Chapter 3 Phys Changes in Pregnancy Voice Over

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Chapter 3:

Chapter 3 Physiological and Psychosocial Changes During Pregnancy Pamela Dennis RNC-OB MSN

Cervix :

Cervix Chadwick’s sign Goodell sign Softens Forms mucus plug Call if discharge bloody or yellow/green, foul odor, itching, or pain

Vagina and Vulva:

Vagina and Vulva Thickening of vaginal mucosa Rugae Becomes edematous More susceptible to yeast infections pH: decreases from 6.0 to 3.5 Discuss vulvar hygiene

Other Reproductive Changes:

Other Reproductive Changes Ovaries Breasts Montgomery tubercles Increased pigmentation (areolae) Discuss bra size changes, options for infant feeding, and strategies for successful breastfeeding

Integumentary System:

Integumentary System Hyperpigmentation Chloasma Linea nigra Cutaneous vascular changes Striae gravidarum Angiomas Palmar erythema

Neurological System:

Neurological System Decreased attention span Poor concentration Memory lapses Carpal tunnel syndrome Syncope Anticipatory guidance regarding changes

Heart:

Heart Position: pushed upward, laterally to left Cardiac hypertrophy due to increased blood volume, cardiac output Heart sounds: exaggerated first and third; systolic murmurs

Blood Volume:

Blood Volume Plasma and erythrocyte volume increase Increased need for iron Physiologic anemia Teach regarding adequate hydration and diet high in protein, iron Increased fibrinogen volume

Cardiac Output:

Cardiac Output Blood pressure Stasis of blood in lower extremities: risk for varicose veins and venous thrombosis Encourage daily walks to enhance circulation, improve intestinal peristalsis

Supine Hypotension Syndrome:

Supine Hypotension Syndrome Pressure from enlarged uterus decreases venous return from lower extremities Hypotension, dizziness, diaphoresis, pallor Orthostatic hypotension Stagnation of blood in lower extremities Encourage to rise slowly; keep feet moving while standing

Respiratory System:

Respiratory System Increased tidal volume Increased oxygen consumption Diaphragm elevates Increased chest circumference — dyspnea Educate regarding normal changes and symptoms

Eyes, Ears, Nose, Throat :

Eyes, Ears, Nose, Throat Blurred vision — decreased intraocular pressure and corneal thickening Temporary condition Nasal stuffiness, congestion — increased mucus production Epistaxis Encourage increased fluid intake

Upper GI Tract:

Upper GI Tract Mouth Gingivitis, ptyalism, hypertrophy of gums, epulis Esophagus — pyrosis, reflux Stomach and small intestine Morning sickness, absorption of nutrients

Lower GI Tract:

Lower GI Tract Large Intestine — constipation Liver and gallbladder Cholestasia, cholecystitis, cholelithiasis

Urinary System:

Urinary System Bladder Urinary frequency and urgency Kidneys and ureters Structural changes Functional changes Glomerular filtration rate increases

Endocrine Glands:

Endocrine Glands Adrenal glands Increased cortisol Increased aldosterone Pancreas Increased number, size of beta cells

Musculoskeletal System:

Musculoskeletal System Postural changes Lumbar lordosis “Waddle” gait Calcium storage Decreased maternal serum calcium Lower extremity cramps

Assessment and Health Education:

Assessment and Health Education Comprehensive history and physical exam Ongoing education focusing on current trimester and physical changes

Psychosocial Changes:

Psychosocial Changes Decreased ability to deal with stress and cope with changes of pregnancy Major developmental phases — ambivalence and conflicting emotions Nursing care tailored through each pregnancy milestone

Developmental and Family Changes:

Developmental and Family Changes Duvall: stages of family development Prepare for role as childcare providers Reorganize home, family member duties, patterns of money management Reorient family relationships Each pregnancy — adjust to transitions in relationships with each other, children

Maternal Role Transition :

Maternal Role Transition Rubin — “tasks of pregnancy” Incorporate pregnancy into identity Acceptance of the child Reorder relationships

Maternal Tasks of Pregnancy:

Maternal Tasks of Pregnancy Seeking safe passage Securing acceptance Learning to give of self Committing self to the unknown child

Pregnant Adolescent :

Pregnant Adolescent Normal adolescent developmental tasks conflict with tasks of pregnancy May not seek prenatal care Not future oriented — may not accept reality of unborn child Acceptance of pregnancy hindered

Paternal Adaptation:

Paternal Adaptation Styles of involvement: observer, expressive, and instrumental Couvade “Announcement” phase “Moratorium” phase “Focusing” phase

Developmental Processes:

Developmental Processes Grappling with the reality of pregnancy and the child Struggling for recognition as a parent Creating the role of involved father Seeking parenting information Couvade

Adaptation of Siblings:

Adaptation of Siblings Reactions influenced by age and level of involvement with pregnancy Toddlers Regression Older children May not grasp reality of a baby in the family Adolescents

Adaptation of Grandparents:

Adaptation of Grandparents Age affects reactions Number and spacing of other grandchildren Perceptions of the role of grandparents

Other Considerations:

Other Considerations Single mother Cultural influences High-tech management Societal influences

Nursing Assessment of Psychosocial Changes:

Nursing Assessment of Psychosocial Changes Thorough history: family background, past obstetrical events, status of current pregnancy Each visit — ask about pregnancy experience, address concerns, offer anticipatory guidance