Physiological Changes in Pregnancy: Cardiovascular System

Maternal and Fetal Care during Perinatal Period

• Learning objectives: describe psychological and physiologic changes during pregnancy, assess a woman for these changes, identify outcomes for family adaptation, plan and implement nursing care, and integrate knowledge with the nursing process.

Assessment of Pregnant Woman

• Components of health history: demographic data, chief concern, family and social profile, past medical history, typical day history, review of systems, and physical assessment/examination
• Demographic data: name, age, address, telephone number, religion, and health insurance information
• Chief concern: LMP, pregnancy test, signs of early pregnancy, exposure to contagious diseases, medications taken, and danger signs of pregnancy
• Family and social profile: who lives at home, support people, occupation, financial support, lifestyle, exercise, hobbies, smoking/drinking habits, living conditions, nutrition, and sleep pattern
• Past medical history: kidney disease, heart disease, etc.

Physical Assessment/Examination

• Baseline data: height, weight, prepregnancy body mass index, vital signs, fundal height measurement (after 12 weeks), and fetal heart sounds
• System assessment: full examination to confirm general health
• Pelvic examination: general assessment, Pap smear, HPV culture, additional cultures for chlamydia and gonorrhea, and pelvic measurements

Estimating Fetal Growth

• McDonald's rule: determining AOG in months by measuring from the fundus to the symphysis pubis in centimeters then dividing by 4
• Bartholomew's rule: estimating AOG by the relative position of the uterus in the abdominal cavity

Physiologic Changes of Pregnancy

• Cardiovascular system: increased total cardiac volume, easy fatigability, shortness of breath, heart murmurs, palpitations, edema and varicosities, increased fibrinogen level, elevated white blood count, increased platelet count, and increased blood lipid level
• Gastrointestinal system: heartburn, constipation, flatulence, morning sickness, and hyperptyalism
• Urinary system: urinary frequency, urinary stasis, urethral and kidney dilation, and increased glomerular filtration rate
• Skeletal system: softening of pelvic ligaments and joints, lordosis, and leg cramps
• Endocrine system: increased estrogen, progesterone, human chorionic gonadotropin, and human placental lactogen

Health Promotion during Pregnancy

• Calf stretching: relieves leg cramps
• Shoulder circling: relieves upper backache and numbness of arms and fingers
• Modified knee-chest: relieves hemorrhoids, vulvar varicosities, and low backache
• Leg elevation: relieves swelling, fatigue, and varicosities of lower extremities
• Leg raising: strengthens abdominal muscles
• Sleep: promotes overall health

Teratogenicity of Drugs

• Principles of drug intake during pregnancy: any drug can be detrimental to fetal welfare, and a woman should only take prescribed or approved drugs during pregnancy.

Medications and Nutrition during Pregnancy

• FDA Pregnancy Risk Categories of Drugs: categories A, B, C, D, and X
• Recommended weight gain during pregnancy: 11.2 to 16 kg (25 to 40 lbs)
• Caloric needs: an additional 300 calories (total of 2,500 calories)
• Protein needs: an increase of 10 grams daily (total of 60 grams)
• Fat needs: fatty acid from vegetable oils
• Vitamin needs: increased requirements for fat-soluble and water-soluble vitamins during pregnancy.