CH11_maternal adaptation.pptx

Maternal Adaptations to Pregnancy Chapter 11 Signs of Pregnancy 1.Presumptive (Subjective data) 2.Probable (Objective data) 3.Positive (Objective and diagnostic data) Presumptive Fatigue (12 weeks) Breast tenderness (3 to 4 weeks) Nausea and vomiting (4 to 14 weeks) Hyperpigmentation of skin (16 wee...

Maternal Adaptations to Pregnancy Chapter 11 Signs of Pregnancy 1.Presumptive (Subjective data) 2.Probable (Objective data) 3.Positive (Objective and diagnostic data) Presumptive Fatigue (12 weeks) Breast tenderness (3 to 4 weeks) Nausea and vomiting (4 to 14 weeks) Hyperpigmentation of skin (16 weeks) Fetal movements (quickening) (16 to 20 weeks) Amenorrhea (4 weeks) Uterine enlargement (7 to 12 weeks) Urinary frequency (6 to 12 weeks) Breast enlargement (6 weeks) Probable signs Braxton Hicks contractions (16 to 28 weeks) Positive pregnancy test (4 to 12 weeks) Abdominal enlargement (14 weeks) Ballottement (16 to 28 weeks) Goodell’s sign (5 weeks) Chadwick’s sign (6 to 8 weeks) Hegar’s sign (6 to 12 weeks) Chadwick’s sign Bluish-purple coloration of the vaginal mucosa and cervix Goodell’s sign Softening of the cervix Hegar’s sign Softening of the lower uterine segment or isthmus Positive signs Ultrasound verification of embryo or fetus (4 to 6 weeks) Fetal movement felt by experienced clinician (20 weeks) Auscultation of fetal heart tones via Doppler (10 to 12 weeks) Blood levels are not a positive sign Reproductive System Adaptations Uterus Increase in size, weight, length, width, depth, volume, and overall capacity Pear shape to ovoid shape; positive Hegar’s sign Enhanced uterine contractility; Braxton Hicks contractions Ascent into abdomen after first 3 months Fundal height by 20 weeks’ gestation at level of umbilicus; 20 cm; reliable determination of gestational age until 36 weeks’ gestation Cervix Softening (Goodell’s sign) Mucous plug formation Increased vascularization (Chadwick’s sign) Ripening about 4 weeks before birth Reproductive System Adaptations Vagina Increased vascularity with thickening Lengthening of vaginal vault Secretions more acidic, white, and thick; leukorrhea Ovaries Enlargement until 12th to 14th week of gestation Cessation of ovulation Breasts Increase in size and nodularity to prepare for lactation; increase in nipple size, becoming more erect and pigmented Production of colostrum: antibody-rich, yellow fluid that can be expressed after the 12th week; conversion to mature milk after delivery Gastrointestinal System Adaptations Gums: hyperemic, swollen, and friable Ptyalism Dental problems; gingivitis Decreased peristalsis and smooth muscle relaxation Constipation + increased venous pressure + pressure from uterus = hemorrhoids Slowed gastric emptying; heartburn Prolonged gallbladder emptying Nausea and vomiting Cardiovascular System Adaptations Increase in blood volume (50% above prepregnant levels) Increase in cardiac output; increased venous return; increased heart rate Slight decline in blood pressure until midpregnancy, then returning to prepregnancy levels Increase in number of RBCs; plasma volume > RBC leading to hemodilution (physiologic anemia) Increase in iron demands, fibrin, plasma fibrinogen levels, and some clotting factors, leading to hypercoagulable state Prenatal vitamins. Respiratory System Adaptation Breathing more diaphragmatic than abdominal due to increase in diaphragmatic excursion, chest circumference, and tidal volume Increase in oxygen consumption Congestion secondary to increased vascularity Renal/Urinary System Adaptations Dilation of renal pelvis; elongation, widening, and increase in curve of ureters Increase in length and weight of kidneys Increase in GFR; increased urine flow and volume Increase in kidney activity with woman lying down; greater increase in later pregnancy with woman lying on side Musculoskeletal System Adaptations Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis Postural changes: increased swayback and upper spine extension Forward shifting of center of gravity Increase in lumbosacral curve (lordosis); compensatory curve in cervicodorsal area Waddle gait Integumentary System Adaptations Hyperpigmentation; mask of pregnancy (facial melasma) Linea nigra Striae gravidarum Varicosities Vascular spiders Palmar erythema Decline in hair growth; increase in nail growth Endocrine System Adaptations Thyroid gland: slight enlargement; increased activity; increase in BMR Pituitary gland: enlargement; decrease in TSH, GH; inhibition of FSH and LH; increase in prolactin, MSH; gradual increase in oxytocin with fetal maturation Pancreas: insulin resistance due to hPL and other hormones in second half of pregnancy (see Box 11.2) Adrenal glands: increase in cortisol and aldosterone secretion Prostaglandin secretion Placental secretion: hCG, hPL, relaxin, progesterone, estrogen (see Table 11.3) Nutrition Direct effect of nutritional intake on fetal well-being and birth outcome Need for vitamin and mineral supplement daily Dietary recommendations o Increase in protein, iron, folate, and calories (Table 11.5) o Use of USDA’s Food Guide MyPlate o Avoidance of some fish due to mercury content USDA Food Guide MyPlate Client education (Teaching Guidelines 11.1) Special considerations Cultural variations Lactose intolerance Vegetarianism Pica Stay away from tuna (mercury) Maternal Emotional Adaptations Ambivalence Introversion Acceptance Mood swings Changes in body image Maternal Role Tasks Ensuring safe passage throughout pregnancy and birth Seeking acceptance of infant by others Seeking acceptance of self in maternal role to infant (“binding in”) Learning to give of oneself Pregnancy and Sexuality Numerous changes, possibly stressing sexual relationship Changes in sexual desire with each trimester Sexual health and link to self-image Pregnancy and Partner Family-centered emphasis Partner’s reaction to pregnancy and changes Couvade syndrome, ambivalence Acceptance of roles (second trimester) Preparation for reality of new role (third trimester) Pregnancy and siblings Age-dependent reaction Sibling rivalry with introduction of new infant into family Sibling preparation imperative