Pregnancy and Psych Meds: Assessment and Breastfeeding

Assessment of Childbearing Women

Physiological and Anatomical Changes

• Pregnancy brings about various physiological and anatomical changes in the body, mainly influenced by estrogen and progesterone hormones.
• Changes occur in the skin, hair, and nails, including:
  • Stretch marks (striae gravidarum) on the abdomen, breasts, thighs, and buttocks
  • Hyperpigmentation on the face (chloasma) and abdomen (linea nigra)
  • Darkening of areolae, nipples, axillae, umbilicus, and perineum
  • Vascular changes, such as spider nevi and palmar erythema
  • Acne vulgaris (unpredictable response)

Skin Changes

• Breast changes:
  • Tingling sensations and tenderness
  • Enlargement of breast and nipple
  • Hyperpigmentation of areola and nipple
  • Enlargement of Montgomery tubercles
  • Prominence of superficial veins
  • Development of striae
  • Expression of colostrum in the second and third trimesters
• Skin changes:
  • Darkening of scars and moles
  • Gingival bleeding and hypertrophy

Cardiovascular System

• Increase in cardiac output and maternal blood volume by 40% to 50%
• Heart rate increases by 10 to 15 beats per minute
• Systolic murmurs may be heard

Peripheral Vascular System

• Physiologic anemia (pseudoanemia) commonly develops
• Clients may experience dizziness and lightheadedness due to increased blood volume
• Arterial blood pressure stabilizes and symptoms resolve in the third trimester

Abdomen

• Abdominal muscles stretch as the uterus enlarges
• Diastasis recti abdominis may occur (permanent separation of rectus abdominis muscles)
• Lower pelvic discomfort may result from stretching of the ligaments, especially the round ligaments

Genitalia

• Uterus changes:
  • Weighs approximately 44 g before conception
  • Can hold approximately 10 mL of fluid
  • Grows to weigh approximately 1,000 g and hold 5 L of amniotic fluid during pregnancy
• Uterine changes:
  • Ovulation ceases
  • Uterine endometrium thickens
  • Number and size of uterine blood vessels increase
  • Uterus should be palpated at the top of the symphysis pubis at 10 to 12 weeks' gestation

Anus and Rectum

• Constipation is a common problem during pregnancy
• Progesterone decreases intestinal motility
• Iron supplementation can contribute to constipation
• Hemorrhoids may develop due to pressure on the venous structures

Musculoskeletal System

• Not mentioned

Neurologic System

• Pain or tingling feeling in the thigh: Caused by pressure on the lateral femoral cutaneous nerve
• Carpal tunnel syndrome: Caused by pressure on the median nerve
• Leg cramps: Caused by inadequate calcium intake
• Dizziness and lightheadedness: In early pregnancy, caused by blood pressure slightly decreasing due to vasodilation and decreased vascular resistance; in later pregnancy, caused by compression of the vena cava and aorta

Collecting Subjective Data

• Questions to ask the client:
  • Weight changes and normal weight before pregnancy
  • Fever or chills since the last menstrual period
  • Nasal "stuffiness" and nosebleeds
  • Throat problems
  • Nausea or vomiting
  • Bowel habits
  • Urinary tract symptoms
  • Vaginal bleeding, leakage of fluid, or discharge
  • Breast pain, lumps, or fluid leakage
  • Problems at home or work
  • Depression or feelings of sadness
  • Thoughts of suicide
  • Professional counseling history

Personal Health History

• Questions to ask the client:
  • Age at the time of delivery
  • Genetic relationships to the baby's father
  • Number of times pregnant
  • Pregnancy history, including child's name, birth date, birth weight, sex, gestational age, and type of delivery
  • Complications during previous pregnancies
  • Neonatal complications
  • Perinatal or neonatal losses
  • Abortions (spontaneous or elective)
  • Hydatidiform mole or ectopic pregnancy
  • Regular menstrual periods
  • Last menstrual period
  • Bleeding or spotting since the last period
  • Birth control methods used
  • Reproductive surgery or abnormal Pap smear results### Personal Health History
• Infections:
  • Infections during pregnancy need treatment
  • Partner's history of STI and treatment is important
  • Vaginal infections (e.g., bacterial vaginosis, yeast infection) require treatment
  • Metronidazole may be used in the second or third trimester
• Blood Type and Rh Factor:
  • Rh-negative mothers should receive Rho immunoglobulin at 28 weeks' gestation
  • Importance of knowing blood type and Rh factor for preventing isoimmunization
• Medical Problems:
  • Identification of medical problems is crucial during pregnancy
  • Certain medical conditions put the mother at high risk for complications
  • Examples: heart trouble, rheumatic fever, hypertension, diabetes, lung problems, etc.
• Medications and Allergies:
  • Identification of medication allergies is necessary to prevent complications
  • Discussion of medications taken during pregnancy is important

Family History

• Birth Defects and Inherited Diseases:
  • Identification of birth defects or inherited diseases in the family is important
  • Examples: cleft lip or palate, hemophilia, mental retardation, etc.
  • Cystic fibrosis screening should be offered to all clients during preconceptual counseling
• Cardiovascular Disease:
  • Cardiovascular disease may be inherited
  • Family history of heart trouble or rheumatic fever before age 50 years is important

Lifestyle and Health Practices

• Substance Abuse:
  • Daily alcohol intake puts the fetus at risk for fetal alcohol syndrome
  • Smoking correlates with an increased incidence of perinatal mortality, preterm delivery, and other complications
  • Cocaine use during pregnancy increases the rate of spontaneous abortions and abruptio placentae
• Nutrition and Diet:
  • Maternal nutrition has a direct relationship to maternal-fetal well-being
  • Importance of consuming a balanced diet with sufficient vitamins and minerals
• Exercise and Activity:
  • Daily exercise is highly recommended during pregnancy
  • Lifting heavy weights during pregnancy has been shown to increase spontaneous abortion

Toxic Exposure

• Chemical and Radiation Exposure:
  • Assessment of toxic exposure can identify potential teratogens to the fetus
  • Importance of proper handling of cat litter to prevent toxoplasmosis

Physical Assessment

• Blood Pressure:
  • Importance of accurate measurement of blood pressure during pregnancy
  • Elevated blood pressure may indicate chronic hypertension, hydatidiform mole pregnancy, or thyroid storm
• Temperature:
  • Normal temperature range during pregnancy is 97°–98.6°F
  • Elevated temperature may indicate infection
• Height and Weight:
  • Importance of establishing a baseline height and weight during pregnancy
  • Normal weight gain during pregnancy is 25-35 pounds### Physical Assessment: Head and Neck
• Inspect and palpate the neck: normal findings include smooth, non-tender, small cervical nodes may be palpable
• Abnormal findings: hard, tender, fixed, or prominent nodes may indicate infection or cancer

Physical Assessment: Eyes

• Inspect eyes: normal findings include pupils equal and round, reactive to light, and accommodate
• Abnormal findings: narrowing of arterioles or AV nicking may indicate hypertension

Physical Assessment: Ears

• Inspect the ears: normal findings include clear tympanic membranes and visible landmarks
• Abnormal findings: red and bulging tympanic membrane with pus may indicate infection

Physical Assessment: Mouth, Throat, and Nose

• Inspect the mouth: normal findings include hypertrophy of gingival tissue, bleeding may occur due to brushing teeth or dental examinations
• Abnormal findings: epulis nodules may be present, representing benign changes of the gum that may spontaneously resolve after pregnancy
• Inspect the throat: normal findings include pink, no redness or exudate
• Abnormal findings: red throat, exudate present, and tonsillary hypertrophy indicate infection

Physical Assessment: Thorax and Lungs

• Inspect, palpate, percuss, and auscultate the chest: normal findings include increased anteroposterior diameter, thoracic breathing, and slight hyperventilation
• Abnormal findings: dyspnea, rales, rhonchi, wheezes, and unequal breath sounds may indicate respiratory distress

Physical Assessment: Breasts

• Inspect and palpate the breasts and nipples: normal findings include venous congestion, prominence of veins, and breast size increase
• Abnormal findings: nipple inversion, localized redness, pain, and warmth could indicate mastitis, and breast cancer may cause bloody discharge and skin retraction

Physical Assessment: Heart

• Auscultate the heart: normal findings include normal sinus rhythm and soft systolic murmurs
• Abnormal findings: irregular rhythm, progressive dyspnea, palpitations, and markedly decreased activity tolerance may indicate cardiovascular disease

Physical Assessment: Peripheral Vascular

• Inspect face and extremities: normal findings include dependent edema in the third trimester
• Abnormal findings: calf pain, positive Homans’ sign, generalized edema, and diminished pedal pulses may indicate thrombophlebitis

Physical Assessment: Abdomen

• Inspect the abdomen: normal findings include striae, linea nigra, and uterine size corresponding to gestational age
• Palpate the abdomen: normal findings include the uterus palpable beginning at 10-12 weeks' gestation
• Abnormal findings: abnormal masses palpable in the abdomen may indicate uterine fibroids or hepatosplenomegaly

Physical Assessment: Fetal Movement

• Palpate for fetal movement after 24 weeks: normal findings include fetal movement felt by the mother by approximately 18-20 weeks
• Abnormal findings: if fetal movement is not felt, the estimated delivery date may be wrong or intrauterine fetal demise may have occurred

Physical Assessment: Fundal Height

• Measure fundal height: normal findings include uterine size approximately equal to the number of weeks of gestation
• Abnormal findings: measurements beyond 4 cm of gestational age may indicate multiple gestation, polyhydramnios, fetal anomalies, or macrosomia, and measurements smaller than expected may indicate intrauterine growth retardation

Physical Assessment: Fetal Position

• Using Leopold's maneuvers, palpate the fundus, lateral aspects of the abdomen, and the lower pelvic area: normal findings include a longitudinal lie, cephalic, breech, or shoulder presentation
• Abnormal findings: a longitudinal lie, cephalic, breech, or shoulder presentation may indicate complications in fetal position

Physical Assessment: Fetal Heart

• Determine the location, rate, and rhythm of the fetal heart: normal findings include a fetal heart rate ranging from 120-160 beats/min
• Abnormal findings: inability to auscultate fetal heart tones with a fetal Doppler at 12 weeks may indicate retroverted uterus, uncertain dates, fetal demise, or false pregnancy

This quiz assesses the nurse's knowledge on evaluating clients with psychological medications during pregnancy, breastfeeding, and other relevant concerns. It covers questions on medication, breastfeeding, and age-related factors.