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Questions and Answers
What significant effect does MSH have on the body during pregnancy?
Which of the following best describes the role of relaxin during pregnancy?
What physiological change occurs in the uterus during the first trimester of pregnancy?
What is a characteristic change in the vagina during pregnancy?
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What condition can result from lying on the back during pregnancy?
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What term describes a woman who has had one or more pregnancies that delivered after at least 20 weeks?
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Which prenatal care goal is focused on promoting the well-being of the entire family?
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What is the average duration of a term pregnancy measured from the first day of the last normal menstrual period?
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What does preconception care primarily focus on?
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Which of the following histories is NOT typically included in the initial assessment for prenatal care?
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What is the recommended approach for a pregnant adolescent's nutritional needs?
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What dietary modifications should be made for someone with gestational diabetes?
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Which food category is most important for a pregnant woman following a vegetarian or vegan diet?
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What symptom is indicative of lactose intolerance during pregnancy?
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What should a pregnant woman ensure regarding her sodium intake during pregnancy?
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What is the definition of 'gravida' in obstetrical history?
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Which term best describes a woman who is pregnant for the first time?
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What does the TPAL system stand for in obstetrical history?
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Which measurements are used to confirm the estimated due date (EDD) after 14 weeks of gestation?
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What does the term 'multipara' signify in obstetrical terminology?
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What does the 'P' in the GTPAL system represent?
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In obstetric terms, what does 'abortion' refer to?
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Which of the following is considered a presumptive sign of pregnancy?
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What does the L in the GTPAL system indicate?
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What is the primary reason for urinary frequency during the early months of pregnancy?
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What is the recommended daily protein intake for pregnant women?
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Which of the following foods should be avoided by pregnant women due to high mercury content?
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What is the recommended weight gain during pregnancy for women with a normal weight?
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Which vitamin is critical for placental implantation and fetal development and cannot be adequately obtained solely from prenatal vitamins?
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What is the effective absorption strategy for iron supplements during pregnancy?
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What physiological change increases the risk of urinary tract infections in pregnant women?
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How does glucose metabolism change during pregnancy?
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What effect does progesterone have on the gastrointestinal system during pregnancy?
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What factor contributes to the development of varicose veins during pregnancy?
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What changes occur in the integumentary system during pregnancy?
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Which of the following describes abdominal striae during pregnancy?
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What hormone is primarily responsible for the maintenance of the endometrium during pregnancy?
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At what point during gestation may fetal outline be identified by palpation?
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Which of the following is NOT considered a probable sign of pregnancy?
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Which hormone is essential due to its effect on glucose and protein metabolism during pregnancy?
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Study Notes
Obstetrical History
- Ante: before
- Antepartum: before delivery
- Gravida: a woman who is or has been pregnant
- Nullipara: a woman who has never completed a pregnancy beyond a spontaneous or elective abortion
- Primigravida: a woman pregnant for the first time
- Multigravida: a woman who has been pregnant more than once
- Para: number of pregnancies that have progressed to 20 or more weeks of gestation at delivery
- Primipara: a woman who has given birth once after a pregnancy of at least 20 weeks
- Multipara: a woman who has given birth two or more times at 20 or more weeks of gestation
- Abortion: spontaneous or elective termination of pregnancy before the 20th week of gestation
- Gestational Age: the number of complete weeks of fetal development calculated from the first day of the last menstrual period.
- Postpartum: pertaining to the first 6 weeks after childbirth
- TPAL System:
- T: term infants
- P: preterm infants
- A: aborted pregnancies
- L: living children now
Prenatal Care
- Goals of prenatal care:
- Promote the health of the mother, fetus, newborn, and family
- Ensure a safe birth for mother and child
- Teach health habits that continue postpartum
- Educate in self-care for pregnancy
- Develop a partnership with parents and family to provide health care
- Provide physical care
- Prepare parents for parenthood
- Optimal obstetric care includes:
- Preconception care: preparation for the newborn’s impact on the family
- Prenatal care: monitoring, care, and management of issues during pregnancy
- Intrapartum care: continuous presence and support of parents during birth
- Postpartum care: supporting postpartum adjustment, encouraging breastfeeding, skin-to-skin contact and bonding
- Preconception care identifies modifiable risk factors before conception to reduce negative outcomes.
- Prenatal care begins as soon as a woman suspects she is pregnant if not already receiving preconception care.
- Prenatal care history includes:
- Obstetric history: number and outcomes of past pregnancies
- Menstrual history: frequency and cycles, duration of flow, first day of last menstrual period (LNMP)
- Contraceptive history: type used
- Medical and surgical history: infections, surgical procedures
- Family history: identifying genetic defects or incompatibilities
- Psychosocial history: to identify lifestyle stability and cultural beliefs
- The first prenatal visit includes a complete physical examination, pelvic exam, and estimated date of delivery (EDD) calculation.
- Routine lab work is performed on the first or second visit, repeated throughout pregnancy.
- Recommended schedule for uncomplicated pregnancy:
- Conception to 28 weeks – every 4 weeks
- 29 to 36 weeks – every 2 to 3 weeks
- 37 weeks to birth – weekly
- Early and regular prenatal care is important for reducing the number of low-birth-weight infants and for reducing morbidity and mortality for mothers and newborns.
Estimating Delivery Date
- Average term pregnancy duration is 40 weeks
- Pregnancy is divided into three 13-week trimesters.
- Nagele’s Rule:
- Identify the first day of the LNMP
- Count backward 3 months
- Add 7 days, updating the year if applicable.
- Ultrasound can confirm EDD using crown-rump length in the first trimester and other measurements after 14 weeks
GTPAL System
- The GTPAL system describes a woman's pregnancy outcomes.
- Gravida indicates the number of pregnancies.
- Para indicates the outcome of pregnancies, only increasing with deliveries after 20 weeks.
- Para breakdown:
- T: Term infants (after 37 weeks)
- P: Preterm infants (after 20 weeks or before 37 weeks)
- A: Abortions before 20 weeks
- L: Living children now
Signs of Pregnancy
- Presumptive Signs: indicators of pregnancy but also other conditions.
- Amenorrhea: absence of menstruation
- Nausea and Vomiting: begins at 4 weeks and resolves around 20 weeks
- Breast changes and skin: tenderness, tingling, striae, hyperpigmentation (chloasma, linea nigra, areola darkening)
- Urinary Frequency: common in the early months due to increased blood supply to the pelvic area
- Fatigue and drowsiness: caused by increased metabolic needs
- Quickening: first fetal movement felt by the mother, occurs at 16-20 weeks
- Probable Signs: strong evidence of pregnancy but could be caused by other factors
- Goodell’s Sign: softening of the cervix and vagina
- Chadwick’s Sign: purplish or bluish discoloration of the cervix, vagina, and vulva
- Abdominal Enlargement: fairly reliable indicator
- Hegar’s Sign: softening of the lower uterine segment
- Braxton Hicks contractions: irregular, painless contractions
- Ballottement: fetal part displaced by light tap and rebounds quickly
- Palpation of Fetal Outline: may be identified by palpation after the 24th week
- Abdominal striae: fine, pinkish white, or purplish gray lines
- Pregnancy Tests: urine or blood tests for HCG
- Positive Signs: only caused by a developing fetus.
- Fetal heartbeat: detected by 10 weeks using a Doppler device
- Fetal movement: felt by a trained examiner in the second trimester
- Visualization of the fetus: by ultrasound
Physiologic Changes in Pregnancy
- The woman's body undergoes dramatic changes due to hormonal influences.
- Every organ system is affected.
- Microbiomes:
- Play a role in maintaining pregnancy, preparing for labor, and establishing the newborn’s microbiome
- Development of an acidic vaginal environment prevents infections
- Microbes in the mother’s mouth are spread to the placenta and may influence preterm birth.
- Microbiomes in breast milk contribute to the infant’s gut microbiome.
- Endocrine System:
- Hormones are essential for maintaining pregnancy.
- Most hormones are initially produced by the corpus luteum and later by the placenta.
- Estrogen:
- Source: Ovaries and placenta
- Significance: Enlarges uterus, breasts, genitals, promotes fat deposition, hyperpigmentation, vascular changes, striae gravidarum, sodium and water retention
- Progesterone:
- Source: Corpus luteum, ovaries, and placenta
- Significance: Maintains endometrium, inhibits uterine contractions, promotes breast development for lactation, stimulates sodium secretion, reduces smooth muscle tone
- T4:
- Source: Thyroid gland
- Significance: Influences thyroid gland size and activity, increases heart rate, increases basal metabolic rate by 23%
- hCG:
- Source: Trophoblast
- Significance: Stimulates progesterone and estrogen production by the corpus luteum, used in pregnancy tests
- hPL:
- Source: Placenta
- Significance: Affects glucose and protein metabolism, has a diabetogenic effect
Hormonal Changes During Pregnancy
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MSH (Melanocyte-stimulating hormone) is produced by the anterior pituitary gland and causes skin pigmentation to darken, resulting in brown patches on the face, a dark line on the abdomen, and darkening of moles, freckles, nipples, and areola.
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Relaxin is produced by the corpus luteum and placenta and remodels collagen, making the connective tissue of the symphysis pubis more moveable and the cervix softer. It inhibits uterine activity.
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Prolactin is produced by the anterior pituitary gland and prepares the breasts for lactation.
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Oxytocin is produced by the posterior pituitary gland and stimulates uterine contraction. It is inhibited by progesterone during pregnancy. After birth, it helps keep the uterus contracted and stimulates the milk ejection reflex during breastfeeding.
Reproductive System Changes
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Uterus undergoes significant changes, including increasing in size and weight during pregnancy. At term, the uterus reaches the xyphoid process, weighing about 2.2 pounds and having a capacity of about 5000 mL.
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Cervix changes in color and consistency shortly after conception, with Chadwick's and Goodell's sign appearing. Thick mucus secretion forms a mucous plug that seals the cervical canal, preventing vaginal organisms from entering the uterus. The plug is expelled during labor.
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Ovaries do not produce eggs during pregnancy, but the corpus luteum remains on the ovary and produces progesterone to maintain the decidua for the first 6-7 weeks of pregnancy until the placenta takes over.
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Vagina experiences increased blood supply, causing a bluish color (Chadwick's sign), thickening of the mucosa, and softening of connective tissue for distention during birth. Vaginal secretions increase, promoting overgrowth of Candida albicans, leading to yeast infections. The vaginal pH becomes more acidic to protect against pathogenic microorganisms.
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Breasts prepare for lactation due to high levels of estrogen and progesterone. In the last few months of pregnancy, colostrum, a thin yellow fluid, may be expressed from the breast. Colostrum is high in protein, fat-soluble vitamins, and minerals and contains the mother's antibodies to diseases.
Respiratory System Changes
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Oxygen consumption increases by 15% during pregnancy leading to deeper breathing with minimal, if any, increase in respiratory rate.
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The expanding uterus exerts pressure on the diaphragm, causing it to rise and resulting in increased rib cage circumference.
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Increased estrogen levels cause edema of the mucous membranes in the nose, pharynx, mouth, and trachea, leading to stuffiness, epistaxis, and voice changes.
Cardiovascular System Changes
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Blood volume gradually increases by 45% during pregnancy, needed for nutrient, oxygen, and waste exchange within the placenta, expanded maternal tissue, and blood loss reserve at birth.
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Cardiac output increases due to increased blood pumped with each contraction, and the pulse rate rises by 10-15 BPM. Blood pressure does not increase due to decreased resistance to blood flow.
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Supine hypotension syndrome can occur when lying on the back, as the uterus compresses the inferior vena cava, reducing blood return to the heart and potentially causing fetal hypoxia.
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Orthostatic hypotension may occur when raising from a recumbent position, causing a decrease in cardiac output due to a sudden drop in venous return from the lower body.
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Dilution anemia(pseudoanemia) occurs during pregnancy, where plasma increases more than red blood cells, leading to a lower red blood cell count despite increasing plasma volume.
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Increased levels of clotting factors occur during the second and third trimesters to prevent excessive bleeding at delivery. This, however, increases the risk of thrombophlebitis during pregnancy.
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Venous pressure in the femoral veins may increase, leading to varicose veins in some women.
Gastrointestinal System Changes
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The growing uterus displaces the stomach and intestines, increasing salivary secretions and affecting taste and smell. Mucous membranes become more tender due to increased blood vessel development from high estrogen levels.
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Increased fetal demand leads to increased appetite and thirst. Decreased gastric secretions and motility of intestines can cause bloating, constipation, and hemorrhoids.
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Heartburn is caused by relaxation of the cardiac sphincter.
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Glucose metabolism is altered due to increased insulin resistance during pregnancy.
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Progesterone and estrogen relax the gallbladder muscle, resulting in bile salt retention, which can lead to pruritus (itching) during pregnancy.
Urinary System Changes
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The glomerular filtration rate increases due to the urinary system excreting waste products for both the mother and the fetus. The tubules increase reabsorption of essential substances, leading to more frequent glycosuria and proteinuria. Water retention is caused by increased blood volume and nutrient dissolving for the fetus.
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Progesterone relaxes the renal pelvis and ureters, decreasing peristalsis to the bladder. This increases the diameter of the ureters and bladder capacity, causing urine stasis and increasing the risk of bladder infections.
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The enlarging uterus presses on the bladder, causing frequent urination, especially in the first and third trimesters.
Fluid and Electrolyte Balance Changes
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Sodium retention is influenced by elevated pregnancy hormones. The fetus uses a lot of sodium, and the excess can lead to maternal fluid accumulation (edema).
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Fluid retention can cause problems during labor with oxytocin administration, potentially resulting in water intoxication.
Integumentary and Skeletal Systems Changes
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In addition to pigmentation changes, the sweat and sebaceous glands become more active during pregnancy. Spider nevi (small red skin elevations with radiating lines) and red palms may occur, usually resolving post-birth.
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The woman's posture changes due to the weight of the expanding uterus, leading to a more pronounced lordotic curve in the lumbar spine.
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Pelvic joints relax due to hormonal changes, causing a "waddling gait" and predisposition to balance problems.
Nutritional Needs During Pregnancy and Lactation
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A balanced diet is crucial for fetal health, and starting pregnancy with good nutrition improves the chances of a healthier fetus.
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Individualized diet plans, based on activity level, are available online at www.MyPyramid.gov and www.healthierus.gov/dietaryguidelines.
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USDA recommendations for pregnant women provide specific amounts of each food group to be consumed per day, based on the trimester. A calorie increase of 340 cal/day (second trimester) and 450 cal/day (third trimester) is recommended.
Nursing Interventions for Nutrition During Pregnancy
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Determine age, parity, current weight, pre-pregnancy nutritional status, food preferences/intolerances for individualized diet plans.
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Determine socioeconomic and cultural factors influencing food choices for individualized diet plans and WIC identification.
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Review specific nutritional needs, provide written materials, and tailor information based on culture and food intolerances.
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Teach the purpose and maintenance of a food diary to evaluate the patient's diet and potential dietary referrals.
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Maintain and review the patient's actual weight at each visit to identify adequate or excessive weight gain.
Weight Gain
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Weight gain guidelines are based on the woman's pre-pregnancy Body Mass Index (BMI), with normal BMI for a woman deemed 18.5-24.9.
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Current weight gain guidelines during pregnancy with a single fetus are:
- Normal weight women: 25-35 lb.
- Underweight women: 28-40 lb.
- Overweight women: 15-25 lb.
- Obese women: 11-20 lb.
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The pattern of weight gain is crucial. The general recommendation is to gain up to 4.4 lb. during the first trimester and 1 lb. per week for the rest of the pregnancy.
Nutritional Requirements for Pregnancy
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Protein
- Needed for metabolism and supporting growth and repair of maternal and fetal tissues.
- 60 g/day intake is recommended.
- Best sources: meat, poultry, fish, dairy products, beans, lentils, legumes, breads, cereals, seeds, and nuts.
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Calcium
- Increased calcium requirements are nearly 50% to 1000 mg/day.
- Main sources: dairy products, enriched cereals, legumes, nuts, dried fruit, broccoli, green leafy vegetables, canned salmon, and sardines with bones.
- Supplements necessary for women with insufficient intake of calcium-rich foods.
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Iron
- High demand for iron during pregnancy due to fetal storage and increased erythrocyte production.
- Recommended intake: 30 mg for pregnant women.
- Heme iron absorbed best, found in red meat and organ meats.
- Nonheme iron found in plant foods like molasses, whole grains, fortified cereals, breads, dried fruits, and dark leafy greens.
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Vitamins and Minerals
- Adequate intake of vitamins is essential, usually met through prenatal vitamin supplements.
- Excess intake of vitamins can cause fetal anomalies and defects.
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Folic Acid
- Water-soluble B vitamin crucial for red and white blood cell formation and maturation.
- Reduces the incidence of neural tube defects like spina bifida and anencephaly when taken before conception.
- Sources: liver, lean beef, kidney, lima beans, dried beans, potatoes, whole wheat bread, peanuts, and fresh dark green leafy vegetables.
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Fluids
- Pregnant women should drink 8-10 8-ounce glasses of fluid daily, primarily water.
- Caffeinated beverages should be avoided due to their diuretic effect.
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Sodium
- Essential for maintaining normal levels in plasma, bone, brain, and muscle.
- It should not be restricted, but additional sodium should be avoided.
Special Nutritional Considerations
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Pregnancy Adolescents
- Consider resistance, ambivalence, and inconsistency common in adolescents when planning interventions.
- Inadequate weight gain and nutrient deficits are common.
- The girl's continuing growth combined with the fetus's growth makes meeting nutritional needs challenging.
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Vegetarian or Vegan Diets
- Focus on protein-rich foods like soymilk, tofu, tempeh, and beans.
- Prenatal vitamins should be taken.
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Pica
- Craving and ingestion of non-food substances like clay, starch, raw flour, and ice.
- Can interfere with iron absorption, cause fecal impaction, and harm the fetus due to lack of essential nutrients.
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Lactose Intolerance
- Caused by a lack of the enzyme that digests lactose.
Side Effects of Pregnancy
- Abdominal distention, flatulence, nausea, vomiting, and loose stools are possible side effects during pregnancy.
- Daily calcium supplements are recommended.
Cultural Preferences and Food Practices
- Cultural beliefs influence food choices during pregnancy.
- Foods are often categorized as "hot" or "cold". This classification is unrelated to temperature.
- "Hot" foods are believed to treat "cold" conditions and vice versa.
- Nutritional education must incorporate cultural beliefs and practices.
Gestational Diabetes
- Diagnosed during pregnancy.
- Calories should be distributed evenly throughout the day, with 3 meals and 3 snacks.
- Mothers are prone to hypoglycemia during sleep due to the fetus's continued glucose usage.
- A registered dietician can help manage glycemic control.
- Dietary control is key to preventing macrosomia (large newborns) and stillbirths.
Nutrition for Lactation
- Recommended daily caloric intake should be 500 calories more than a non-pregnant woman's.
- Stable maternal weight and increasing newborn weight are signs of adequate nutrition.
- Protein, calcium, iron, and vitamin supplements are the same as during pregnancy to meet the infant's needs.
- Adequate fluids are crucial, aiming for 8-10 glasses of caffeine-free liquids.
- Medications should be taken only with healthcare professional advice as many drugs can be secreted in breast milk.
Exercise During Pregnancy
- Mild to moderate exercise is beneficial during normal pregnancy, but vigorous exercise should be avoided.
- Exercise goals should focus on maintaining fitness, not improving it or losing weight.
- Monitoring body temperature is essential.
- Avoid hot tubs and saunas as they raise body temperature above 100.4 F.
- Elevated maternal temperature can cause issues with fetal circulation and cardiac function.
- Heat exposure during pregnancy is linked to neural tube defects and miscarriage.
- Be mindful of exercise positions as hypotension can decrease fetal blood flow and cause hypoxia.
- Moderate exercise is preferred due to the increased workload on the heart.
- Prolonged strenuous exercise can divert blood away from the uterus, causing fetal hypoxia.
- Catecholamine release during exercise may affect placental filtering, potentially leading to fetal bradycardia and hypoxia.
- Exercise can impact oxygen consumption and hormone levels, potentially causing implantation issues or premature labor.
- Hormonal changes can lead to joint instability, increasing the risk of injury.
- Aim for moderate exercise several times a week from the 8th week of pregnancy until delivery, avoiding vigorous activity and competitive sports.
- Exercise programs should include a warm-up and cool-down.
- Avoid overheating, drink plenty of liquids, and start with a moderate level of effort.
- Those who exercised regularly prior to pregnancy may follow more liberal guidelines for weight-bearing exercise.
- Eat a balanced meal 2-3 hours before exercising and immediately after.
- Avoid scuba diving, skydiving, horseback riding, and skiing.
- Exercise intensity should be adjusted based on the "talk test".
- Examples of safe exercises during pregnancy include pelvic tilts, tailor sitting, proper stretching, and step aerobics.
Common Discomforts of Pregnancy
Smoking
- Smoking during pregnancy has detrimental effects on fetal neural development.
- It is associated with increased risk of psychiatric disorders, such as schizophrenia and ADHD in children.
- Smoking during pregnancy can affect the developing eggs of the female fetus, potentially impacting future generations.
- Marijuana use is linked to preterm birth.
- Nicotine patches are not recommended as a smoking replacement for pregnant women.
- Early patient education regarding smoking and drug use is crucial.
Travel
- Air travel is generally safe up to 36 weeks of gestation.
- Avoid long periods of sitting due to increased clotting factors and plasma fibrinogen, which raise the risk of blood clots.
- Travel to areas with a high risk of infectious disease should be avoided.
- Practice good hand hygiene and follow dietary precautions to prevent diarrhea.
- If diarrhea occurs, rehydration is vital.
- Consume foods high in potassium.
- Consult a healthcare provider if diarrhea persists.
- Wear comfortable shoes and long sleeves to prevent insect bites.
- Use insect repellent with DEET after the first trimester.
Common Discomforts and Nursing Interventions
Nausea and Vomiting
- Common in the first trimester.
- Caused by hormonal changes, decreased gastric motility, fatigue, and emotional factors.
- Usually subsides by 16 weeks.
- Persistent vomiting can lead to hyperemesis gravidarum (severe nausea and vomiting).
- Recommendations: Avoid an empty stomach, eat dry crackers or toast before rising in the morning, eat frequent small meals, drink fluids between meals, avoid greasy, odorous, spicy, and gas-forming foods, increase vitamin B6 intake, consider ginger, use acupressure wrist bands, and consult a healthcare provider if these interventions fail.
Breast Tenderness
- Common in the first trimester.
- Caused by hormonal changes leading to increased vascular supply and breast tissue hypertrophy.
- Can cause tingling, fullness, and tenderness.
- Recommendations: Wear supportive bras, avoid soap on nipples to prevent cracking.
Urinary Frequency
- Common during the first and third trimesters.
- Caused by pressure of the uterus on the bladder and progesterone’s relaxation of bladder muscles.
- Recommendations: Void when needed, increase fluids during the day, decrease fluids in the late evening to reduce nocturia, limit caffeine, practice Kegel exercises.
Vaginal Discharge (Leukorrhea)
- Common in the first trimester.
- Increased estrogen levels and pelvic blood flow lead to increased cervical mucus production.
- Resulting in white, viscid vaginal discharge.
- Recommendations: Bathe or shower daily, wear cotton underwear, avoid tight clothing, keep the perineum clean and dry, avoid douching and tampons, wipe perineum from front to back after using the toilet, contact a healthcare provider if there are any changes in the color, odor, or character of the discharge.
Heartburn (Pyrosis)
- Common in the second and third trimesters.
- Caused by increased progesterone levels, relaxing the esophageal sphincter.
- Leads to regurgitation of stomach contents into the esophagus, causing a burning sensation, burping, and sour taste.
- Recommendations: Sit upright for 30 minutes after meals, avoid gas-forming and greasy foods, avoid overeating, use low-sodium liquid antacids, avoid Alka-Seltzer and sodium bicarbonate.
Constipation and Flatulence
- Common in the second and third trimesters.
- Caused by increased progesterone levels, leading to slower bowel movements and increased water absorption.
- The pressure of the growing uterus on the intestines, dietary habits, lack of exercise, and decreased fluids can contribute.
- Iron supplements can worsen constipation.
- Recommendations: Increase fluid intake, avoid carbonated and caffeinated beverages, increase fiber in the diet, exercise regularly to stimulate bowel movements, establish a regular bowel routine, avoid mineral oil and enemas, consult a healthcare provider about stool softeners.
Hemorrhoids
- Common in the second and third trimesters.
- Varicosities of the rectum caused by pelvic vascular enlargement, straining during bowel movements, and the descending fetal head.
- They often resolve after delivery when the pressure is relieved.
- Recommendations: Use anesthetic ointment, cool witch hazel pads, or rectal suppositories, take Sitz baths, increase fiber intake, maintain regular bowel habits to prevent constipation.
Backaches
- Common in the second and third trimesters.
- Caused by postural changes as the uterus enlarges, shifting the center of gravity and leading to lumbar lordosis and muscle strain.
- Recommendations: Maintain proper posture, avoid exaggerating the lumbar curve, squat instead of bending over to pick up objects, wear low-heeled shoes, engage in exercises like sitting cross-legged, shoulder circling, pelvic rocking, rest, and apply localized heat.
Round Ligament Pain
- Common in the second and third trimesters.
- Pain in the lower abdomen caused by the stretching of abdominal ligaments by the growing uterus, often triggered by sudden movements.
- Recommendations: Avoid jerky or quick movements, use pillows to support the abdomen, practice good body mechanics.
Leg Cramps
- Common in the second and third trimesters.
- Caused by pressure of the uterus on blood vessels, impairing circulation to the legs and leading to muscle strain and fatigue.
- An imbalance in calcium and phosphorus levels can contribute.
- Recommendations: Dorsiflex foot, straighten the leg with downward pressure on the knee, stand with feet flat on the floor when cramps occur, evaluate diet and calcium intake.
Headache
- Common in the second and third trimesters.
- Caused by emotional tension, fatigue, increased blood volume, and heart rate, leading to dilation and distention of blood vessels in the brain.
- Recommendations: Emotional support, relaxation exercises, regular meals, consult a healthcare provider if the headache persists as it may indicate gestational hypertension.
Varicose Veins
- Common in the second and third trimesters.
- Caused by elevated progesterone levels relaxing vein walls and the pressure of the enlarging uterus on veins, leading to varicosities in the vulva, rectum, and legs.
- Recommendations: Avoid prolonged standing or sitting, constrictive clothing, and straining during bowel movements, walk frequently, elevate legs when resting, wear support hose (avoid knee-high stockings), exercise to stimulate venous return.
Edema in Feet and Ankles
- Common in the second and third trimesters.
- Caused by circulatory congestion in the lower extremities.
- Recommendations: Elevate legs when sitting, increase rest periods, avoid constrictive clothing, and prolonged standing or sitting.
Faintness and Dizziness
- Common in the second and third trimesters.
- Caused by vasomotor instability or postural hypotension, often triggered by prolonged standing and leading to venous stasis in the lower extremities.
- Recommendations: Avoid sudden changes in position, prolonged standing, and warm, crowded areas, move slowly from a resting position, avoid hypoglycemia by eating 4-5 small meals a day, lie on the left side when resting to avoid supine hypotension, contact a healthcare provider if symptoms persist.
Fatigue
- Common in the first trimester.
- Caused by hormonal changes and periodic hypoglycemia due to the embryo’s rapid growth.
- Most prominent in the early months of pregnancy.
- Recommendations: Aim for 8-10 hours of sleep per night, nap during the day if possible, practice relaxation techniques, meditate, or change of scenery.
Dyspnea (Shortness of Breath)
- Common in the third trimester.
- Caused by the rising uterus pressing against the diaphragm.
- Recommendations: Sleep with pillows under the head, use deep chest breathing before bed, maintain proper posture, and avoid exertion.
Water Aerobics
- Can alleviate edema in healthy pregnant women by the hydrostatic pressure forcing fluids into circulation, increasing glomerular filtration rate and water excretion.
Nasal Stuffiness (Edema of Nasal Tissues)
- Common during pregnancy.
- Caused by elevated estrogen levels.
- Relief can be obtained through saline nasal drops or humidifiers.
Psychological Adaptations During Pregnancy
- Pregnancy can generate a range of emotions for the entire family.
- Nurses play a crucial role in supporting families throughout this period.
- Identifying and managing psychosocial challenges is important for a positive pregnancy outcome.
- Identifying barriers to healthcare, such as insurance coverage, financial difficulties, knowledge gaps, transportation issues, housing, and domestic violence, is a key nursing responsibility.
Impact on the Mother: Maternal Tasks
- There are 4 maternal tasks that women accomplish during pregnancy.
- Seeking safe passage for herself and her fetus: Seeking professional healthcare and adhering to cultural practices.
- Securing acceptance of herself as a mother and her fetus: Ensuring her partner and family accept the infant.
- Learning to give of herself and receive care from others: Recognizing the shift in her life and reliance on others.
- Committing herself to the child: Protecting and nurturing the fetus emotionally.
Psychosocial Adaptations in the First Trimester
- Early pregnancy may be marked by uncertainty due to limited physical changes.
- Ambivalence is normal with conflicting feelings about pregnancy and potential anxieties about making the right choices.
- This period is often focused on the mother's physical experiences and emotional fluctuations due to hormonal changes.
- Reassurance is important, emphasizing that ambivalence and mood swings are common and will stabilize after pregnancy.
Psychosocial Adaptations in the Second Trimester
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The fetus becomes more real as the mother's weight increases, the uterus becomes visible, and fetal movement and heartbeat are detected.
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The second trimester is typically more stable, and women start embracing the role of expectant mothers.
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Increased focus on the developing child and changing body image leads to "narcissism", with emphasis on health and well-being for both mother and infant.
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Women often seek information about infant development, sharing stories about their own childhoods to "try on" the role of mother. ###Â Psychosocial Adaptations During Pregnancy
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Second Trimester: A woman experiences physical changes that highlight pregnancy. These changes lead to both positive and negative feelings about her appearance, and increase introspection about motherhood.
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Third Trimester: The mother's mood may be more volatile and her thoughts shift towards labor and becoming a mother. She becomes more introspective and may have a sense of separation from the pregnancy.
Impacts on the Father
- Announcement Phase: Fathers experience ambivalence and self-questioning about their readiness for fatherhood. Acceptance of the pregnancy strengthens family support and expands the social network. Rejection can create communication and resentment.
- Adjustment Phase: Fathers may revise financial plans, participate in planning accommodations for the child, and begin listening to or feeling fetal movement. Lack of adjustment may lead to an increase in outside interests or feelings of being eclipsed by the child.
- Focus Phase: Fathers actively plan for participation in the birth process and adjust to the change in lifestyle, feeling a tangible sense of "fatherhood."
Impacts on Pregnant Adolescents
- They may experience conflict about their unplanned pregnancy and anxiety about telling parents and the father of the child. Denial of pregnancy is not uncommon. Other concerns may include financial strain, shame, guilt, relationship problems, and low self-esteem.
- The young age can be difficult, as adolescents are focused on their peer group and appearance and may find it difficult to consider the needs of others.
- Nurses need to assess the girl's developmental and educational level and her support system to provide the most appropriate care.
- Tailored prenatal classes can help young mothers learn to care for themselves and prepare for their new role.
Impacts on Older Couples
- They are often well-educated, have life experience to cope with parenthood, and are ready for a lifestyle change.
- Potential concerns may include physical exertion as the child grows, confronting their own mortality, and childcare requirements. They may also encounter difficulties meeting the financial demands of a college-age child at retirement age.
- Older parents are often in a "high-risk" prenatal group, but most pregnancies should be treated normally. Advancements in maternal care and delivery practices have reduced the risk of complications. Although there may be an increased risk of congenital anomalies and multiple pregnancies, special testing can be offered during pregnancy.
Impacts of Single Motherhood
- They may have special emotional needs and rely on family or friends for support. Without a strong support system, the emotional transition of pregnancy may be more difficult.
- They may have conceived through in-vitro fertilization due to a strong desire for a child. Those who planned the pregnancy are often more prepared for financial and lifestyle changes.
- Nurses should engage in a non-judgmental manner and assist in achieving the psychological tasks of pregnancy for single mothers.
Impacts on the Single Father
- They may take on childcare duties and financial responsibility, and may have delayed plans for marriage.
- They may provide emotional support for the mother during pregnancy and birth and participate in childrearing plans after birth.
- It is important to recognize that sometimes the mother may reject the father's involvement.
###Â Impacts on Grandparents
- Prospective grandparents have varying reactions. Some are excited about the role, while others may not feel ready or equate it with growing older.
- The first grandchild generates the most excitement, while subsequent grandchildren may evoke more subdued responses. This can be hurtful to the new parents.
- Grandparents have different levels of involvement based on their own lives and the distance between them and the young couple.
- Conflicts arise when there are differing expectations of involvement between the generations. Nurses can facilitate understanding between the generations and help them negotiate solutions for conflict.
Impacts on Siblings
- Preparations for the arrival of a new baby should begin before the birth to ensure the siblings feel loved and included.
- Young children may struggle to cope with the changes and may exhibit behavioral changes. It is crucial to devote special time and effort to make siblings feel as loved as they were before.
Prenatal Education
- Process: Prenatal education is interactive, and it requires input from the patient to assess individual needs and ensure a healthy outcome for the mother, child, and family unit.
- Benefits: Prenatal education promotes positive attitudes and perceptions, enhances knowledge of pregnancy and childbirth, and teaches skills for coping with labour and transitioning into parenthood.
- Content: It includes education about proper nutrition and healthy lifestyle, exercise, breathing and relaxation techniques, and birthing methods.
- Types of Education: Formal classes and office visits, as well as every interaction with a patient, should be opportunities for education.
- Cultural Needs: These need to be taken into consideration when developing a personalized birth plan.
Childbirth Preparation Methods
- Dick-Read Method: Teaches relaxation techniques to interrupt the fear-tension-pain cycle of labour.
- Bradley Method: Known as the "husband-coached" method, it makes the father an integral part of labor and emphasizes slow abdominal breathing and relaxation techniques.
- Lamaze Method: Forms the basis of many childbirth preparation classes and teaches women to respond to contractions with relaxation and specific breathing techniques to manage pain.
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Description
Test your knowledge on prenatal care and the physiological changes that occur during pregnancy. This quiz covers essential topics such as hormonal effects, dietary considerations, and assessments needed for the well-being of pregnant women and their families. Prepare to explore the complexities and significant changes that occur throughout pregnancy.
