Pregnancy Signs & Symptoms PDF

1/16/24, 10:10 PM Realizeit for Student Introduction Pregnancy is a dynamic and precisely coordinated process involving systemic and local changes in the mother that support the supply of nutrients and oxygen to the growing fetus in utero and in subsequent lactation. The success of pregnancy depen...

1/16/24, 10:10 PM Realizeit for Student Introduction Pregnancy is a dynamic and precisely coordinated process involving systemic and local changes in the mother that support the supply of nutrients and oxygen to the growing fetus in utero and in subsequent lactation. The success of pregnancy depends on (1) fertilization and successful implantation of the developing embryo into the endometrium; (2) development and function of the placenta; (3) adaptation of the maternal physiology to accept the fetal allograft and satisfy its nutritional, metabolic, and physical demands; (4) appropriate growth and functional development of organs and homeostatic systems in the fetus; and (5) proper timing of birth so that the fetus is mature enough to survive outside the uterus (Strauss & Barbieri, 2019). A pregnancy is divided into three trimesters of 13 weeks each. Within each trimester, numerous adaptations take place that facilitate the growth of the fetus. The most obvious are physical changes to accommodate the growing fetus, but pregnant women also undergo psychological changes as they prepare for parenthood. A thorough understanding of these numerous changes and adaptations is essential for all nurses caring for women during pregnancy. Marva, age 17, appeared at the health department clinic complaining that she had a stomach virus and needed to be seen right away. When the nurse asked her additional questions about her illness, Marva reported that she had been sick to her stomach and “exhausted” for days. She had stopped eating to avoid any more nausea and vomiting. Signs and Symptoms of Pregnancy Traditionally, signs and symptoms of pregnancy have been grouped into the following categories: presumptive, probable, and positive ( Box 11.1). The only signs that can determine a pregnancy with 100% accuracy are positive signs. What additional information is necessary to complete the assessment of Marva, the 17-year-old with nausea and vomiting? What d confirm the nurse's suspicion that she is pregnant? Subjective (Presumptive) Signs Presumptive signs are those signs that the mother can perceive. The most obvious presumptive sign of pregnancy is the absence of menstruation. Skipping a period is not a reliable sign of pregnancy by itself, but if it is accompanied by consistent nausea, fatigue, breast tenderness, and urinary frequency, pregnancy may be likely. Presumptive changes are the least reliable indicators of pregnancy because any one of them can be caused by conditions other than pregnancy (Napso et al., 2018). For example, amenorrhea can be caused by early menopause, endocrine dysfunction, malnutrition, anemia, diabetes mellitus, long-distance running, cancer, or stress. Nausea and vomiting can be caused by gastrointestinal disorders, food poisoning, acute infections, or eating disorders. Fatigue could be caused by anemia, stress, or viral infections. Breast tenderness may result from chronic cystic mastitis, premenstrual changes, or the use of oral contraceptives. Urinary frequency could have a variety of causes other than pregnancy, such as infection, cystocele, structural disorders, pelvic tumors, or emotional tension (Edmonds et al., 2019). Consider This Jim and I decided to start our family, so I stopped taking the pill three months ago. One morning when I got out of bed to take the dog o hoped I wasn’t coming down with the flu. By the end of the week, I was feeling really tired and started taking naps in the afternoon. I bathroom frequently, despite not drinking much fluid. When my breasts started to tingle and ache, I decided to make an appointment wi contracted. After listening to my list of physical complaints, the office nurse asked me if I might be pregnant. My eyes opened wide: I had somehow and pregnancy. I started to think about when my last period was, and it had been two months ago. The office ran a pregnancy test and mu https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zTYaQRcVeGjlcsXn1BnhV1BdrBMb3lqiFIhL1oNdUK7j0NCYTE… 1/3 1/16/24, 10:10 PM Realizeit for Student Thoughts: Many women stop contraceptives in an attempt to achieve pregnancy but miss the early signs of pregnancy. This woman w pregnancy—urinary frequency, fatigue, morning nausea, and breast tenderness. What advice can the nurse give this woman to ease these related to her pregnancy would be appropriate at this time? Physical Signs Probable signs of pregnancy are those that can be detected on physical examination by a health care provider. Common probable signs of pregnancy include softening of the lower uterine segment or isthmus (Hegar's sign), softening of the cervix (Goodell's sign), and a bluishpurple coloration of the vaginal mucosa and cervix (Chadwick's sign). Other probable signs include changes in the shape and size of the uterus, abdominal enlargement, Braxton Hicks contractions, and ballottement (the examiner pushes against the woman's cervix during a pelvic examination and feels a rebound from the floating fetus). Pregnancy Tests Along with these physical signs, pregnancy tests are also considered a probable sign of pregnancy. In-home pregnancy testing became available in the United States in late 1977. In-home testing appealed to the general public because of convenience, cost, and confidentiality. Several pregnancy tests are available (Table 11.1). The tests vary in sensitivity, specificity, and accuracy and are influenced by the length of gestation, specimen concentration, presence of blood, and the presence of some drugs. Human chorionic gonadotropin (hCG) is detectable in the serum of approximately 5% of clients 8 days after conception and in more than 98% of clients by day 11 (Luppa & Junker, 2018). At least 25 different home pregnancy tests are currently marketed in the United States. Most of these tests claim “99% accuracy” according to a U.S. Food and Drug Administration (FDA) guideline or make other similar statements on the packaging or product insert. The 99% accuracy statement in reference to the FDA guideline is misleading in that it has no bearing on the ability of the home pregnancy test to detect early pregnancy (Luppa & Junker, 2018). The limitations of these tests must be understood so that pregnancy detection is not significantly delayed. Early pregnancy detection allows for the commencement of prenatal care, potential medication changes, and lifestyle changes to promote a healthy pregnancy. hCG is a glycoprotein and the earliest biochemical marker for pregnancy. Many pregnancy tests are based on the recognition of hCG or a beta subunit of hCG. An hCG level lower than 5 mIU/mL is considered negative for pregnancy, and anything higher than 25 mIU/mL is considered positive for pregnancy. hCG levels in normal pregnancy usually double every 48 to 72 hours until they peak approximately 60 to 70 days after fertilization. At this point, they decrease to a plateau at 100 to 130 days of pregnancy. The hCG doubling time has been used as a marker by clinicians to differentiate normal from abnormal gestations. Low levels are associated with an ectopic pregnancy and higherthan-normal levels may indicate a molar pregnancy or multiple-gestational pregnancies (Bastian & Brown, 2019). Although probable signs suggest pregnancy and are more reliable than presumptive signs, they still are not 100% reliable in confirming a pregnancy. For example, uterine tumors, polyps, infection, and pelvic congestion can cause changes to uterine shape, size, and consistency. And although pregnancy tests are used to establish the diagnosis of pregnancy when the physical signs are still inconclusive, they are not completely reliable, because conditions other than pregnancy (e.g., ovarian cancer, choriocarcinoma, hydatidiform mole) can also elevate hCG levels. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zTYaQRcVeGjlcsXn1BnhV1BdrBMb3lqiFIhL1oNdUK7j0NCYTE… 2/3 1/16/24, 10:10 PM Realizeit for Student Take Note! This elevation of hCG corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy. Positive Signs Usually within 2 weeks after missed menses, enough subjective symptoms are present so that a woman can be reasonably sure she is pregnant. However, an experienced health care provider can confirm the woman’s suspicions by identifying positive signs of pregnancy that can be directly attributed to the fetus. The positive signs of pregnancy confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy a certainty. If the pregnancy test is positive, the clinical visit should include an estimation of gestational age so that appropriate counseling can be provided. In addition, clients should receive information about the normal signs and symptoms of early pregnancy, and should be instructed to report any concerns to the health care provider for further evaluation. Once pregnancy has been confirmed, the health care provider will set up a schedule of prenatal visits to assess the woman and her fetus throughout the entire pregnancy. Assessment and education begins at the first visits and continues throughout the pregnancy. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zTYaQRcVeGjlcsXn1BnhV1BdrBMb3lqiFIhL1oNdUK7j0NCYTE… 3/3