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Health Education and Interventions for Physiological and Psychological Changes During Pregnancy

Maternal Changes Fertilization occurs

First Trimester Signs and Symptoms/Discomforts Pregnancy test is positive

Increased progesterone levels result in amenorrhea

Absence of menses

Sodium retention increases due to increased levels of progesterone

Edema

Blood volume increases progressively Levels of relaxin hormone increase causing diminished gastric motility High levels of estrogen,progester one, and hCG

Fainting is possible

Morning sickness Sensitivity to odors increases Couvade syndrome a man also suffers nausea and vomiting during pregnancy

Health Education/Interventions Guide regarding nutritional needs and folic acid (folate) requirements Food sources: spinach, asparagus, orange juice, peanuts, fortified cereal and pasta Encourage to seek early prenatal care Assess attitude toward this pregnancy and how it affects the family Elevate feet and legs Change position frequently Avoid using diuretics Foods high in sodium must be consumed in moderation Teach how to rise slowly from prone position Avoid an empty stomach at all times Eat dry crackers or toast before arising in AM then get out of

Vitamin B6 (pyridoxine) deficiency Increased acidity Emotional factors Altered glucose metabolism

Increased levels of relaxin and progesterone and decreased motilin level causes relaxation of the cardiac sphincter of the stomach which slows gastric emptying time leading to reflux of gastric contents Pressure of the expanding uterus against the stomach Levels of hCG increase

Pyrosis, Heartburn or Acid Indigestion

Increased levels of estrogen Stimulation of the salivary glands by eating starch or perceived to be caused by the decrease in Ptyalism or excessive salivation

the bed slowly Drink fluids between meals Avoid greasy, fried, spicy foods, or ones with strong odor Avoid stress Eat a protein snack or drink a glass of milk before bedtime Carry snacks in purse to anticipate times of nausea Avoid spicy, greasy, and gasforming foods Sleep using several pillows (at least 2) under head and shoulders Avoid lying down for at least 1-2 hours after meals to reduce reflux Drink sips of water to help relieve the burning sensation Small, frequent feeding Try deep breathing Gum chewing Small, frequent meals Oral lozenges

unconscious swallowing by the woman when nauseated Pituitary gland releases melaninstimulating hormone

Pigmentation deepens on face, chloasma, or mask of pregnancy and on abdomen (linea nigra)

Fetus grows

Abdomen enlarges at end of first trimester when uterus rises out of the pelvis

Uterus begins to enlarge

Small weight gain occurs Enlarged uterus presses on bladder leading to urinary incontinence or frequency of urination. This can also be caused by increased volume to the kidneys

Increase in oxygen consumption by 15% to 20%. Half is utilized by the fetus and the other half by the placenta. The rest is consumed by the uterus, breast

Fatigue

Discuss body changes and assure patient that pigmentation will fade after puerperium Avoid high temperatures around abdomen (baths and spas) Discuss effects of medication and herbs on fetal development Kegels exercise hold for 10 seconds and relax 10 seconds. Repeat the contractionrelaxation cycle 30 times per day Empty bladder when feeling a full sensation Discuss role of frequency of urination on lifestyle and activities Get a full nights sleep Eat a healthy balanced diet Schedule a nap early in the afternoon daily When tired, get rest

tissue, and the increased respiratory and cardiac demands Increased levels of progesterone and relaxin; increased metabolic changes; psychosocial changes; etc Abnormal craving for non-food stuff

Pica

Teach the importance of proper nutrition Minimize risk of habitual abortion between third and fourth month when placenta takes over Kegel exercise to strengthen pelvic floor muscles Avoid very strenuous activities Bend toward the pain, squat, or bring the knees up to the chest to relieve pain by relaxing the ligaments Sleep on a sidelying position Change positions slowly Avoid warm, crowded areas

Corpus luteum is absorbed and placenta takes over fetal support (between third and fourth month)

Second Trimester Blood volume increases in placental bed

Broad ligament and round ligament stretches as uterus enlarges. Also caused by increased levels of relaxin and progesterone

Occasional pain in the side or groin area occurs usually on the right side

Blood volume and vasomotor lability increases Increased blood volume is needed for the following reasons: To transport nutrients and oxygen to the placenta where

Orthostatic or supine hypotension can occur due to partial occlusion of the vena cava. Also called vena caval occlusion/vena caval syndrome/supine hypotensive syndrome Accompanied by faintness,lightheadedness,dizziness,agita tion, and syncope, a brief lapse in consciousness

they become available for the growing fetus. Meet increased metabolic needs of the mother and to meet the needs for increased perfusion of other organs especially the womans kidneys because she is excreting waste products for herself and the fetus. Meet the demands of the expanded maternal tissue in the uterus and the breasts. Adequate hydration of fetal and maternal tissue when the woman assumes an erect or supine position. Fluid reserve for blood loss during delivery and puerperium. Cardiac output increases leading also to increased blood volume Dilution of RBC may decrease blood viscosity preventing thrombi formation

Physiologic anemia or pseudoanemia may occur due to hemodilution of RBC and increased plasma volume leading to decreased maternal hematocrit True anemia or iron deficiency anemia occurs when the hemoglobin is less than 11g/dl in the first and third trimesters or less than 10.5g/dl during the second trimester and hematocrit of 30%-35%

Iron supplements may be prescribed because the fetus requires 350 to 400 mg; the mother needs an additional 400 mg of iron. The total need is 800 mg Teach that vitamin C enhances iron

Renal threshold decreases Also caused by increased level of progesterone

Glycosuria Small quantities of amino acids and water-soluble vitamins are excreted Perineal itching may occur

Uterus rises out of pelvis

Center of gravity of the body changes and the woman assumes a wide stance

Pressure on bladder and rectum increases

Enlarging uterus compresses nerves supplying lower extremities Decreased calcium levels and increased phosphorus levels are possible which interferes with circulation

Leg cramps or leg muscle spasms occur, especially when reclining

absorption Sources: red meats, liver, internal organs, poultry, green leafy vegetables Avoid foods that are rich in simple sugars such as candies and cookies Test for glucose in the urine and require glucose tolerance test to rule out gestational diabetes Hygienic measures when high glucose level is present (front to back wiping; wear cotton panties) Proper shoe/heel height to avoid falling Pelvic rocking exercises Anticipate urinary frequency during long trips Kegels exercise Check for Homans sign Dorsiflexion of the foot to relieve spasms Massage foot but not legs Increase consumption of foods rich in calcium

Decreasing cardiac reserve and increasing respiratory effort start late in second trimester

Physiological stress is possible if exercise levels are not decreased

Hormonal influence causes id to come to surface

Mood swings occur

Levels of relaxin hormone increase. Sphincter of stomach relaxes, and gastrointestinal motility is slowed Compression on the colon Increased progesterone level causes relaxation of GIT and dilatation Increase in estrogen levels causes increased excretory function of the skin

Constipation Flatulence and bloating

Avoid excessive foods high in phosphorus levels which causes binding of calcium in the intestines and prevent calcium absorption Monitor pulse rate (maximum is 90 beats per minute) Stop exercising when if numbness, pain, or dizziness occurs Prepare spouse/significa nt other and family for mood swings, outspoken behavior, and labile emotions Increase fluid intake; 8oz glasses of water per day High fiber diet to promote regular, unhurried bowel movement

Skin itches Palmar pruritus

Wear loose clothing Shower frequently and use bland soap for comfort

Anterior pituitary secretes MSH

Skin pigmentation deepens and development of spider nevi

Rupture and atrophy of connective tissue layers that will manifest reddish, slightly depressed streaks on the abdomen, breasts, and thighs Estrogen levels increase

Striae gravidarum or stretch marks

Reassure patient that most fade after puerperium Teach that this will not totally fade after birth

Palmar erythema or redness of soles of the feet Gingivitis/epulis/gingival granuloma gravidarum

Use calamine lotion Teach proper oral hygiene techniques. Use soft-bristled toothbrush and floss daily Blow nose gently, one at a time Manage nose bleeding Since edema can occur, assess blood pressure and report proteinuria Reassure that this will disappear during the puerperium Cleanse nipples to keep ducts from being blocked by colostrum Avoid soaps, ointments, and alcohol that dry the skin

Increased vascularity of the upper respiratory tract Edema of the eardrum and Eustachian tube

Nasal and sinus stuffiness, epistaxis, changes in the voice, and marked inflammatory response that can develop into a mild upper respiratory infection Fullness in the ears or earaches

Minute, red elevations on the skin caused largely by the elevation of estrogen Pituitary gland secretes prolactin Effects of estrogen and progesterone

Angiomas/Telangiectasis/Vascular spiders commonly found on the face, neck, thighs, upper chest, and arms with radicles branching out from a central body (dilated arterioles) Colostrum leaks from nipples Breasts enlarge and there is tingling

Traction on brachial plexus is caused by drooping of shoulders as breast size increases Placental barrier allows certain elements and organisms to pass through to fetus Lowered oxygen levels can cause fetal hypoxia

Acroesthesia numbness and tingling of the hands

Use a supportive maternity bra

Some medications can pass through the placental barrier and cause fetal defects Traveling to countries that have endemic diseases can have negative effect. Active immunization should be avoided

Avoid smoking and selfmedication

Increased levels of platelets occur. This safeguards the woman from undue bleeding during labor and delivery Fetal growth continues

Women are prone to have thrombus formation or thrombophlebitis in the legs if they are inactive, sit, or stand for prolonged periods

Mother feels signs of life; fetus moves and kicks

Most commercial airlines have cabin pressure at or below 5000 foot level and therefore do not pose risk to fetus Keep hydrated Avoid massage Avoid prolonged activity Avoid prolonged sitting or standing Proper nutrition avoiding empty calories Attend child care/parenting classes Teach need for rest periods and organization of work Care of nipples Avoid nipple stimulation to prevent preterm labor Professional

Weight gain of 2025 pounds occurs

Third Trimester Patient tires easily

Colostrum forms

Colostrum may leak from breasts

Increased estrogen

Voice changes

levels cause edema of larynx Maximum increase in cardiac output (increase in stroke volume) about 25%-50% occurs Edema involving the peripheral nerves may result in carpal tunnel syndrome Edema of hands Consequences of increased cardiac volume: Easy fatigability and SOB Systolic murmurs Epistaxis Palpitations The syndrome is characterized by paresthesia (abnormal sensation such as burning or tingling disorder of the nervous system) and pain in the hand radiating to the elbow. The dominant hand is usually affected most.

singers may lose voice quality Teach need for rest periods

Splinting of the wrist during the night may be necessary Teach about signs of gestational hypertension and assess water retention Elevate both legs above heart level Avoid constrictive clothing Avoid crossing legs Wear support stockings Vulva: elevate hips; knee-chest High fiber diet Increase water intake Prevent straining Avoid exercises precipitating dyspnea Teach talk test for selp evaluation of exercise tolerance Small, frequent

Uterus increases in size about 2.2 lbs. Growth is due to hyperplasia and hypertrophy; will lead to: Venous congestion. Blood pools in the deep and superficial veins of the legs. The resulting stasis of blood exerts pressure on the veins and may cause the veins to become distended. Elevation of diaphragm about 4cm and its movement slightly increased Limited space for expansion of the diaphragm Pressure on the

Varicosities of the legs and vulva

Hemorrhoids

Breathing becomes more diaphragmatic than abdominal causing SOB

Decrease in appetite

stomach occurs Pressure on the colon

Constipation and flatulence

Pushing of liver upward and backward. Intrahepatic cholestasis (retention and accumulation of bile in the liver) in response to placental steroids occurs late in pregnancy Pressure on the bladder

Pruritus gravidarum (severe itching) with or without jaundice

feeding Teach how to avoid constipation and flatulence Oatmeal bath and use of lotion Bathe with mild soap Increase fluid intake

Frequency of urination

Change in the center of gravity

Abdominal muscles stretched beyond their capacity Increase in leukocytes

Lordotic posture Waddling gait or Proud walk of pregnancy Backache/low back pain Rectus abdominus muscles separate (diastasis recti)

Average count is 5,000 to 15,000 per cubic meter and increase to 20,000 to 25,000 per cubic meter

Increase activity of the sweat and sebaceous glands due to increased circulation to the skin Increased level of progesterone

Elevation of body temperature and increase perspiration

Teach how to manage frequency of urination Proper posture Pelvic tilt, or rocking exercise Avoid fatigue Can be managed by abdominal exercises Teach that this is normal and in preparation for labor and delivery Frequent bathing is advised

Acne and facial blemishes

Sensitivity to Braxton Hicks contractions

Fetal head may engage (uterus drops lightening)

Tell patient that this will fade after birth of the baby Teach about signs of labor and when to

increases

Hormone levels increase

Id is at the surface Woman becomes self-centered and worries how she will manage labor

come to the hospital Offer tour labor and delivery unit Review labor management learned in prenatal classes Discuss sibling care and support system

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