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Chapter 14-15
Anatomy and Physiology of Pregnancy
Page 296
Vagina
Increased vascularization
Vaginal secretions-Vaginal cells high in
Chadwicks sign-Breasts
Size
Colostrum
Nipples, areola darken
May develop striae
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Chadwicks sign
Cardiovascular
Heart displaced up, forward, left (diaphragm)
Blood volume increases progressively to 45 %
Physiologic Anemia of Pregnancy
Pulse rate increases 10 15 bpm
BP lowers in 2nd trimester, returns to normal 3rd
Cardiac output increases 30 to 50 % (20-24 wks)
WBC count increases (10,000-11,000 WBC/mm3)
Fibrin levels increase about 40%
Supine Hypotensive Syndrome (2nd/3rd trimesters)
vena cava syndrome
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Respiratory
Substernal angle increases (estrogen)
ribcage ligaments relax
Slight hyperventilation
O2 consumption increases 15 to 20 %
Elevated diaphragm causes SOB
Nasal stuffiness/epitaxis r/t edema, vascular
congestion (increased estrogen)
Urinary Tract (Renal)
Urinary frequency (1st and 3rd trimester)
Renal pelvis/ureters dilate
Increased GFR
Glycosuria r/t GFR increase
Proteinuria-usually doesnt occur during pregnancy
1+/lower acceptable during pregnancy
Endocrine
Increased vascularity (thyroid) BMR increases 25%
Pancreasincreased insulin production
(Estrogen/Progesterone/HPL/HCS decrease mothers ability to
utilize insulin effectively. This inability to use mothers insulin
ensures a generous glucose supply for the use of the fetus.
Integumentary System
Linea nigra/melasma (chloasma)/striae
Hormones of Pregnancy
Human Chorionic Gonadotropin (HCG)
Human Placental Lactogen (HPL)
Estrogen
Progesterone
Relaxin
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Hormones in Pregnancy
Hormone
Action
Effect
Human Chorionic
Gonadotropin (HCG)
Estrogen
Progesterone
Human Placenta Lactogen
Oxytocin
Relaxin
Prolactin
Prostaglandins
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Ballottement
Maternal Adaptation
of pregnancy parallels
the growing acceptance of the reality of a child
Nonacceptance of the pregnancy should not be equated with
rejection of the child. A woman may dislike being pregnant but
feel love for the child
Mood swings
Ambivalent feelings
2. Identifying with the mothering rolea mothers role begins
when she is a child and is being mothered herselfalso influenced
by social groups
3. Reordering personal relationshipsa womans own relationship
with her mother is significant in adaptation to pregnancy and
motherhood.
4. Establishing a relationship with the fetus
phase 1fetus part of mother, not separate
phase 2fetus distinct from herselfattachment grows
phase 3prepares for birth
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Pregnancy
9 calendar months
10 lunar months
280 days
40 weeks
Definition of terms/time of each:
Antepartum
Gestation
Intrapartum
Postpartum
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0-3 months
2nd trimester
4-6 months
3rd trimester
7-9 months
Antepartal Terms
Term
Preterm
Postterm
Viability
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Gravida
Primigravida
Multigravida
Nulligravida
Para
Primipara
Multipara
Nullipara
Grand Multipara
G_____T_____P_____A_____L_____
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G_____P_____A______
G_____T_____P_____A_____L_____
G_____P_____A_____
G_____T_____P_____A_____L_____
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G_____T_____P_____A_____L_____
Nageles Rule
Subtract 3 months from 1st day
of last menstrual period
Add 7 days
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Antepartal Assessment
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Laboratory Assessment
Blood:
CBC: hematocrit, hemoglobin
Blood type/RH (RhIG/RhoGAM 28 wks for Rh-)
RDR/VDRL (Syphilis)/HIV screening
Antibody Screen: , Varicella, toxoplasmosis,
Rubella Titer
Tuberculin Test
Hepatitis B Screen
Sickle Cell
Quad Screen (15-21 wks) neural tube defects,
trisomy 18 (MSAFP), page 336
Urine
Urinalysis/Culture if necessary
Protein/Glucose/ketones
Pap Smear
Culture: Chlamydia, gonorrhea
Group B streptococcusbetween 35/37 weeks
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Screening Tests
Throughout pregnancy
Gestational diabetes mellitus (GDM)
Hemoglobin (Hgb) and hematocrit (Hct)
Group B streptococcus (GBS)
Hemoglobin electrophoresis
Varicella immunity
Purified protein derivative of tuberculin (PPD)
Planning
Safe, Effective Care
Physiological & Psychosocial Integrity
Health Promotion & Maintenance
Implementation
Record Gravida & Para
EDC,EDB,EDD Calculation
Physical Exam
Follow-Up Visits
Frequency
every 4 weeks for the first--every 2 weeks until --every week --
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Physical Exam:
Fetal Heart Tones
Figure 15-3
A cross-sectional view of fetal position when McDonalds method is used to assess fundal height.
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Follow-Up Visits
1st trimester: every 4 weeks
VS, weight, urine (glucose, protein, ketones), fetal heart
tones, discomfort of pregnancy, nutritional assessment,
adjustment to pregnancy, assess for warning signs,
education, fetal heart tones
2nd trimester: every 4 weeks:
above plus AFP 16 weeks (QUAD SCREEN), Indirect
Coombs Test (28 weeks), ultrasound, fetal movement,
prenatal classes, education, assess for warning signs,
discomforts
3rd trimester: every 2 weeks/every week: (RhoGam if
needed 28-32 weeks
above plus gestational diabetes screen, 24-28 weeks
Culture for Group B Strep (37 weeks), Assess for signs
of labor,
Weight Gain
First Trimester:
Second Trimester:
Third Trimester
Page 340
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Danger Signs
Vaginal Bleeding
miscarriage,
placenta previa
abruptio placentae
Persistent Vomiting
hyperemesis
gravidarum
HTN, PIH
ROM
Elevated Temperature
Infection
Abdominal Pain
premature labor
abruptio placenta
URI
Epigastric Pain
Severe
preeclampsia
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Discomforts of Pregnancy
350
1st trimester
nausea and vomiting
urinary frequency
fatigue
breast tenderness
increased vaginal discharge
nasal stuffiness
excess salivation
Discomforts, continued
2nd and 3rd trimester
heartburn
ankle edema
varicose veins
hemorrhoids
constipation
backache
leg cramps
text, 349
Self-Care Education
Travelpage 362
Difficulty Sleeping
Sexpage 366
Clothing
Bathing
Employment
Exercisepage 363
Dental Carepage 366
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Teratogenic Substances
OTC Medications herbs, allergy meds
Alcohol
Tobacco
Marijuana, Cocaine
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Contraception
Stop oral contraceptives 2-3 months prior
to conception
Have IUD removed 1 month prior to
conception
Use barrier methods of contraception
while waiting
Childbirth Options
Chapter 13
Pregnancy/Birth Options
Health Care Provider
Physician
Midwife
Birth Setting
Birth Center
Hospital
Labor support person
Significant other
Doula
Nurse
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Childbirth Education
Birth Planchoose options r/t childbirth
experience that are important to
childbearing family (text, pg. 438)
Doulasnonprofessional trained to
provide labor support, does not get
involved with clinical tasks
Birth Centers
LDR, LDRP, home births
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Nutritional Requirements:
Calories
Protein
Carbohydrates
Primary source of energy
Fiber
Fats
Energy
More completely absorbed during pregnancy
Minerals
Calcium and phosphorus
Mineralization of fetal bones and teeth
Energy and cell production
Acid-base buffering
Iodine
Essential for brain development
Minerals (contd)
Sodium
Metabolism
Regulation of fluid balance
Zinc
Protein metabolism
Synthesis of DNA and RNA
Fetal growth
Lactation
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Minerals (contd)
Magnesium
Cellular metabolism
Structural growth
Iron
Oxygen-carrying capability
Vitamins
Vitamin A
Growth of epithelial cells, metabolism
Vitamin D
Absorption, utilization of calcium and
phosphorus
Vitamin E
Fat absorption
Vitamin K
Synthesis of prothrombin
B Vitamins
Thiamine
Riboflavin
Niacin
Folic acid
Vitamin B6
Vitamin B12
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Folic Acid
Increase intake of folic acid to prevent
neural tube defects
Sources:
Mercury Warning
High levels of mercury can harm the
fetus developing nervous system
Nutrition, continued
Problems: LBW, SGA, IUGR1st half of pregnancy
Prenatal vitamins/minerals
Folic acid Calcium, magnesium, vitamin D
bone health
Iron
Picaconsuming nonfood substances
Clay, dirt, laundry starch
Causes: nutritional deficiencies, stress, low socioeconomic
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NutritionWeight Gain
25 to 35 pounds weight gain during pregnancy
3-4 pounds in first trimester
12 pounds in second trimester
12 pounds in third trimester
Underweight 28-40 pounds
Overweight 15-25 pounds
Obese 15 pounds (Institute of Medicine)
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Nutritional Counseling
for the Adolescent
Positive approach
Suggest nutrient-rich foods
Include other family members involved in
meal preparation
Involve expectant father
Emphasize benefits to her and her baby
Peer classes
Postpartum Nutrition
Assess new mothers weight, labs, clinical
signs
Weight loss at birth
Rate of weight loss
Evaluate weight
Assess clinical symptoms
Nutritional Care of
Formula-Feeding Mothers
Dietary requirements return to
prepregnancy levels
Understanding of nutrition
Refer to dietitian if excessive weight gain
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Nursing Diagnoses
Imbalanced Nutrition: Less than Body
Requirements
Imbalanced Nutrition: More than Body
Requirements
Readiness for Enhanced Knowledge
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Evaluation
Food journal
Writing weekly menus
Returning for weekly weighing
Periodic hematocrit assessment
Referral to dietitian
Questions
Anyone?
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