Physiological Changes During Pregnancy and Aging

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Questions and Answers

What effect does progesterone have on maternal respiration during pregnancy?

Decreases the threshold to carbon dioxide (correct)

Inhibits mucus production

Causes bronchi to constrict

Increases the threshold to carbon dioxide

What physiological change occurs in the uterus during pregnancy?

It only holds about 1,000 mL at any point

It can weigh as much as 2.24 to 2.6 lb by the end of pregnancy (correct)

It maintains a fluid capacity of about 10 mL throughout pregnancy

It consistently weighs about 2.5 oz

Which of the following statements about respiratory changes during pregnancy is accurate?

Residual volume increases

Tidal volume decreases

Functional residual capacity increases

Expiratory reserve volume decreases (correct)

In what way does maternal metabolism change during pregnancy?

Demand for carbohydrates increases Signup and view all the answers

What circulatory change occurs in pregnant women?

Blood volume increases up to 50% more Signup and view all the answers

Which statement describes how pregnancy affects the gastrointestinal system?

Intestinal pressure reduces motility substantially Signup and view all the answers

Which physiological changes can occur as a result of pregnancy?

Altered normal response to trauma Signup and view all the answers

What happens to the kidneys during pregnancy?

Kidneys increase in size and volume Signup and view all the answers

Which symptom is most associated with Ménière disease?

Tinnitus Signup and view all the answers

What is a possible risk associated with ill-fitting dentures?

Choking Signup and view all the answers

Which change in the renal system is notable with aging?

Decreased weight of kidneys Signup and view all the answers

What impact do medications have on the liver in older adults?

They may contribute to hepatic damage or drug toxicity Signup and view all the answers

Which digestive issue can be caused or worsened by medication in older adults?

Constipation Signup and view all the answers

What is a consequence of decreased gastric secretions in older adults?

Higher likelihood of indigestion Signup and view all the answers

What sensory change is typically last to diminish with age?

Sense of smell Signup and view all the answers

What metabolic disorder has a greater risk of development in older adults?

Type 2 diabetes Signup and view all the answers

What is a significant change in the respiratory system as one ages?

Decreased maximal inspiratory pressure Signup and view all the answers

How does aging affect the efficiency of the cardiovascular system?

It becomes less efficient Signup and view all the answers

What change occurs in the heart's electrical conduction system due to aging?

Decreased number of pacemaker cells Signup and view all the answers

What is one of the consequences of vascular stiffening as one ages?

Increased risk of systolic hypertension Signup and view all the answers

What might a decline in mental function affect in the aging population?

Regulation of multiple bodily functions including blood pressure Signup and view all the answers

As one ages, how does visual acuity change?

It decreases regardless of disease presence Signup and view all the answers

What common condition is associated with gradual hearing loss in aging individuals?

Otosclerosis Signup and view all the answers

Which intervention should be performed if the newborn's heart rate is less than 100 beats/min?

Provide positive pressure ventilation (PPV) Signup and view all the answers

What is a common misconception about sensory decline in elderly patients?

All elderly patients will experience severe vision loss Signup and view all the answers

What is the preferred route for administering epinephrine during neonatal resuscitation?

Intravenous line Signup and view all the answers

What is the threshold for considering neonatal jaundice as pathologic in terms of bilirubin levels?

Bilirubin increases more than 5 mg/dL/day Signup and view all the answers

Which sign is NOT typically associated with fever in newborns?

Increased feeding Signup and view all the answers

What should be done if bradycardia persists after initial interventions?

Administer epinephrine every 3 to 5 minutes Signup and view all the answers

Which of the following is a risk associated with meconium-stained amniotic fluid?

Atelectasis Signup and view all the answers

What action should be taken first in the management of a neonate with diarrhea?

Estimate dehydration degree Signup and view all the answers

What action is recommended to minimize the risk of persistent pulmonary hypertension in newborns?

Provide supplemental oxygen when necessary Signup and view all the answers

What is the average normal temperature for a newborn?

37°C (98.6°F) Signup and view all the answers

In assessing congenital heart disease, which defect is characterized by left-to-right shunt?

Atrial septal defect Signup and view all the answers

Which condition primarily increases the risk of morbidity in low birth weight infants?

Underdeveloped lungs Signup and view all the answers

In the context of neonatal resuscitation, what should be suspected if an infant is not responding well to initial care?

Airway occlusion or pneumothorax Signup and view all the answers

Newborns have limited thermoregulation. What is their typical temperature range?

36.6°C to 37.2°C Signup and view all the answers

What is the initial management step when a neonate presents with significant clinical jaundice?

Start IV fluids Signup and view all the answers

What defines a premature infant?

Born before 37 weeks of gestation Signup and view all the answers

Which factor is least likely to cause a newborn's fever?

Hypothermia Signup and view all the answers

What is a critical consequence of compromised circulation in patients?

Decreased reserves during a circulatory crisis Signup and view all the answers

Which factor is NOT included in the comprehensive history for patients?

Travel history Signup and view all the answers

Why might determining a patient’s chief complaint be challenging?

Patients may downplay symptoms to avoid medical attention Signup and view all the answers

What should be done first when treating a patient with circulation problems?

Administer oxygen as soon as possible Signup and view all the answers

Which statement about history taking in older patients is true?

Standard lists of screening questions may be beneficial Signup and view all the answers

What is the recommended approach during the secondary assessment of elderly patients?

Limit physical manipulation and respect body temperature Signup and view all the answers

What is a common misconception that affects the report of symptoms in older patients?

They believe all symptoms are age-related Signup and view all the answers

When assessing blood pressure in older patients, which statement is true?

Marked BP changes may indicate hypovolemia or overmedication Signup and view all the answers

Study Notes

Special Populations Review

This review covers special populations, focusing on obstetrics.

Obstetrics

Physiological maternal changes during pregnancy can alter the normal response to trauma and exacerbate or create medical conditions.
Uterus changes throughout pregnancy:
- Before pregnancy, the uterus weighs approximately 2.5 ounces (70 grams) and has a fluid capacity of about 10 mL.
- At the end of pregnancy, the uterus can weigh up to 2.24 to 2.6 pounds (1100 to 1200 grams) and hold about 5,000 mL.
Fundal measurement can indicate potential developmental problems such as uterine growth problems, breech position or multiple pregnancies (twins).
Pressure on the intestines and rectum, from the growing uterus, often causes smooth muscle relaxation in the GI tract, resulting in slower stomach emptying, enlarged kidneys, and widened ureters.
Hormones influence changes in skin, hair, and eyes during pregnancy.
Circulatory changes during pregnancy:
- Blood volume increases by up to 50% to meet the increased metabolic needs of the fetus and adequately perfuse maternal organs.
- The number of red blood cells increases, while fibrinolytic factors decrease. The size of the heart also increases.
Heart rate increases by an average of 15 to 20 beats per minute by term. ECG changes may include ectopic beats, supraventricular tachycardia, slight left axis deviation, and Lead II changes.
Sensitivity to body position increases with gestation. Lying supine can compress the inferior vena cava, decreasing cardiac output if pressure isn't relieved.
Birthing positions, like lithotomy, can stress the cardiovascular system.
Respiratory changes during pregnancy are influenced by the shifting uterus:
- The diaphragm is pushed upward.
- Maternal oxygen demand increases.
- Progesterone decreases the threshold to carbon dioxide and causes the bronchi to dilate, while regulating mucus production.
- Expiratory reserve volume, functional residual capacity, and residual volume decrease while tidal volume and inspiratory reserve volume increase.
Maternal metabolism involves significant changes:
- Weight gain averages 27 pounds (12.3 kg).
- Increased blood volume, intracellular and extracellular fluid.
- Uterine growth, placental and fetal growth, increased breast tissue, and increased proteins and fat deposits.
- Relaxin softens collagenous tissues and relaxes the ligamentous system. The demand for carbohydrates increases.

Supine Hypotensive Syndrome

Uterus may compress the inferior vena cava, impeding venous return to the heart, causing significant hypotension.
Management should involve repositioning the patient to the left lateral recumbent position, treating any underlying causes, monitoring vital signs and obtaining EKG.

Cardiac Conditions

Assess and treat any heart abnormalities.
Note and manage any cardiac medications.
Record history of dysrhythmias, heart murmurs, rheumatic fever or congenital heart defects, and episodes of dizziness.

Hypertensive Disorders

Chronic hypertension: Blood pressure consistently equal to or greater than 140/90 mmHg; increases the risk of stroke and other cardiovascular problems.
Gestational hypertension: Develops after the 20th week of pregnancy and often resolves spontaneously after delivery.
Preeclampsia: Manifests after the 20th week with a triad of symptoms which includes edema, gradually increasing hypertension, and protein in the urine. Risk factors include first pregnancy under 20 years old, advanced maternal age and history of multiple pregnancies, as well as renal disease or diabetes. Complications like liver or renal failure, cerebral hemorrhage, abruptio placenta, or HELLP syndrome may occur.

Seizures

Treatment can be challenging because some medications can cause fetal distress.
Magnesium sulfate is typically recommended.
Potential complications include abruptio placenta, hemorrhage, and disseminated intravascular coagulation.

Diabetes

Gestational diabetes mellitus is an inability to process carbohydrates during pregnancy. Treatment usually involves diet control and potentially oral hypoglycemic medications.
Pregnancy may affect existing diabetes. Patients with pre-existing diabetes should undergo blood glucose level testing.

Respiratory Disorders

Shortness of breath or dyspnea is a common complaint during pregnancy, often related to hormone changes.
Asthma is a significant condition that can complicate pregnancy, potentially leading to premature labor, preeclampsia, respiratory failure, vaginal hemorrhage, or eclampsia. Fetal complications of asthma include preterm birth, low birth rate, growth retardation, and fetal death.

Abortion: Refers to expulsion of a fetus before the 20th week of gestation; may be spontaneous or elective. Habitual abortion is three or more consecutive miscarriages. Underlying causes may include ovarian, uterine, cervical issues, or infections.
Threatened abortion: Vaginal bleeding in the first half of pregnancy, potentially progressing or subsiding.
Imminent abortion: Spontaneous and inevitable abortion; characterized by severe abdominal pain, vaginal bleeding, and cervical dilation. Emergency management includes stabilizing vital signs, oxygen, IV access, and rapid transport.
Incomplete abortion: Part of the products of conception remains in the uterus, accompanied by continuous vaginal bleeding.
Missed abortion: Fetus dies in the first 20 weeks but remains in the uterus. Uterus becomes a hard mass, and fetal heartbeat is absent.
Septic abortion: Uterine infection after an abortion, presenting with fever, vaginal discharge, and abdominal tenderness. Prehospital management involves IV line, oxygen, ECG, rapid transport, and fluid therapy.
Third-trimester bleeding: Serious risk for hemorrhage, and compensatory mechanisms are altered by pregnancy.
Ectopic pregnancy: Ovum implants outside of the uterus, leading to severe abdominal pain and hypovolemic shock. Immediate treatment, shock management, and rapid transport are critical.
Abruptio placenta: Premature separation of the placenta from the uterine wall, causing hemorrhage characterized by sudden abdominal pain, cessation of fetal movement, and vaginal bleeding, often with dark red blood. Signs of shock may include a rigid and tender abdomen and absent fetal heart sounds.
Placenta previa: Abnormal implantation of the placenta near or over the cervical canal, leading to painless vaginal bleeding with bright red blood, a soft, non-tender uterus.

Evaluate bleeding nature using OPQRST (Onset, Provocation/Palliation, Quality, Radiation, Severity, Timing).
Assess orthostatic vital signs.
Look for signs like Grey Turner or Cullen.

Position the woman on her left side.
Administer supplemental oxygen.
Provide rapid transport.
Establish IV line of normal saline.
Obtain ECG and baseline vitals.
Loosely place trauma pads over the vagina.

Cephalic Presentation

The newborn's head is extended, creating a face presentation at birth. Types of cephalic presentation include brow, occiput-posterior, and military presentations.
If the head cannot be externally rotated or delivery completed, support the woman and fetus and provide rapid transport.

Breech Presentations

A different body part, other than the head, leads the way through the birth canal during delivery; types include Frank, Incomplete, and Complete.
If presenting with buttocks and imminent delivery, position with legs flexed and allow spontaneous delivery. Support the body and lower the newborn slightly once the legs are clear.

Shoulder Dystocia

Difficulty in delivering the shoulders, potential brachial nerve damage.
McRoberts maneuver, which involves hyperflexion of the woman's legs, might be necessary. Pressure to the lower abdomen may also be applied in conjunction with gently pulling on the fetal head.

Nuchal Cord

Umbilical cord wraps around the newborn's neck during delivery.
A finger should be slipped under the cord to gently slip it over the shoulder and head.
If unsuccessful, cut the umbilical cord.

Prolapsed Umbilical Cord

The umbilical cord emerges before the fetus, obstructing oxygenated blood supply and leading to fetal asphyxia.
Position the woman supine with elevated hips, maintain 100% oxygen, and have the woman pant with each contraction, gently pushing the presenting part back into the vagina until it no longer presses on the cord.
Maintain pressure while another paramedic covers the exposed cord with dressings throughout transport.

Postpartum Hemorrhage

Bleeding occurring within 24 hours or up to 6 weeks postpartum that exceeds 500 mL blood loss.
Common causes include lacerations, prolonged labor, retained products of conception, multiple pregnancy, placenta previa, and full bladder.
Managing postpartum hemorrhage involves continuing uterine massage, encouraging breastfeeding, notifying receiving facility, rapid transport, and appropriate fluid administration, without packing dressings in the vagina.

Trauma and Pregnancy

Trauma is a leading cause of maternal deaths in the United States.
Abdominal trauma in pregnant women occurs through the same mechanisms as in non-pregnant women.
The uterus's anatomic changes during pregnancy affect trauma. The first trimester protects the uterus, while the second and third trimesters make it more vulnerable, with abdominal contents shifting upward into the upper abdomen, the diaphragm rising, and the peritoneum stretching. The pregnant patient may present with different signs or responses to trauma or decreased hypovolemia signs. The fetus can also suffer injury from rapid deceleration or impaired fetal circulation, and in severe maternal bleeding, maternal circulation may reroute blood from the fetus.
The fetal heart rate is a crucial indicator of fetal status post-trauma, with a normal rate between 120–160 beats per minute. A rate below 120/min indicates fetal distress. A pregnant trauma patient should be managed on her left side to prevent vena cava syndrome.
Prehospital management involves several steps including assuring an airway, administering oxygen, assisting ventilations as needed, controlling external bleeding and splinting fractures, starting one or two IV lines of normal saline, and transporting the patient in the lateral recumbent position. CPR and ALS should be provided for maternal cardiac arrest.

Neonate

Procedures for arrival of a newborn:
- Obtain patient history, prepare environment (minimum needs: warm, dry blankets, bulb syringe, clamps/ties, scissors).
- If delivery in an ambulance: Use blankets, confirm ABCs (airway breathing circulation), position newborn on mother's chest, suction mouth, then nose, and keep newborn at the level of the mother.
- Clamp and cut the umbilical cord, perform primary survey, examine skin, head and eyes for irregularities, and inspect umbilical cord for abnormalities.
- Place on prewarmed towels or a radiant warmer, carefully dry the head and body, and cover newborns with a dry towel and cap.
- If newborn is cyanotic but remains vigorous, maintain ongoing observation and maintain thermoregulation with direct skin-to-skin contact with the mother.
- Evaluate Apgar score, potentially repeating in 5-minute intervals until 20 minutes after birth if it's below 7.
  - (Apgar uses appearance, pulse rate, grimace, activity, respiration to assess condition at birth).
Algorithm for neonatal resuscitation:
- Follow current neonatal resuscitation guidelines; initial steps, reevaluation and ventilation should occur within the first 60 seconds.
- Additional oxygen may be necessary if the target preductal oxygen saturation hasn't been reached.
- If pulse rate is apneic or less than 100 beats/min, begin PPV (positive pressure ventilation). Begin chest compressions if pulse rate is below 60 bpm. If ventilation and chest compressions don't improve bradycardia, administer epinephrine via IV line.
Bradycardia: Often due to inadequate ventilation, often responds to effective PPV. Morbidity and mortality depend on underlying cause and speed of correction. Management includes PPV if heart rate is less than 100 beats/min; chest compressions if heart rate is less than 60 beats/min; administer epinephrine if heart rate remains below 60 beats/min; repeat epinephrine every 3-5 minutes for persistent bradycardia.
Meconium-stained amniotic fluid: High risk for morbidity. If inhaled, airway may become blocked, leading to atelectasis, persistent pulmonary hypertension, hypoxemia, aspiration pneumonitis, and pneumothorax. Management and prevention of persistent pulmonary hypertension includes ensuring a clear airway, maintaining warmth, minimizing stimulation, and administering supplemental oxygen when necessary. If depressed, start PPV and potentially intubation and suctioning.
Premature and low birth weight infants: Infants born before 37 weeks gestation or weighing less than 5.5 pounds (2,500 grams) face increased mortality and various associated morbidities. Assessment of prematurity relies on physical features, family history of gestational dating, and maternal or fetal complication information. To optimize survival in the field, provide cardiorespiratory support, a thermoneutral environment, and use only minimal pressure necessary for PPV during chest compressions. Management focuses on clearing the airway, providing gentle stimulation, and supplying supplemental oxygen and PPV when needed, along with chest compressions; maintenance of a warm environment.
Seizures in newborns: May indicate underlying neurologic disorders. Prolonged seizures lead to potential brain damage. Management includes evaluating prenatal and birth history, performing a careful physical exam, obtaining vital signs and oxygen saturation, providing additional oxygen, assisted ventilation, blood pressure evaluation, and IV access. If blood glucose is less than 40 mg/dL, administer an IV bolus of 10% dextrose solution. Maintain normal body temperature and keep the family informed while transporting.
Hypoglycemia: Blood glucose levels less than 45 mg/dL. May lead to seizures and brain damage. Risk factors include decreased glycogen stores and increased glucose use.
Vomiting: Common in newborns; persistent or bilious vomiting within 24 hours may indicate upper digestive tract obstruction or increased intracranial pressure. Vomitus aspiration may lead to respiratory insufficiency or airway obstruction. Sudden, unexpected vomiting may occur with asphyxia, meningitis, or hydrocephalus. Assessment and management involve stomach examination, noting fever or hypothermia, assessing for temperature instability, apnea or bradycardia, and abdominal tenderness or guarding. ABCs should be addressed first with consideration of decompression, avoiding antiemetics, and placing the newborn on their side while transporting.
Diarrhea: Assessment and management should involve estimating the number and volume of loose stools, assessing decreased urinary output, and evaluating the degree of dehydration. Initial management involves ABCs.
Neonatal jaundice: Considered pathologic when clinically visible within the first 24 hours, serum bilirubin increases more than 5 mg/dL/day, bilirubin exceeds 12 mg/dL, or conjugated bilirubin makes up more than 20% of total serum bilirubin. Clinical jaundice that lasts for more than a week in full-term infants or for more than 2 weeks in preterm infants is also considered pathologic. Management involves essential transport and initiating IV fluids if significant jaundice is present. Communicate the situation to the receiving facility.
Thermoregulation: Newborns have limited thermoregulatory capabilities. Average normal temperature is 37°C (99.5°F). The range for newborns is 36.6°C to 37.2°C (97.9°F to 99°F). Methods by which heat gain/loss slows include atherosclerotic vessels, slowed circulation, and decreased sweat production. Chronic disease, medications and alcohol use can affect thermoregulation.
Fever: Rectal temperature over 38°C (100.4°F) in newborns may not always indicate illness or infection, it can be due to overheating or dehydration. Assessment and management involves checking for rashes, taking medical history, and noting increased respiratory rate and work of breathing. Obtain vital signs and ensure adequate oxygenation and ventilation. Cool the patient.
Congenital heart disease (CHD): Most common birth defect, presenting with varying degrees of cardiorespiratory compromise. Types of CHD include increased pulmonary blood flow, decreased pulmonary blood flow, and mixed blood flow. Noncyanotic CHD involve left-to-right shunts (e.g., atrial septal defect, ventricular septal defect, patent ductus arteriosus). Cyanatotic CHD involves right-to-left shunts (e.g., pulmonary stenosis, truncus arteriosus, tricuspid atresia, hypoplastic left heart syndrome, tetralogy of Fallot, transposition of great arteries, total anomalous pulmonary venous return). Prompt detection is critical for intervention.
Primary survey: Use the Appearance, Work of Breathing, and Circulation to Skin method to evaluate children. Appearance is crucial for evaluating illness severity and determining treatment need.
Hands-on primary survey:
- Airway: Assess for airway patency and adequate chest rise. Position airway and perform necessary suction if obstruction is present.
- Breathing: Calculate respiratory rate, auscultate breath sounds, and check pulse oximetry.
- Circulation: Assess heart rate (double the 30-second pulse count) and evaluate skin color and temperature. Perform hand-on evaluation of capillary refill time.
- Disability: Assess level of consciousness (using AVPU or Pediatric Glasgow Coma Scale), assess pupillary response, evaluate motor activity, and combine with PAT observations for neurologic status. Perform a rapid exam of the entire body, addressing heat loss, immediately covering any exposed skin
- Exposure: Uncover only necessary areas for examination or treatment to maintain body temperature. Cover the body immediately.
Transport decision: Transport a patient immediately if experiencing a serious mechanism of injury (MOI), a physiologic abnormality, significant anatomic abnormality, or unsafe environment. Attempt vascular access en-route as needed.
Secondary assessment: Attempt blood pressure measurement on the upper arm or thigh. Assess pediatric pain with developmental age considerations, discuss child's pain with caregivers using a standardized tool like the Wong-Baker Faces Pain Rating Scale. Consider pharmacologic methods like acetaminophen, opiates, benzodiazepines, and nitrous oxide.

Geriatrics

The aging process begins in the late 20s/early 30s. Genetic predisposition, preexisting disease, diet, activity levels, and toxin exposures accelerate aging.
Aging rates vary among individuals. A decrease in functional capacity is common.
Respiratory capacity diminishes with age, leading to decreased vital capacity and increased residual volume. Changes in blood flow impact PaO2.
Decreased sensitivity to arterial blood gases, reduced lung volume and maximal inspiratory pressure, and limited chest expansion are observed. Respiratory rate and tidal volume change adaptation is reduced, while defense mechanisms are less effective.
Cardiovascular system efficiency, heart hypertrophying, arteriosclerosis, vascular stiffening, and heart conduction system alterations decline with age which increases susceptibility to bradycardia or atrial dysrhythmias.
Neurologic exams reflect aging changes in the nervous system. Brain decreases in weight and volume. As mental function declines, so does the regulation of pulse rate, blood pressure and hunger/thirst/temperature.
Sensory organs decline, with potential for hearing loss, vision changes (cataracts/glaucoma, visual acuity changes), and changes in appetite/touch/smell.
Digestive system changes may include fewer taste buds, reduced saliva, dental loss, ill-fitting dentures increasing the risk of choking, heartburn or abdominal pain, reduced gastric secretions which causes heartburn, indigestion and acid reflux, as well as changes in bowel functions leading to incontinence and constipation.
Renal system changes with aging include weight loss, decreased nephron units, effective filtering reduction, slow sodium response and electrolyte imbalance. Overhydration risk increases from large sodium loads while hyperkalemia occurs with acidosis or increased potassium loads.
Endocrine system alterations include an increase in ADH leading to electrolyte or fluid imbalances, and a decrease in hormone secretion during menopause.
Changes to the immunological system impact infections. Aging weakens defense mechanisms against infection, causing infections to present differently in older individuals.
Integumentary system changes include wrinkling, drier thinner skin, subcutaneous fat thinning, decreased elastin, increased fragility and tenting in skin turgor tests, decreased sweat gland activity, and gray or white hair. Circulation impacts oxygenation and skin-cell regeneration. Thin and brittle nails are observed.
Homeostatic capabilities are reduced in older adults impacting their bodies ability to regulate thirst mechanism, temperature, and blood glucose response
Musculoskeletal changes such as decrease in bone mass resulting in brittle bones, loss of tendon and ligament elasticity, thickened synovial fluids, decrease in cartilage, changes in height/posture and possible muscle atrophy accompany aging. More susceptibility to fractures from falls happens in older persons.
Primary Assessment in Geriatrics utilizes GEMS diamond to identify the Geriatric patient (respect and awareness of aging-related changes), Environmental assessment, Medical issues to provide proper care, and Social assessment covering daily living activities (ADLs).
Airway and breathing is often impacted in geriatric patients; ensuring the airway is clear and oxygen therapy is necessary.
Circulation has less reserve in older adults, so lower heart rates, difficulty detecting radial pulses accompanied by irregular rhythms are typical.
Transport decisions and history-taking are important considerations. Evaluate life-threatening issues first, and treat effectively while transporting. Obtain a complete history, understanding the potential for confusion or underreporting of symptoms. Use a standardized list of screening questions to assess the major organ systems affected by the condition.

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Description

This quiz focuses on the physiological changes that occur in women during pregnancy, as well as changes that happen with aging, particularly related to metabolism, circulation, and organ function. Explore various aspects from respiratory effects to gastrointestinal adaptations, and how aging impacts renal and digestive systems. Test your knowledge on these crucial developmental stages of human biology.