Care-of-the-Pregnant-Womanppt (1).pdf

Care of the Pregnant Woman Physiologic Changes 1. Reproductive 1. Uterus 1.Increase in size and weight 2.Hegar’s Sign 1.Softening of the uterine isthmus, resulting in its compressibility on bimanual examination; observed by the 6th – 8th week...

Care of the Pregnant Woman Physiologic Changes 1. Reproductive 1. Uterus 1.Increase in size and weight 2.Hegar’s Sign 1.Softening of the uterine isthmus, resulting in its compressibility on bimanual examination; observed by the 6th – 8th week AOG 3.Braxton Hick’s contractions a.k.a false labor Physiologic Changes 1. Reproductive 2. Cervix 1.Operculum 2.Goodell’s Sign 1.Softening of the cervix 3.Chadwick’s Sign 1.Bluish discoloration of the cervix due to hypervascularization Physiologic Changes 1. Reproductive 3. Breast 1. Size and nodularity increase; some increased tenderness occur 2. Superficial veins are prominent 3. Increased pigmentation of the areola and nipple 4. Colostrum is usually produced by week 12 Physiologic Changes 2. Respiratory System i. Increased tidal volume; airway resistance decreases ii. Diaphragm elevated; substernal angle is increased iii. Breathing changes from abdominal to thoracic Physiologic Changes 3. Cardiovascular i. Blood volume increases about 40% - 45%; physiologic anemia/hemodilutional anemia ii. Systemic and pulmonary vascular resistance decreases iii. By 20th – 24th weeks AOG, cardiac output increases by 30% - 50% over prepregnant levels and remain elevated for duration of pregnancy Physiologic Changes 3. Cardiovascular iv. Pulse rate increases v. BP decreases slightly by 2nd trimester and is near prepregannt levels at term vi. Aortocaval syndrome/Vena cava syndrome/ Supine hypotension vii. Leukocytosis viii. Thrombocytosis Physiologic Changes 4. Gastrointestinal i. Nausea and vomiting ii. Ptyalism iii. Constipation iv. Acid reflux v. Hemorrhoids Physiologic Changes 5. Urinary i. Urinary frequency ii. Glycosuria Physiologic Changes 6. Skin and Hair i. Linea Negra ii. Chloasma iii. Striae gravidarum iv. Decreased growth of hair Physiologic Changes 7. Musculoskeletal i. Waddling gait ii. Lordosis iii. Diastasis recti Discomforts During Pregnancy Morning sickness Urinary frequency Fatigue Breast tenderness Increased vaginal discharge Nasal stuffiness and epistaxis Discomforts During Pregnancy Ptyalism Pyrosis Ankle edema Varicose veins Constipation Hemorrhoids Backache Leg cramps Discomforts During Pregnancy Faintness Dyspnea Difficulty sleeping Flatulence Psychologic Response to Pregnancy Ambivalence i. Ambivalence is common initially, even if pregnancy is planned ii.Mother may have concerns about her career, her relationship with her partner, financial implications and role change iii.She may make comments such as “ I thought I wanted a baby, but now I am not so sure.” Psychologic Response to Pregnancy Acceptance of Pregnancy a.As acceptance grows, the woman shows a high degree of tolerance for the discomforts she may experience in the first trimester b.In the second trimester, she begins to wear maternity dresses. c.She begins to perceive movement at about 17-20 weeks. She may make comments such as “Feeling the baby move makes it all seems real.” Psychologic Response to Pregnancy Introversion a.The expectant woman typically becomes more inwardly focused, less interested in outside activities b.She is using this time to plan and adjust Psychologic Response to Pregnancy Mood Swings i. Mood swings from joy to sadness are common and difficult for the woman and her family ii.The woman often feels a great need for love and affection, but her partner, confused by her emotional changes, may react by withdrawing. She may say, “I’m not usually so emotional, but lately any little thing can set me off.” Psychologic Response to Pregnancy Changes in Body Image a.The woman tends to feel somewhat negative about her body as pregnancy progresses b.Her increasing abdomen coupled with the waddling gait of pregnancy may cause a woman to feel ungainly and unattractive. Psychologic Task of the Mother Ensuring safe passage through pregnancy, labor, and birth. To meet this task she seeks competent prenatal care, practices good health behaviors and self-care activities, reads about childbirth and gathers information Psychologic Task of the Mother Seeking acceptance of this child by others. The expectant woman seeks to gain support for the coming child from her partner and family. She will also work to help her other children accept the coming baby. Psychologic Task of the Mother Seeking commitment and acceptance of self as mother toe the infant (binding-in) After she perceives fetal movement the mother begins to form bonds of attachment to the child, and the child becomes more real. The woman may talk about the child as a separate person. Psychologic Task of the Mother Learning to give of one’s self on behalf of one’s child. The woman begins to develop patterns of self-denial and delayed personal gratification to meet the needs of her child. She may, for example, give up smoking or alcohol and make plans to adjust her personal schedule to spend more time with her child. Care of the Pregnant Woman during Antenatal Visits Schedule of Visits First Trimester Once a month Second Trimester Every 2 weeks Third Trimester Weekly until term Care of the Pregnant Woman during Antenatal Visits The First Antenatal Visit 1.History Taking 2.Physical Assessment 3.Screening Test Care of the Pregnant Woman during Antenatal Visits 1.History Taking a. The previous obstetric history. b. The present obstetric history. c. A medical history. d. HIV status. e. History of medication and allergies. f. A surgical history. g. A family history. h. The social circumstances of the patient.  Care of the Pregnant Woman during Antenatal Visits 1.Obstetric History a. GTPALM a. Gravida (Kapila namabdos) – any pregnancy, regardless of duration, including present pregnancy b. Term (sakto sa buwan) – number of term infants born – infants born after 37 weeks AOG or more c. Preterm (kuwang sa buwan) – number of preterm infants – infants born after 20 weeks AOG but less than 37 weeks AOG d. Abortion ( nakuha) – number of pregnancies ending in either spontaneous or therapeutic abortion;