Pregnancy Body System Changes PDF

Determine gravida and para using both the GTPAL and G/P system. - Gravida- number of pregnancies a patient has had - Para- number of pregnancies in which a fetus or fetuses have reached at least 20 weeks - G1 P0 -- pt is pregnant for the first time - G1 P1 -- pt has been pregnant onc...

Determine gravida and para using both the GTPAL and G/P system. - Gravida- number of pregnancies a patient has had - Para- number of pregnancies in which a fetus or fetuses have reached at least 20 weeks - G1 P0 -- pt is pregnant for the first time - G1 P1 -- pt has been pregnant once and has taken 1 baby home - G -- gravida, T -- term births (after 37 wks), P -- preterm births (between 20 and 36 wks), A -- abortions (before 20 wks), L -- living children Describe various pregnancy tests and how to interpret results. - Serum tests and urine tests - Quantitative serum testing -- high level of accuracy (measures hCG in blood) - Sandwich type immunoassay testing (qualitative hCG testing) -- measures hCG in urine - hCG will be detected in urine or blood 7-8 days before next expected period - Doubles every few days before the first month and peaks at 60-70 days after implantation - High hCG- downs syndrome of multiple gestation - Decreased hCG- ectopic or impending miscarriage - False positive -- anticonvulsants and tranquilizers - False negative -- test done too early, diuretics or Phenergan Explain body system changes during pregnancy. - Uterus - Changes in size (r/t high levels of estrogen and progesterone), shape (pear shaped at conception, spherical at 2^nd^ trimester, and egg shaped later), and position (1^st^ trimester uterus in pelvis, 12 wks uterus is larger and rises into abdominal cavity, fundal height reaches above symphysis pubis at 12 wks, reaches above umbilicus at 20 wks, rises until lightening (baby drops)) - Changes in contractility (false contractions do not cause cervical dilation, dilation is the most reliable indicators of true labor) - Uteroplacental blood flow (placental perfusion depends on maternal blood flow to uterus, blood flow increases size of uterus increases) - Uterine souffle -- sound of blood flow through uterine arteries to placenta - Fundic souffle -- sound of fetal blood rushing through umbilical cord - Cervical changes -- Goodell sign (cervix softens), friability (cervical tissue is easily damaged), operculum (mucus plug, barrier to protect baby from being exposed to bacteria) - Vagina and vulva - Pregnancy hormones cause mucosa to thicken, connective tissue to loosen, and smooth muscle to hypertrophy - Chadwick's sign -- blueish vaginal mucosa - Leukorrhea -- normal white/gray vaginal discharge - Lower pH to prevent bacterial infections - Breasts - Fullness, sensitive, tingle, heavy, nipples/areola get darker, nipples more erect - Montgomery tubercles -- little dots around areola, hypertrophy of sebatious glands of areola, secrete lubrication and a substance to help prevent infection - Lactogenesis stage 1 -- colostrum - Pre-milk substance - First several days after birth - High protein, antibodies, and fat soluble vitamins/minerals - CV System - Blood volume increases by 40-45% to provide a fluid reserve to compensate for blood loss during birth and postpartum - Cardiac output increases 30-50% during pregnancy - Blood pressure should stay the same - May experience supine hypotensive syndrome - Happens during the second half of pregnancy - Baby puts pressure on the inferior vena cava which can cause a lower BP and cardiac output - Symptoms include nausea, faint, dizzy, pale, sweaty, and tachycardia - Uterus also compresses other blood vessels which can cause dependent edema, varicose veins, and hemorrhoids - Heart becomes enlarged, raised and shifted to the left - May have systolic ejection murmurs - Blood is in a hypercoagulable state, mother is 5-6x greater chance of getting a blood clot - Respiratory System - Maternal o2 consumption increases - Increased estrogen causes increased vascularity of upper respiratory tract can cause increased congestion and nose bleeds - Chronic mild hyperventilation is normal in pregnancy - Mother in a state of respiratory alkalosis - GI System - N/V peaks by 8-12 wks - Pica -- nonfood craving could be r/t iron deficiency - Can have heartburn - Gallstones - Abdominal discomfort - Gums may swell and bleed - Increased progesterone causes decreased in motility and tone of smooth muscle (constipation) - Renal System - Higher risk of UTI's - Increased GFR by 50% - Fluid and electrolyte balance - Tubular reabsorption of glucose is impaired, causing glucosuria to occur at varying times and to varying degrees - Increased excretion of protein and albumin - If proteinuria exceeds more than 300mg/24 hrs after 20 wks could be abnormal - Integumentary System - Hyperpigmentation r/t increase in hormone melanotropin - Chloasma or melasma -- temporary hyperpigmentation of cheeks - Linea nigra -- dark line down the midline of stomach - Striae Gravidarum -- stretch marks - Angiomas -- vascular spiders - Palmar erythema- redness of palms - Musculoskeletal System - Center of gravity shifts forward - Lordosis - Waddle - Diastasis recti -- abdominal muscles separate - Neurologic System - Headaches resulting from muscular contraction, tension d/t hormonal changes, eyestrain, emotional tension, nasal congestion, or fatigue - Alterations in sleep - Carpal tunnel syndrome -- last trimester d/t edema of peripheral nerves - Lightheadness/Fainting are common r/t hyperglycemia, postural hypotension, and vasomotor instability - Immune System - Protects mother from infection while preventing rejection of genetically foreign fetus Differentiate between presumptive, probable, and positive pregnancy signs. - Presumptive -- changes felt by a women - Missed period, nauseam tender breasts, fatigue - Probable -- changes noted by a provider - Positive pregnancy test, hegar's sign (lower uterine segment softens), goodell's sign (cervical softening), chadwicks's sign (bluish cervix and vaginal mucosa), and ballottement (baby bouncing/floating) - Positive -- signs only detected because of the fetus - Ultrasound and doppler Examine selected lab values that change with pregnancy. - Increased red blood cell mass; physiologic anemia - Increase blood volume is faster than body can make RBC - 1^st^ and 3^rd^ trimester -- anemia -- Hgb less than 11 and Hct less than 33% - 2^nd^ trimester -- anemia -- Hgb less than 10.5 and Hct less than 32 - WBC increases and is normal up to 15,000 and 30,000 in postpartum - T3 and T4 may increase due to thyroid gland enlargement Examine selected pituitary and placental hormones. - Pituitary Hormones - Prolactin -- prepares breasts for lactation and secretion of milk - Oxytocin -- stimulates milk let-down and uterine contractions - Placental Hormones - Estrogen -- enlarges genitals, uterus, breasts, increases vascularity, and relaxes pelvis - Progesterone -- relaxes smooth muscle, causes fat deposits in abdomen/back/thighs, also decreases mothers ability to use insulin Chapter 14 - Describe strategies for confirming pregnancy and estimating the date of birth - Pregnancy is 40 wks or 280 days from LMP - 1^st^ trimester -- 1^st^ day of LMP -- 13 6/7 wks - 2^nd^ trimester -- 14 wks -- 27 6/7 wks - 3rd trimester -- 28 wks -- 40 6/7 wks - Ultrasound most accurate assessment of EDB is based on measurement of embryo during first trimester - Naegele's Rule to calculate EDB - Assume that women has 28-day cycle and the fertilization occurs on 14^th^ day - After determining first day of LMP, subtract 3 calendar months and add 7 days - Summarize the physical, psychosocial, and behavioral changes that usually occur as the expectant mother and other family members adapt to pregnancy. - Mother - Normal to have conflicting feelings (very excited but also scared) - First has to accept the pregnancy - Then identify with mother role - Reorder personal relationships - Establish relationship to fetus (3 phases) - Accepts biological fact of pregnancy - Accepts growing fetus as distinct from herself - Prepares realistically for the birth - Father - Accept pregnancy - Identifying with parent role - Reorder personal relationships - Establish relationship with fetus - Prepare for birth - Evaluate the benefits of prenatal care and problems of accessibility for some women. - Promotes health and well-being of pregnant women, her fetus, the newborn and the family - Outline the patterns of health care used to assess maternal and fetal health status at initial and follow-up visits during pregnancy. - Initial visit - Prenatal interview - Reason for seeking care - Reproductive and sexual history - Medications - Occupational history/health history - Mental health screening - Physical exam - Lab Tests - Urine, cervical, and blood samples - Screening and diagnostic tests for infectious disease and metabolic conditions - UTI - Gonorrhea - Chlamydia - HIV - Syphilis and Hep B - Follow up visit - Interview - Physical exam - Gestational HTN: systolic greater than 140 or diastolic greater than 90 - Has to occur on 2 or more occasions at least 2 hours apart after 20 wks gestation - Fetal assessment - Gestational age - Fetal heart tones - Health status (tell mom to take kick counts after 28 wks) - Fundal height - Lab Tests - 1 hr glucose tolerance test (24-28 wks) - No fasting, positive if BS is greater than or equal to 130-140 - Group B Strep Screen at 36 wks to check for bacterial infection (will treat mom with antibiotics during labor if positive) - AFP -- alpha fetal protein -- helps identify neural tube defects - Genetic Screening - Can get a quad screen in 2^nd^ trimester - Sequential screening -- another genetic screen during second trimester - Routine Fetal ultrasound Exam - Select the typical nursing assessments, diagnosis, interventions, and methods of evaluation in providing care for the pregnant women. - Provide education needed by pregnant women to understand and manage physical discomforts related to pregnancy and to recognize the signs and symptoms of potential complications. - Teach about expected maternal/fetal changes - Weight gain of 25-35 lbs for normal BMI - Nutrition - Add 350 calories in second trimester - 450 in third trimester - 500 while breastfeeding - Personal hygiene - Prevention of UTI - Kegal exercises - Strengthen muscles around vagina and urethra to improve muscle tone - Preparation for breastfeeding - Only wash nipples with water - Oral health - Gum infections can increase risk for preterm birth, preeclampsia, and gestational DM - Physical Activity - Moderate activity for 30 min daily - Posture/body mechanics - Pelvic tilt/rock exercises can help alleviate back pain - Side lying allows for better uterine perfusion - Rest and relaxation - Employment - Clothing - Travel - If low risk can fly within US until 36 wks - Should makes sure to get up and stretch legs to prevent blood clots - Meds and Herbs - Immunizations - No live or attenuated vaccines (MMR, varicella) - Can get Tdap and Hep B - Rh Immune Globulin - See page in packet - Substance use - Nicotine can cause preterm birth, smaller babies, miscarriage, SIDs, oral/facial defects - Do not drink alcohol - Normal discomforts - N/V common in first trimester - Eat a dry carb upon awakening - 5-6 small meals - Do not skip meals - May prescribe diclegis (antiemetic) - Heartburn - Small frequent meals - No tight clothes - Avoid trigger foods - Stay upright after meals - Constipation - Fluids, fiber, physical activity - Backpain - Good posture and body mechanics - Do not wear heels - Abdominal support - Local heat/ice - Leg cramps - Dorsiflex foot - Have enough calcium - Ankle edema - Elevate legs - Exercise - Support stockings - Urinary Frequency - Kegal exercise - Avoid caffeine - Limit fluid before bed - Carpal tunnel - Elevate arms - Splinting hands may help - Recognizing potential complications - Severe vomiting - Fever/chills - Burning with urination - Vaginal bleeding - Severe backache or flank pain - Change in fetal movement - Uterine contractions before 37 wks - Visual disturbances - Swelling of faces or fingers - Severe headaches - Sexual Counseling - Psychosocial Support - Evaluate the effect of age, parity, and number of fetuses on the response to the family to the pregnancy and on the prenatal care provided. - Adolescent Pregnancy - Less likely to receive adequate prenatal care - More likely to smoke - Less likely to gain adequate weight - Increased risk for preterm birth - Increased risk for anemia, preeclampsia, HELLP, or postpartum hemorrhage - Advanced Maternal Age - Increased risk of genetic disorders, miscarriage, ectopic pregnancy, preterm birth, stillbirth, stillbirth, diabetes, HTN, placenta previa, placental abruption, c section, postpartum hemorrhage, low birth weight, multiple gestations - Multifetal Pregnancy - Increased risk for miscarriage, hyperemesis, anemia, gestation HTN, preeclampsia, postpartum hemorrhage, and maternal death - Preterm birth more likely, low birth weight, congenital abnormalities, neonatal death, cerebral palsy, one twin larger than other - Needs more prenatal care visits - Analyze the effects of variations in childbearing choices, cultural beliefs and practices on care of women during pregnancy. - Compare the options for health care providers and birth-setting choices that are available. Chapter 15 - Discuss recommendations for maternal weight gain during pregnancy. - Women with normal BMI - 2-4 lbs in first trimester - 1 lb each week for 2^nd^ and 3^rd^ trimester - Overall 25-35 lbs - Overweight - 0.5 -- 0.7 lbs each week for 2^nd^ and 3^rd^ trimester - Overall 15-25 lbs - Obese - 0.4 -- 0.6 lbs each week for 2^nd^ and 3^rd^ trimester - Overall 11 -- 20 lbs - Low - 1 -- 1.3 lbs each week for 2^nd^ and 3^rd^ trimester - Overall 28 -- 40 lbs