Physical and Psychological Changes of Pregnancy PDF

Physical and Psychological Changes of Pregnancy Annie Nelson BSN, RNC-MNN NUR 105 S25 North Country Community College, Ticonderoga  Nausea/vomiting Fatigue Presumptive Urinary frequency Signs of Pregnancy Breast enlargement and tenderness...

Physical and Psychological Changes of Pregnancy Annie Nelson BSN, RNC-MNN NUR 105 S25 North Country Community College, Ticonderoga  Nausea/vomiting Fatigue Presumptive Urinary frequency Signs of Pregnancy Breast enlargement and tenderness Fetal movement (20 weeks) Probable Signs of Pregnancy Goodells sign – cervix softening Chadwicks sign – blueish purple coloration of the cervix and vaginal mucosa Hegars sign – softening of the lower uterine segment Ballottement – pushing on the cervix and feeling the BOW/fetus moving away + pregnancy test Positive Signs of Pregnancy Fetal heart auscultation by doppler Fetal movement detected by a practitioner Ultrasound Uterus, Cervix, Vagina increase in uterine size/weight Goodell’s (softening of cervix) Hegar’s (softening of lower uterus) Chadwick’s (bluish coloration of cervix vaginal mucosa, and vulva) pH of vagina (candidiasis) mucous plug Increased blood flow & vaginal lubrication Breasts tenderness enlargement (incl. nipples, areola, Montgomery follicles) striae prominent veins d/t increased blood flow colostrum nipple color change CV & Resp. Cardiovascular Respiratory decrease in peripheral vascular resistance (lower increased O2 consumption 15-20% bp), increase in respiratory rate increased blood volume (30-50%), hypervolemia, shortness of breath increased heart rate, nasal and sinus congestion increased RBCs by 30% and plasma by 50% Epistaxis anemia, hemodilution Vasodilation, increased permeability increased WBCs thoracic breathing increase in fibrin/fibrinogen SUPINE HYPOTENSIVE SYNDROME (uterus compresses inferior vena cava, lay on left side)  GI & GU Renal GI frequency nausea and vomiting increased risk of UTI Heartburn (smooth muscle relaxation) increased output bloating, flatulence dependent edema Constipation – high fiber!! When is this a red flag? PICA gingivitis/bleeding gums Increasing plaque build up Hemorrhoids Cont’d MSK Integumentary waddle gait Linea nigra increase risk of falls d/t change in center of gravity melasma increased elasticity and hot flashes relaxation of ligaments perspiration Diastasis recti striae gravidarum angiomas (spider veins) palmar erythema increased sebaceous gland secretions Oily skin vs glow higher levels of estrogen, progesterone, and melanocyte- stimulating hormone  Cont’d Endocrine Nervous FSH, Progesterone, estrogen, prolactin, oxytocin, headaches hCG, human placental lactogen syncope increased vascularity of thyroid increased basal metabolic rate increase in cortisol Psychosocial Aspects of Pregnancy Acceptance – profound and irrevocable changes; care seeking, social acceptance, maternal fetal attachment, personal sacrifices of motherhood, ambivalence should be minimal by end of pregnancy Family Dynamics – relationship with mother, caring/involved partner Preparation – classes/education, birth plan Fear – loss of control, trust in medical staff (compassionate, empathetic, available), pain management  Multiparity / Multigestational Easier or harder Maternal Age Factors that Young mothers, AMA Family Structure influence Sexual orientation, medical staff (M vs F), single mothers, adoption, surrogacy, military, SES Intimate Partner Violence adaptation Increases w/ pregnancy 1 in 6 women For all: involve family where feasible, assess learning needs, offer anticipatory guidance, assess for excessive anxiety/depression, grief may be present for change in body image, loss of old life The Birth Plan – considerations (medical/pain interventions, support people) Mental health issues – can lead to physical issues and poor pregnancy outcomes ABCs!! Finances, accessibility to health care, daycare, transportation Previous birth experiences Health Disparities w/ Race & Ethnicity Black Women three to four times more likely to die in pregnancy five times more likely to die from pregnancy-related cardiomyopathy and blood pressure disorders than White women Maternal mortality rate for Hispanic women increased by 44% from 2019-2020 “Weathering Hypothesis”  stress leads to cortisol production, which leads to HTN and elevated blood glucose and subsequent insulin resistance Chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes that can have intergenerational effects  Pregnant Adolescent Competing developmental tasks of adolescence and those of becoming a mother Priorities typical for this age: Appearance Peer group Focus on own needs May keep the pregnancy a secret Denial until late in gestation is common Experience anxiety informing: Her parents Baby’s father Friends Behaviors: Ambivalence Resistance Inconsistency The Father Most important person to the pregnant patient is usually spouse or partner The mother needs partner to accept the child Some spouses or partners experience physical changes: Couvade syndrome Undergoes psychological changes: Ambivalence Strong protective feelings Concerned about ability to be a good father Examine own father-child relationship Unplanned/unwanted pregnancy: May not accept changes in lifestyles or life plans May feel left out Unsure of relationship after baby born May engage in extramarital affairs Express disappointment and frustration with violence ACOG suggests screening for violence at each prenatal visit Concerned about ability to provide emotional support during childbirth- cope by doing concrete tasks Siblings New baby is a major crisis Response influenced by: Child’s age Parents’ attitudes How prepared for the upcoming birth Toddlers: become clingy and irritable; baby is only a story Preschool child: sense of loss; being replaced; jealous Older children: interested and ask questions about conception, pregnancy, and childbirth; think of ways to be helpful Older children and teenagers: embarrassed by parents’ sexuality Grandparen ts Most are pleased Remember their own experiences of pregnancy and raising children “Firsts” used as a link between the generations Face the reality of aging May react negatively to the news: “too young to be grandparents” Nonsupport adds stress and decreases the self-esteem of the parents-to-be Nursing Care During Pregnancy Annie Nelson BSN, RN NUR 105 Spring 2024 North Country Community College, Ticonderoga Pregnancy Quick Facts Trimesters: 1st 0-14, 2nd 15-28, 3rd 29-40 Due Date: LMP (Naegle’s Rule = 1st day of LMP – 3 months + 7 days), Fundal Height Measurement, Ultrasound Where the “pregnancy wheel” comes from Due Date: Early Term = 37 weeks to 38+6 Term = 39 weeks – 41+6 Late term = 41 weeks to 41+6 Post term 42+ Gravida/Para, G-total number of times pregnant, T-term infants (38-42 weeks) P-preterm infants A-abortions (spontaneous or induced) L-children currently living, Prenatal Care – monthly up to 28 weeks, then q2-3w until 36, then weekly Case dependent Initial Data Collection Begins with the suspicion of pregnancy Diagnosis: Amenorrhea – usually the first sign Use of a home pregnancy test Teaching on the correct use is essential Abdominal ultrasonography Transvaginal ultrasonography (TVUS) Health Promotion Schedule the first prenatal visit as soon as pregnancy is confirmed Obtain a thorough past medical history and current health history Encourage asking questions Answer all questions honestly Encourage to obtain all laboratory tests ordered Stress subsequent prenatal visits and care throughout the pregnancy Assisting with the First Assessment Pelvic examination: Lithotomy position is used Information obtained: Examination of the external genitalia Culture for sexually transmitted infections (STI) may be obtained Examination of the internal genitalia to observe the cervix for the signs of pregnancy Papanicolaou (Pap) smear may be obtained Bimanual exam of the uterus to determine size Pelvic bones are assessed to determine size and adequacy for a vaginal birth Pelvic assessment measurements Antepartum Labs Complete blood count (CBC) Papanicolaou (Pap) Antibody screen Urinalysis Blood typing and Rh status Tuberculosis Rubella titer Glucose tolerance test (GTT) Varicella titer Group B Streptococci test (GBS) Hepatitis B and C HIV and STI screen NIPT – Noninvasive prenatal testing find some chromosome abnormalities in the baby Down syndrome (trisomy 21), trisomy 18, trisomy 13 looks at the pregnant person's blood for DNA that has shed off the placenta. First Trimester Testing Pregnancy-associated plasma protein-A: done between 11 and 13 weeks to help detect trisomy 18 and trisomy 21 Fetal ultrasonography Chorionic villi sampling (CVS): done between 11 and 13 weeks gestation and checks for genetic disorders Nuchal translucency testing (NTT): done between 11 and 13 weeks gestation to screen for chromosomal abnormalities Second Trimester Testing Quadruple screen: done using the mother’s serum between 15 and 20 weeks to detect levels of specific serum markers: Alpha-fetoprotein (AFP): high levels may indicate fetal neural tube defect and lower levels could indicate risk for Down syndrome or trisomy 18 Human chorionic gonadotropin (hCG): higher levels indicate risk for Down syndrome Unconjugated estriol (UE): lower levels indicate a risk for Down syndrome Inhibin-A: higher levels indicate a risk for Down syndrome Amniocentesis: performed to diagnose Down syndrome, cystic fibrosis, spina bifida, and other genetic disorders Percutaneous umbilical cord sampling (PUBS): test of cells obtained directly from the umbilical cord Antepartum Tests Nurse’s role Teach Provide support Growth scans, confirmation scans Assist Sterile fields Conduct certain tests NSTs Monitor maternal and fetal response  Subsequent Visits and Care Frequency: Monthly for the first 28 weeks gestation Every two weeks until 36 weeks gestation Weekly after 36 weeks until childbirth Care: Evaluate any physical or psychological patient concerns and answer questions Current weight Vital signs Urinalysis: Glucose Ketones Protein Nitrates Fundal height Fetal heart rate Psychological assessment Provide education Screen for intimate partner violence Fetal Development Data Quickening: the mothers sensation of Fetal Heartbeat: fetal movement, normal is 110-160 bpm expected between 16 and 22 weeks gestation