTIC MEASURES.
A THOROUGH ONGOING ASSESSMENTS,
EARLY INTERVENTION, THERAPEUTIC
COMPLIANCE, AND PREVENTION OF
COMPLICATIONS CAN CONTROL THE
DISORDER
