Pregnancy Physiology and Hormonal Changes
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Questions and Answers

How does progesterone primarily affect the gastrointestinal tract during pregnancy?

  • It decreases smooth muscle activity, potentially causing constipation. (correct)
  • It reduces the absorption of nutrients in the small intestine.
  • It increases smooth muscle activity, leading to more frequent bowel movements.
  • It has no significant effect on the gastrointestinal tract.

A pregnant woman with a history of gallstones is at an increased risk for gallstone formation due to which physiological change?

  • Increased levels of plasma cholesterol and additional cholesterol in bile. (correct)
  • Decreased levels of plasma cholesterol.
  • Reduced incorporation of cholesterol in bile.
  • Decreased activity of the gallbladder.

What physiological change during pregnancy contributes to the development of hemorrhoids?

  • Decreased blood pressure in the lower extremities.
  • Pressure from the uterus on veins returning from the lower extremities. (correct)
  • Increased production of clotting factors.
  • Increased blood volume in the upper extremities.

Which hormonal change is most likely responsible for the increased saliva formation (hyperptyalism) observed in some pregnant women?

<p>Increased levels of estrogen. (B)</p> Signup and view all the answers

How do elevated levels of estrogen and progesterone from the placenta affect the mother's pituitary hormones?

<p>They decrease the production of FSH and LH. (A)</p> Signup and view all the answers

What is the primary role of increased aldosterone production during pregnancy?

<p>To promote sodium reabsorption and maintain osmolarity. (B)</p> Signup and view all the answers

Why does the pancreas increase insulin production during pregnancy?

<p>To counteract the effects of increased levels of glucocorticoids produced by the adrenal glands. (C)</p> Signup and view all the answers

What is the most characteristic psychological task of the first trimester of pregnancy?

<p>Accepting the pregnancy and dealing with ambivalence. (C)</p> Signup and view all the answers

Which prenatal diagnostic method involves obtaining a sample directly from the implantation site through the cervix?

<p>Chorionic villi sampling (CVS) (B)</p> Signup and view all the answers

An ultrasound is utilized during pregnancy for several reasons. Which of the following is NOT a typical use of ultrasound?

<p>Identification of chromosomal aberrations (D)</p> Signup and view all the answers

Amniocentesis is typically performed after the 14th week of gestation. What is the primary reason for this timing?

<p>To allow sufficient amniotic fluid to be present for sampling (A)</p> Signup and view all the answers

Why is X-ray generally avoided in early pregnancy?

<p>It poses a risk of causing damage to the fetus and mother due to ionizing radiation. (A)</p> Signup and view all the answers

Alpha-fetoprotein (AFP) screening is conducted on maternal serum to detect which of the following conditions in the fetus?

<p>Open neural tube defects (B)</p> Signup and view all the answers

Which component found in amniotic fluid is used to estimate fetal kidney function and maturity?

<p>Creatinine level (C)</p> Signup and view all the answers

At which gestational age does the L/S ratio in amniotic fluid typically reach 2:1, indicating fetal lung maturity?

<p>35-36 weeks (C)</p> Signup and view all the answers

Which of the following statements best describes the trend of bilirubin levels in amniotic fluid during pregnancy?

<p>Bilirubin levels are highest early in pregnancy and decrease after 36 weeks gestation. (A)</p> Signup and view all the answers

A pregnant woman is experiencing backache due to lumbar lordosis. Which of the following interventions would be MOST appropriate to recommend?

<p>Squatting to pick up objects instead of bending over. (D)</p> Signup and view all the answers

A pregnant woman reports experiencing persistent epigastric pain. Which condition does this symptom potentially indicate?

<p>A sign of pre-eclampsia. (C)</p> Signup and view all the answers

A pregnant client reports frequent headaches. What is the MOST appropriate initial recommendation?

<p>Rest with cold towels on the forehead and take acetaminophen. (B)</p> Signup and view all the answers

A client at 32 weeks gestation reports a sudden decrease in fetal movement over the past 24 hours. What is the most appropriate initial nursing action?

<p>Advise the client to come to the clinic or hospital immediately for fetal assessment. (B)</p> Signup and view all the answers

A pregnant woman at 24 weeks gestation complains of shortness of breath, especially at night. Which of the following nursing interventions is MOST appropriate?

<p>Recommending she sleep with her head and chest elevated. (D)</p> Signup and view all the answers

A pregnant woman is experiencing ankle edema in her third trimester. Which assessment finding would require FURTHER investigation?

<p>Ankle edema accompanied by proteinuria and hypertension. (D)</p> Signup and view all the answers

During an antenatal class, a pregnant woman asks about the purpose of education for parenthood. What is the primary goal of this education?

<p>To provide knowledge and coping mechanisms to reduce anxiety and promote cooperation during childbirth. (B)</p> Signup and view all the answers

Which of the following is NOT a key objective of fetal diagnostic tests during the antenatal period?

<p>Determining the infant's sex for social planning. (B)</p> Signup and view all the answers

Which of the following is the MOST important instruction for a pregnant woman experiencing frequent headaches?

<p>She should report any unusually intense or continuous headache to her healthcare provider. (C)</p> Signup and view all the answers

A pregnant woman reports backache. Besides postural adjustments, what other non-pharmacological intervention can the nurse suggest?

<p>Applying local heat to the affected area. (D)</p> Signup and view all the answers

A pregnant woman at 38 weeks gestation reports experiencing blurring of vision and severe continuous headache. What is the most immediate concern?

<p>Possible pre-eclampsia. (C)</p> Signup and view all the answers

Which of the following measures is LEAST likely to provide relief from dyspnea during late pregnancy?

<p>Lying flat on the back (C)</p> Signup and view all the answers

A patient is experiencing chills and fever during her pregnancy. Which of the following conditions might this indicate?

<p>Infection. (D)</p> Signup and view all the answers

A pregnant woman is advised to tilt her pelvis forward while walking. What is the PRIMARY reason for this recommendation?

<p>To support the weight of the fetus and reduce back strain. (A)</p> Signup and view all the answers

Which of the following situations requires immediate medical attention during pregnancy?

<p>Bleeding from the vagina. (B)</p> Signup and view all the answers

Which statement best describes the information that antenatal classes provide regarding the childbearing cycle?

<p>Antenatal classes emphasizes both physical and psychosocial changes seen in the childbearing cycle. (A)</p> Signup and view all the answers

A pregnant client at 36 weeks gestation reports decreased fetal movement. Which test would be MOST appropriate to initially assess fetal well-being?

<p>Nonstress test (NST) (D)</p> Signup and view all the answers

During a Nonstress Test (NST), a pregnant client reports feeling fetal movement but the fetal heart rate does not accelerate. What could this indicate?

<p>Poor oxygen perfusion of the fetus (B)</p> Signup and view all the answers

A client is instructed to perform fetal movement counts. Which statement indicates the need for further teaching?

<p>&quot;I only need to count fetal movements once a day to ensure fetal well-being.&quot; (D)</p> Signup and view all the answers

What physiological response is expected during a reactive Nonstress Test (NST)?

<p>An increase of fetal heart rate by 15 bpm lasting 15 seconds with fetal movement. (B)</p> Signup and view all the answers

A physician orders a Percutaneous Umbilical Blood Sampling (PUBS) for a client. What is the PRIMARY purpose of this procedure during pregnancy?

<p>To obtain a fetal blood sample for testing. (C)</p> Signup and view all the answers

A client at 38 weeks' gestation is scheduled for a Biophysical Profile (BPP). Which of the following components is assessed in BPP?

<p>Fetal breathing movements, muscle tone, and amniotic fluid volume (B)</p> Signup and view all the answers

After reviewing a Biophysical Profile (BPP) result, the physician explains that the score indicates the fetus is at risk for asphyxia. What is the MOST likely next step in managing this client?

<p>Prepare for immediate delivery (C)</p> Signup and view all the answers

A nurse is teaching a client about Phosphatidylglycerol (PG). Which statement indicates an understanding of PG in relation to fetal development?

<p>&quot;The presence of PG in amniotic fluid indicates fetal lung maturity.&quot; (A)</p> Signup and view all the answers

A pregnant woman complains of breast tenderness, especially when exposed to cold air. Which of the following nursing interventions is most appropriate?

<p>Advise her to wear a supportive bra with wide shoulder straps and dress warmly. (D)</p> Signup and view all the answers

A pregnant woman reports itching on her palms (palmar pruritus). What information should the nurse provide?

<p>Explain that this is a normal occurrence in early pregnancy, possibly related to increased estrogen levels. (D)</p> Signup and view all the answers

A pregnant patient is experiencing constipation. Which of the following measures should the nurse recommend first?

<p>Suggest increasing fiber intake, drinking more water, and establishing regular bowel habits. (C)</p> Signup and view all the answers

A pregnant woman is constipated and reports significant flatulence. Besides increasing fiber and fluids, what dietary modification should the nurse suggest?

<p>Avoiding gas-forming foods like cabbage and beans. (D)</p> Signup and view all the answers

A pregnant woman asks about taking an over-the-counter laxative for constipation. What is the most appropriate response?

<p>&quot;Let's try increasing your fluid and fiber intake first, as laxatives are generally contraindicated during pregnancy.&quot; (A)</p> Signup and view all the answers

A pregnant patient experiencing nausea and vomiting asks about potential complications. What is the most accurate statement a nurse can make?

<p>&quot;These symptoms are classified as minor but can potentially lead to more serious problems.&quot; (B)</p> Signup and view all the answers

During an initial prenatal visit, a client reports experiencing constipation. Which instruction should the nurse prioritize to promote regular bowel movements?

<p>Consuming at least eight 8-oz glasses of water daily (C)</p> Signup and view all the answers

Which of the following statements accurately reflects the nurse's role in educating pregnant women about common discomforts?

<p>Providing empathic advice and measures to relieve discomforts to promote overall well-being. (C)</p> Signup and view all the answers

Flashcards

Progesterone effect on smooth muscle

Progesterone reduces activity in the gastrointestinal tract during pregnancy.

Gallstones and pregnancy

Increased cholesterol during pregnancy raises gallstone formation risk.

Hemorrhoids in pregnancy

Uterine pressure on veins can cause hemorrhoids in pregnant women.

Gingival hypertrophy

Pregnancy can cause swelling and bleeding of gum tissue due to hormonal changes.

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Hyperptyalism

Increased saliva production in pregnancy, likely due to estrogen.

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FSH and LH during pregnancy

Follicle-stimulating hormone and luteinizing hormone decrease due to increased estrogen and progesterone levels.

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Oxytocin production

The posterior pituitary increases oxytocin production late in pregnancy to aid labor.

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First Trimester psychosocial change

Women often experience ambivalence, feeling both joy and concern about the pregnancy in the first trimester.

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Breast Tenderness

Early pregnancy symptom causing sensitivity in the breasts, worsened by cold.

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Palmar Erythema

Itchy condition in palms during early pregnancy, linked to high estrogen levels.

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Constipation

Bowel movement difficulty during pregnancy due to slowed peristalsis and uterus pressure.

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Dietary Fiber

Essential nutrient to help manage constipation during pregnancy.

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Hydration

Drinking sufficient water to avoid constipation and support health in pregnancy.

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Gas-forming Foods

Foods like cabbage and beans that may worsen flatulence in pregnancy.

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Nausea in Pregnancy

Common symptom affecting at least half of pregnant women, often with vomiting.

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Heartburn (Pyrosis)

Burning sensation in the chest commonly experienced in pregnancy.

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Danger Signs of Pregnancy

Signs that indicate potential complications during pregnancy, requiring medical attention.

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Epigastric Pain

Pain in the upper central region of the abdomen, could indicate serious issues.

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Severe Continuous Headache

Unrelenting headaches during pregnancy that may indicate hypertension or preeclampsia.

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Visual Disturbances

Blurriness, flashes of light, or spots in vision can signal pregnancy complications.

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Edema in Pregnancy

Swelling in legs, hands, or face, indicating fluid retention or other issues.

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Absence of Fetal Movement

Reduced or stopped movement of the fetus, which may indicate distress or complications.

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Fetal Diagnostic Tests

Tests performed to check fetal health and detect potential risks or abnormalities.

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Education for Parenthood

Information provision about pregnancy, labor, postpartum, and lactation to prepare parents.

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Backache in pregnancy

Backache can occur due to lumbar lordosis and postural changes as pregnancy advances.

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Managing backache

Encouraging pelvis tilting and using low-heeled shoes can help alleviate back pain.

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Causes of headache

Headaches during pregnancy may be caused by increased blood volume and pressure on cerebral arteries.

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Relieving headaches

Resting with cold towels and taking acetaminophen can relieve headaches.

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Dyspnea in pregnancy

Dyspnea occurs as the expanding uterus compresses the diaphragm, leading to shortness of breath.

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Relieving dyspnea

Sleeping with head and chest elevated can help relieve nighttime dyspnea.

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Ankle edema

Swelling of the ankles during late pregnancy is common, especially if proteinuria and hypertension are absent.

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Normal vs. abnormal edema

Ankle edema is normal if no proteinuria or hypertension is present, signaling no concern.

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Phosphatidylglycerol (PG)

A substance found in amniotic fluid after 35 weeks of pregnancy, indicating fetal lung maturity.

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Fetal Movement Count

A method for mothers to track fetal movements, recommended 2-3 times daily with 5-6 movements each time.

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PUBS (Percutaneous Umbilical Blood Sampling)

A procedure using ultrasound to sample umbilical cord blood, typically used in the second and third trimesters.

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Biophysical Exams

A series of assessments on fetal health, including movements and heart rate, scored from 0-2 based on observations.

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Nonstress Test (NST)

A fetal monitoring test measuring heart rate responses to movements, ideally revealing 2 accelerations in a specified time.

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Reactive NST

An NST result indicating healthy fetal response, showing at least two accelerations of the heart rate.

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Nonreactive NST

An NST result showing no accelerations in heart rate despite fetal movements, suggesting potential oxygen issues.

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Fetal Heart Rate Increase

An expected increase of 15 beats per minute during fetal movement, lasting at least 15 seconds.

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Chorionic Villi Sampling (CVS)

An early test obtaining fetal cells via a catheter through the cervix.

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Ultrasound

Uses sound waves to examine internal structures and fetal growth.

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Amniocentesis

A procedure to sample amniotic fluid after the 14th week for genetic testing.

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Alpha-fetoprotein Screening

Tests maternal serum for fetal neural tube defects between 16-18 weeks.

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L/S Ratio

Assesses fetal lung maturity using lecithin and sphingomyelin in amniotic fluid.

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Creatinine Level

Estimates fetal kidney function and maturity through amniotic fluid analysis.

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Bilirubin Level

Monitors fetal liver health via amniotic fluid, tracking levels over time.

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X-ray in Pregnancy

Used after fetal bones ossify to confirm position; not for early use.

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Study Notes

Overview of Pregnancy Module 4

  • During pregnancy, a woman's body undergoes significant hormonal changes that enable her to nourish, protect, and prepare for labor and milk production.
  • Understanding these changes is crucial for anticipating potential issues and implementing effective family-centered care.
  • This module examines the key events of conception, fetal development, and the changes in the mother's body that facilitate these processes.
  • The module emphasizes the roles of a nurse in supporting the mother's well-being throughout pregnancy.

Learning Outcomes

  • Assess the mother and child's health status using appropriate methods and tools.
  • Create nursing diagnoses focusing on health promotion and disease prevention related to maternal and child health.

Topic Outline: Care of the Mother During the Perinatal Period

  • Prenatal Care

    • Assessment of the mother
    • Process of conception
    • Physiologic changes (e.g., first, second, and third trimesters)
    • Common discomforts
    • Nutrition and exercise
    • Identifying danger signs and complications
    • Teratogens

  • Care of the Fetus

    • Stages of conception
    • Embryonic and fetal structures
    • Fetal Development
    • Assessment of fetal growth and development
    • Implementing nursing care related to fetal growth and development
    • Evaluation of fetal growth and development related nursing care.

Physical and Psychologic Changes of Pregnancy

  • Reproductive System (Ovaries): Ovulation ceases due to hormonal feedback from the corpus luteum and later the placenta.
  • Vagina: Vaginal epithelium becomes hypertrophic and enriched with glycogen. Vaginal discharge increases (leukorrhea), and the color (Chadwick's sign) may change during pregnancy. The vaginal pH decreases from alkaline to acidic to protect against bacterial invasion.
  • Cervix: The cervix increases in vascularity (Goodell's sign) and softens in response to estrogen. Thick mucous is present called the operculum to prevent infection.
  • Uterus: The uterus expands significantly in size during pregnancy to accommodate fetal growth, with increases in length, depth, width, and weight. This expansion can cause changes in breathing (lightening, as the uterus drops), and urinary frequency caused by pressure on the bladder.

Other Systems

  • Respiratory System: Increased estrogen causes sinus congestion and pressure on the lungs and diaphragm, causing shortness of breath. This is more notable at the end of pregnancy and can be relieved by lightening.
  • Cardiovascular System: Cardiac output increases to support the growing fetus and increased blood volume.
  • Renal System: Urinary output increases during pregnancy, especially during the first trimester, due to extra blood.
  • Integumentary System: Skin may stretch which can cause striae gravidarum, linea nigra (darkening of skin on abdomen), and melasma (darkening on the face).
  • Neurologic System: No major changes are typical during a normal pregnancy. Pressure on the sciatic nerve may occur as the fetus and uterus move.
  • Gastrointestinal System: Gastrointestinal motility slows, leading to constipation, nausea, vomiting, and heartburn (pyrosis) as a consequence of pressure from the growing uterus, relaxin, and progesterone. Women may experience hemorrhoids.
  • Endocrine System: Thyroid gland enlarges and metabolic rate increases; requires adequate folic acid intake.
  • Psychological Changes: Acceptance and readiness for parenthood are critical considerations in managing a pregnancy.

Antepartal Period Assessment and Diagnosis

  • Classification of Pregnancy: Gravida, Para, Primigravida, Multigravida, Nullipara (women without prior pregnancy), Primipara, (first birth), Multipara.
  • Presumptive Signs: Symptoms that are subjective (experienced by the woman), such as missed periods, breast changes, nausea.
  • Probable Signs: Objective signs that can be observed by a healthcare provider, such as enlargement of the uterus, Chadwick's sign, ballottement (uterine bounce)
  • Positive Signs: Undeniable confirmation of pregnancy, including fetal heart sounds via ultrasound

Interventions and Nutrition During Pregnancy

  • Prenatal Care: Establishing baselines, determining gestational age, monitoring maternal/fetal well-being, identifying potential complications, providing anticipatory education, promoting fetal development, and evaluating outcomes.
  • Nutrient Needs: A balanced nutritional intake of protein, fats (healthy ones), vitamins, and minerals is required. Adequate intake of iron, calcium, folate, and other critical nutrients are essential for the health of both the mother and the developing fetus. Discuss supplemental needs if necessary

Fetal Growth and Development

  • Explain typical fundal height measurements related to gestation weeks.
  • Describe fetal heart rate (FHR): baseline rates, variability, and accelerations, both normal and abnormal.
  • Explain the use of non-stress tests (NSTs) and contraction stress tests (CSTs) to evaluate fetal well-being during pregnancy
  • Discuss the assessment of fetal well-being.

High-Risk Conditions

  • Discuss high-risk maternal conditions during pregnancy, particularly those that may impact pregnancy.
  • Detail and outline various high-risk situations, e.g., lack of prenatal care, extremes of BMI, previous health issues, various discomforts, high-risk lifestyle behaviors, and other critical factors.

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Antenatal Care Module 2023-2024 PDF

Description

Explore the physiological and hormonal shifts during pregnancy. The questions cover topics such as the impact of progesterone on the gastrointestinal tract, the risk of gallstone formation, and changes in saliva production. Additionally, it covers the hormonal changes and psychological adaptations during pregnancy.

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