Pregnancy Part 2 (C1) PDF

Normal Pregnancy (2) ‫جامعة وارث األنبياء‬ ‫كلية التمريض‬ Physiological & Psychological Changes Prenatal Care Pregnancy is a temporary ,p...

Normal Pregnancy (2) ‫جامعة وارث األنبياء‬ ‫كلية التمريض‬ Physiological & Psychological Changes Prenatal Care Pregnancy is a temporary ,physiological( that is, normal )process that affects a woman physically and emotionally. There are three phases of pregnancy :antepartum or prenatal (before birth) ,intrapartum (during birth( and postpartum (after birth) The focus of nursing care during pregnancy is to teach the mother how to maintain good health or ,in the case of a mother with a condition that places her or her fetus at risk ,to improve her health as much as possible to promote a healthy outcome for both mother and fetus. Physiological Changes in Pregnancy Physiologic changes that occur during pregnancy can be categorized as local (confined to the reproductive organs) or systemic (affecting the entire body). Both symptoms (subjective findings) and signs (objective findings) of the physiologic changes of pregnancy are used to diagnose and mark the progress of pregnancy. Signs and symptoms of Pregnancy Pregnancy may be assumed based on the presence of certain signs and symptoms Presumptive signs are subjective and recorded under the history of present illness Probable and positive signs of pregnancy are objective and recorded as physical assessment findings.  Pregnancy tests  Urine pregnancy test o Reacts with human chorionic gonadotropin (hCG)  Serum pregnancy test o Useful in monitoring expected pattern of progression of hCG; detects hCG as early as9 days post conception.  Ultrasound o Confirms presence of gestational sac, fetal pole, and fetal cardiac activity Prenatal Care Prenatal care refers to the care that is given to an expected mother from time of conception is confirmed until the beginning of labor. Prenatal care has the potential to reduce the incidence of preterm birth and congenital anomalies and the infant mortality rate. The purposes of prenatal care are to  Establish a baseline of present health  Determine gestational age  Monitor fetal development  Identify the woman at risk for complications  Minimize the risk of possible complications  Provide time for education, which will relieve fear and anxiety Schedule of Prenatal Visits (low-risk pregnancy)  Monthly until 28 weeks’ gestation.  Biweekly from 28 weeks until 36 weeks.  Weekly from 36 weeks until delivery Routine assessments  Vital signs.  Weight.  Urinalysis for protein ,glucose ,and ketone levels.  Blood glucose between 24 and 28 weeks' gestation.  Hematocrit, group B streptococcus, and STD testing (usually at about 36 weeks )  Fundal height.  Leopold’s maneuvers( usually at about 36 weeks.(  Fetal heart rate.  Fetal activity“( kick count( )”usually at about 28 weeks.(  Review of nutrition. ************************************* Maternal Physiology change During Pregnancy Reproductive System Changes 1. Uterus: the uterus increases in size, length, depth, width, weight, wall thickness, and volume. a.Amenorrhea (absence of menstruation) occurs with pregnancy because of the suppression of follicle-stimulating hormone (FSH) by rising estrogen levels. B.Braxton Hicks Contractions (after 16 weeks) are irregular, painless, and occur intermittently throughout pregnancy. 2. Cervix: in response to the increased level of circulating estrogen from the placenta duringpregnancy,  the cervix of the uterus becomes more vascular and edematous. Increased fluidbetween cells causes it to soften in consistency Goodell sign. 3. Ovaries: Ovulation stops with pregnancy because of the active feedback mechanism of estrogen and progesterone produced by the corpus luteum early in pregnancy and by the placenta later in pregnancy. 4. Vagina: -  Vagina mucosa becomes thickened, connective tissue loosen, smooth muscle hypertrophy, and vagina vault lengthen.  Chadwick sign violet bluish color of the vaginal mucosa and crevix.(6- 8 week). Leukorrhea a white or slightly gray mucoid discharge witha faint musty odor.  Vaginal PH is more acidic ( 3.5-6 ) 5. Breasts: Fullness, heightened sensitivity, tingling, and heaviness of the breasts may occurin the early weeks of gestation.  Nipples and areola become more pigmented; nipples become more erectile. The sebaceous glands of the areola (Montgomery’s tubercles)  enlarge. Blood vessels become visible as an intertwining blue network beneath the surfaceof the skin.  Striae gravidarum appear at outer aspects of the breasts.  Growth of the mammary glands and progressive breast enlargement at the second and third trimester.  Colostrum creamy, white to yellowish- to orange pre-milk fluid. Expressed from the nipples as early as 16 weeks of gestation. Figure (6) Comparison of breasts from nonpregnant and pregnant women.  Blood pressure:. Blood pressure actually decreases slightly during the second trimester after that maternal bloodpressure gradually increase and return to 1st.trimester level at term.  Supine hypotensive syndrome: women who lie flat on their backs during the second half of pregnancy compression of the venacava, decrease in systolic blood pressure >30mmhg, reflexive bradycardia, cardiac output is reduced by half, so women fells faint.  Uterus enlargement compression of the iliac veins and inferior venacava increased venous pressure and reduced blood flow in the legs, which will lead to dependent edema, varicose veins in the legs and vulva and hemorrhoids at the latter part of term pregnancy.  Decrease in normal hemoglobin values (>11mg/dl) and hematocrit values ( > 33mg/dl) Physiologic anemia which is most noticeable during the second trimester. Figure (7)  Integumentary System Changes As the uterus increases in size, the abdominal wall must stretch. — This stretching can cause pink or reddish streaks (striae gravidarum) appearing on the sides of the abdominal wall — A narrow, brown line (linea nigra) may form, running from the umbilicus to the symphysis pubis and separating the abdomen into right and left hemispheres — Darkened areas may appear on the face as well, on the cheeks and across the nose. This is known as melasma (chloasma), or the “mask of pregnancy.”  Psychological Changes in Pregnancy The ability of a woman to accept her pregnancy depends on social, cultural, family, and individualinfluences. First Trimester: (1 – 12 week) GA\\ accepting the pregnancy Woman and partner both spend time recovering from shock of learning they are pregnant and concentrate on what it feels like to be pregnant. A common reaction is ambivalence, or feeling both pleased and not pleased about the pregnancy. Second Trimester: (13 – 27) weeks\\ GA accepting the baby Woman and partner move through emotions such as narcissism and introversion as they concentrate on what it will feel like to be a parent. Roleplaying and increased dreaming are common. Third Trimester: (28 – 40) weeks GA\\ Preparing for the baby and end of pregnancy Woman and partner prepare clothing and sleeping arrangements for the baby but also grow impatient with pregnancy as they ready themselves for birth  Immunizations during pregnancy  Live-virus vaccines are contraindicated during pregnancy  Most vaccines in single dose forms are now thime  rosal-free ,and many can be safely.  Vaccines contraindicated during pregnancy include BCG; HPV; live attenuated influenza vaccine in nasal spray form and measles, mumps, and rubella (MMR).  Vaccinations allowable during pregnancy include hepatitis A and B, inactivated influenza, and inactivated polio vaccine when immediate protection is required.  The injectable form of the flu vaccination is also recommended to protect pregnant women