Ch 13 Adaptations to Preg
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Absence of menstruation
Mask of pregnancy
Excess of blood in a part of the body
A woman who has been pregnant more than once
Fall in hematocrit that occurs because of plasma volume expands more than RBC volume
Physiologic anemia of preg
Irregular reddish streaks caused by tears in connective tissue; "stretch marks"
Preg related rituals experienced by some prospective fathers
Changing from one pattern of behavior to another
Uterus can first be palpated above the symphysis pubis at
Fundus can be palpated about halfway between symphysis pubis and umbilicus at
Fundus is at level of umbilicus
Fundus is at xiphoid process
Changes in cervix:
- Chadwick's sign
- Goodell's sign
- Mucous plug
- Bloody show
Bluish color that often extends to the vagina and labia; cause is hyperemia
Cervical, uterine and vaginal softening with increased vascularity and softening of the connective tissue
Plug caused by increase secretion of mucus from cervical glands that blocks ascent of bacteria from the vagina
Mixture of cervical mucus and a small amount of blood disruption of mucuous plug and small capillaries of cervix
Secretion of increased amounts of glycogen:
Increased acidic vaginal discharge that retards growth of bacteria but favors growth of candida albicans (yeast)
Why is progesterone essential in preg?
Pregnancy cannot be maintained without progesterone.
Progesterone is produced first by the __ and then by the __
Corpus luteum and by the placenta
What breast changes occur during preg?
Darkening of areolae, increased nipple and aerola size, aerola become more erect, Montogmery's tubercles become prominent
Describe changes in maternal heart sounds that may occur during pregnancy. When do the heart sounds changes occur?
- Change in sounds begin between 12 and 20 weeks and regress during the 1st week after child birth
- May including splitting of the first heart sound and a sytolic murmur. Murmur may persist beyond the 4th week.
- Increases from 6 to 8 weeks of gestation until 32 weeks.
- Increase of 40-60%
- Increased volume is needed to: transport nutrients and oxygen to placenta where they become available for growing fetus, meet the demands of the expanded maternal tissue in uterus and breasts.
- RBC mass increases by 250-450 mL
- The resulting dilutation of RBC mass causes a decline in maternal hemoglobin and hematocrit (physiologic anemia)
Iron deficiency anemia occurs when the hemoglobin is less than __ and the hematocrit is less than __
- Hgb: less than 11
- Hct: less than 33
- Increase during preg ranging from 5,000 to 12,000 and as high as 15,000
- Increase further in labor and early postpartum period reaching 25,000 to 30,000
- Increase in fibrinogen by 50%
- Preg is a hypercoagulable state wher ethe mother's blood clots more readily this is because of an increase in factors that favor coagulation and a decrease in factors that inhibit coagulation.
- Slight decrease but within normal range
What is supine hypotensive syndrome? What signs and symptoms might a woman with this syndrome display?
- Lying in the supine position places the heavy uterus over the aorta and inferior vena cava which temporarily occludes these vessels.
- Signs and symptoms: fainting, lightheaded, dizzy, agitation, someimtes brief unconciousness
- This position can decrease placental blood flow.
- Prevention treatment is: position on side or with a pillow under hip (LEFT SIDE will increase blood flow better)
Why does the pregnancy induced change in fibrinogen levels have a protective effect yet also increase risk?
Increase fibrinogen levels offer protection from excess blood loss but also presidpose the woman to thrombus formation
What nasal changes are common during pregnancy, what causes them?
- Vasocongestion from estrogen's effects cause increase vascularity and edema leading to nasal stuffiness, nose bleeds and voice changes.
- May result in ear fulless or earaches.
What two factors contribute to a woman's sense of dyspnea?
- Growing uterus eventually lifts the diaphragm and reduces lung expansion
- Resp center becomes more sensitive to carbon dioxide the minute volume increases and the partial pressure of carbon dioxide falls.
Why are pregnant women more likely to develop gallstones?
Hypotonia prolongs emptying time and allows bile to become thicker
What changes in carbohydrate metabolism and in the production utilization and breakdown of insulin occur during pregnancy? Why do these changes occur? How does the woman's body normally respond to these changes?
- The fetus draws on maternal glucose and amino acids, which reduces the mother's glucose levels and her ability to synthesize glucose. Dring the first trimester the lower naternal blood glucose causes the pancreas to secrete less insulin. During the 2nd trimester hormones reduce the maternal tissue sensitivity to insulin.
- Thus the mothers blood glucose levels rise to make more available for the fetus. The woman normally responds by increasing insulin production.
Some signs are amenorrhea, nausea, vomiting, fatigue, urinary freq, breast and skin changes.
Abdominal enlargement, cervial softening, ballottement, Braxton hicks conractions, pregnancy test
Fetal heart sounds, fetal movements felt by examiner, visualization of fetus.
The difference among the indications it that presumptive indicators are the least reliable because they are often caused by other conditions.
Probable indicators are stronger evidence but still have have other causes
Positive indicators are those caused only by pregnancy.
Subtracting 3 months from the first day of the LNMP, adding 7 days and correcting the year if needed.
EDD: LNMP Oct 30th 2012
- Subtract 3 months: July 30th 2012
- Add 7 days: August 6th 2013
Why is pregnancy risk assessment not a one time eval?
Ltaer in the pregn risk factors may appear that were not apparent previous assessment.
What routine urine testing is performed during prenatal visits?
Protein, glucose, ketones
500 mL increase in blood volume over a single preg
Increase because of increased blood volume
Greater diaphragm elevation increased dyspnea
Blood vessel compression:
Greater compression of aorta and inferior vena cava causes earlier and more pronounced supine hypotension
Pressure on bowels increases constipation
- Gravida: number of pregnancies regardless of duration
- Term births: pregnancy delivered between 38-40 weeks gestation
- Preterm: births between 20th - 38th week of gestation
- Abortions: induced or spontaneous pregnancy loss under 20 weeks
- Living: number of living children
refers to the number of pregnancies that have ended at 20 or more weeks, regardless of whether the infant was born alive or stillborn
Nausea and vomiting:
- Eat dry crackers or toast before arising in the morning; then get out of bed slowly
- Small amounts of carbs and protein foods every 2-3 hours and total of 5-6 small meals.
- Drink fluids separate from meals ice chips, water, clear liquids
- Avoid fried greasy fatty goods, eat more bland foods
- Try foods with ginger or peppermint or combine salty and tart foods like potato chips and lemonade
- Take prenatal vitamins and bedtime b/c they may increase nausea if taken in morning
- Small meals every 2-3 hours avoid fatty foods or spicy foods
- Eliminate or curtail smoking and drinking coffee and carbonated beverages, which stimulate acid formation in the stomach
- Try chewing gum
- Take a tablespoon of cream before meals if heartburn is not already present
- Dont eat or drink just before bedtime and sleep with an extra pillow
- Walk or sit upright for 1-2 hours after meals to reduce reflux and relieve symptoms
- Avoid bending over, wear loose fitting clothes
- Use only antacids suggested by doctor, avoid ones high in sodium which cause fluid retention
- Antacids high in calcium provide relief but may cause rebound hyperacidity, liquid antacids may be more effective
- Maintain correct posture, head up shoulders back
- Do not gain excess weight
- Avoid high heeled shoes b/c they increase lordosis
- To pick up objects squat rather than bend at waist, don't lift heavy objects
Round Ligament Pain:
- Good body mechanics; avoid stenuous exercise
- Don't make sudden movements or position changes
- Avoid stretching and twisting at the same time
- When get out of bed turn to the side without twisting and then get up slowly
- Bend toward the pain, squat, or bring the knees up to chest to relieve pain by relaxing the ligament
- Apply heat and lie on the right side to relieve pain
- Decrease fluids in the evening but drink adequate amounts during day
- Avoid caffeine which is a natural diuretic
- Kegels to maintain bladder control
- Avoid constricting clothing and crossing the legs at the knees which impedes blood return from legs
- Rest freq with the legs elevated above the level of hips
- Wear support hose or elastic stockings that reach above the varicosities Apply them before getting out of bed each morning
- If working in one position for prolonged periods walk around for a few minutes at least every two hours
- Use left care measures that are as effective as using laxatives but do not interfere with absorption of nutrients or lead to laxative dependency
- Drink at least 8 glasses of liquids including water, juice or milk don't drink coffee, tea or carbonated drinks
- Add foods high in fiber such as unpeeled fresh fruits and veggies
- Restrict cheese consumption
- Reduce intake of sweets which increase bacterial growth in intestine and lead to flatulence
- Don't d/c iron supplements
- Avoid constipation to prevent straining that causes or worsenes hemorrhoids
- Drink lots of water eat foods rich in fiber and exercise reg
- To relieve existing hemorrhoidal discomfort take freq tepid baths, apply cool witch hazel compresses or anethetic ointments.
- To prevent cramps: elevate legs often during the day to improve circulation
- To relieve cramps: extend the affected leg, keeping the knee straight bend the foot toward the body or ask someone to assist
- Avoid excessive foods high in phosphorus
Maternal responses for 1st trimester?
- Anxious to find confirmation of pregnancy
- Ambivalence, focused on self
Maternal responses for 2nd trimester?
Physical evidence or pregnancy, focus on fetus narcissism, introversion, body image, sexual interest
Maternal response for 3rd trimester?
Feelings of vulnerability, replaced by coming to terms with the situation, fantasies or nightmares, increased dependence desire to see baby, dread about labor, anxious for preg to end
What changes occur that make the fetus seem real to the pregnant woman?
Increase in uterine size, weight gan, breast changes, fetal movement (quickening)
How might sexual interest and activity change during preg? What factors may increase or decrease interest in either partner of the couple?
Pelvic vasoconstriction, increased sensitivity and lubes vaginal area, fear of miscarriage, harming fetus
Woman's perception of the baby change during 1st trimester?
Fetus seems vague and unreal rather than seeming like a baby to her
Woman's perception of the baby change during 2nd trimester?
Perceives the fetus as real and needing her protection, growing since of fetus as a separate person
Woman's perception of the baby change during 3rd trimester?
Wants to see her baby on the outside and as a separate being
What is the significance of quickening in the woman's developing relationship with her fetus?
It makes the fetus seem much more like a separate being rather than a part of the woman's body
Why might grief have a place during a desired and normal pregnancy?
Grief may be caused by feelings of giving up life as a carefree woman and loss of spontantity to go places and do things
Describe the three developmental processess that the expectant father goes through during pregnancy?
- Grappling with reality of pregnancy and new child
- Struggling for recognition as a parent
- Desire to be seen as relevant to the childbearing process.
Young age of pregnant woman
Has difficulty putting aside her own desires for the well being of an infant; must give of herself before developmentally prepared to do so
Absence of a partner:
May be poor and have late prenatal care; must enlist others to provide support that a partner would provide
May grieve for the exclusive relationship with first child, concern about having enough time and energy to spread around, concern about acceptance of new infant by other children
Content covered in early pregnancy classes for 1st trimester:
Dealing with discomforts common in early preg, what to expect, value of prenatal care, avoiding hazards
Content covered in early preg classes for 2nd semester:
Body mechanics working during pregnancy childbirth choices, postbirth needs of mother and infants
A pregnant woman expects to give birth to her first baby in approx 1 week. She asks the nurse whether she has a bladder infection b/c she urinates so much even though urination causes no discomfort the nurse should explain that
Her fetus is probably lower in her pelvis putting more pressure on her bladder
A woman having physiologic anemia of pregnanc has a hgb and hct levels of at least:
10.5 and 33
Slight resp alkalosis during pregnancy enhances:
Transfer of fetal carbon dioxide to maternal blood
A preg woman is prone to UTI primarily because:
Urine statis allows additional time for the bacteria to multiply
A preg woman complains that both of her thumbs hurt at times. Neither thumb is inflamed or discolored the nurse should explain that:
Increased tissue fluid is causing compression of a nerve
A preg woman has a blood glucose screening at 26 weeks of gestation. The result is 128 mg/dl. The nurse should expect that:
No additional glucose testing will be needed
A woman who is 12 weeks preg begins wearing maternity clothes this is most likely an example of:
Choose the maternal behavior that best describes role playing during pregnancy
The woman tries to care for infants while an experienced mother watches
The nurse can best help a man assume his role as a parent by:
Encouraging him to ask questions about his partner's preg
Choose the most likely reaction of an 8 y/o to his mother's preg:
Interest in learning about the developing baby
The nurse is teaching a Laotian woman about self care during preg, the nurse can best determine whether she learned the info by:
Having the woman restate the info that is taught.
The primary benefit of a preconception class is to:
Reduce the risk of having a baby with a birth defect
The primary benefit of perinatal education is to help:
Parents become active in health maintenance during pregnancy and birth
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