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    Pregnancy Changes and Care-14

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    LLLJJJ
    The document describes the many physical, physiological, and psychological changes that occur during pregnancy. It discusses changes to the uterus, cervix, vagina, breasts, respiratory, cardiovascular, and other body systems. It also covers signs and symptoms of pregnancy, nutritional needs, recommended weight gain, definitions of terms like gravidity and parity, initial prenatal care procedures, and factors to consider for education and support of the mother and family throughout pregnancy.

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    Pregnancy Changes and Care-14

    Uploaded by

    LLLJJJ
    60 views46 pages
    The document describes the many physical, physiological, and psychological changes that occur during pregnancy. It discusses changes to the uterus, cervix, vagina, breasts, respiratory, cardiovascular, and other body systems. It also covers signs and symptoms of pregnancy, nutritional needs, recommended weight gain, definitions of terms like gravidity and parity, initial prenatal care procedures, and factors to consider for education and support of the mother and family throughout pregnancy.

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    The document describes the many physical, physiological, and psychological changes that occur during pregnancy. It discusses changes to the uterus, cervix, vagina, breasts, respiratory, cardiovascular, and other body systems. It also covers signs and symptoms of pregnancy, nutritional needs, recommended weight gain, definitions of terms like gravidity and parity, initial prenatal care procedures, and factors to consider for education and support of the mother and family throughout pregnancy.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    60 views46 pages

    Pregnancy Changes and Care-14

    Uploaded by

    LLLJJJ
    The document describes the many physical, physiological, and psychological changes that occur during pregnancy. It discusses changes to the uterus, cervix, vagina, breasts, respiratory, cardiovascular, and other body systems. It also covers signs and symptoms of pregnancy, nutritional needs, recommended weight gain, definitions of terms like gravidity and parity, initial prenatal care procedures, and factors to consider for education and support of the mother and family throughout pregnancy.

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    PREGNANCY CHANGES

    AND CARE

    UTERINE CHANGES

    BEFORE: 7.5X5X2.5, 60 G
    END: 28X24X21, 1000 G
    WALLS THIN AS THEY STRETCH
    INCREASED BLOOD/LYMPH
    VESSELS
    BRAXTON-HICKS CONTRACTIONS

    CERVICAL CHANGES

    INCREASED CELL NUMBER


    MUCOUS PLUG
    GOODELLS SIGN-SOFTENING
    CHADWICKS SIGNDISCOLORATION
    INCREASED VASCULARIZATION

    VAGINAL CHANGES

    HYPERTROPHY
    INCREASED VASCULARIZATION,
    HYPERPLASIA
    INCREASED VAGINAL DISCHARGE
    ACIDIC PH OF DISCHARGE
    LOOSENING OF CONNECTIVE
    TISSUE

    BREAST CHANGES

    INCREASED SIZE, NODULARITY


    SUPERFICIAL VEINS
    NIPPLES ERECT
    DARKENING OF AREOLA
    STRIAE
    COLOSTRUM-12 WK+

    RESPIRATORY CHANGES

    HYPERVENTILATION
    INCREASING TIDAL VOLUME
    CONSUMPTION INCREASES
    VC INCREASES
    DIAPHRAGM ELEVATES, SUBCOSTAL
    ANGLE INCREASES, RIB CAGE FLAIRS
    THORACIC BREATHING
    NASAL STUFFINESS, EPISTAXIS

    CARDIOVASCULAR
    CHANGES

    HEART UP, TO LEFT, ROTATED


    FORWARD
    INCREASED BLOOD VOLUME-PEAKS
    AT MID-3RD TRIMESTER (45%)
    DECREASED VASCULAR RESISTANCE
    INCREASED C.O. TILL 20-24 WKS,
    THEN STEADY

    VITAL SIGN CHANGES

    BLOOD PRESSURE DECREASES


    THROUGH 2ND TRIMESTER,
    GRADUAL INCREASE 3RD
    INCREASED PULSE (0-15 BPM)
    SAME OR INCREASED
    RESPIRATIONS

    CIRCULATION CHANGES

    INCREASED BLOOD TO UTERUS,


    KIDNEYS
    INCREASED STAGNATION IN
    LOWER EXTREMITIES
    INCREASED FEMORAL VENOUS
    PRESSURE

    SUPINE HYPOTENSIVE
    SYNDROME

    VENA CAVA SYNDROME


    DECREASED BP, DIZZY, PALLOR,
    CLAMMY
    TURN PT ON SIDE IMMEDIATELY

    RBC CHANGES

    ERYTHROCYTE VOLUME INCREASES


    INCREASED PLASMA VOLUME
    GREATER THAN ERYRHROCYTE
    DECREASED HCT-PHYSIOLOGIC
    ANEMIA

    WBC CHANGES

    SAME OR INCREASED LEUKOCYTE


    PRODUCTION OVER BLOOD
    VOLUME
    INCREASE HIGHER AT LABOR,
    POST-PARTUM

    CLOTTING FACTORS
    CHANGE

    FIBRIN LEVEL INCREASES


    FIBRINOGEN LEVEL INCREASES
    BLOOD FACTORS INCREASE
    CLOTTING TIME NML

    ALL LEADS TO INCREASED


    HYPERCOAGULABLE STATE, DVT RISK

    GASTROINTESTINAL
    ST
    CHANGES 1 TRIMESTER

    NAUSEA/VOMITING
    CHANGES IN TASTE, SMELL
    GUM TISSUE HYPEREMIC, SOFTER
    INCREASED SALIVA

    GI CHANGES LATER IN
    PREGNANCY

    HEARTBURN
    BLOATING
    CONSTIPATION
    HEMORRHOIDS
    PROLONGED EMPTYING TIME OF
    GALLBLADDER

    URINARY TRACT CHANGES

    FREQUENCY
    IMPAIRED DRAINAGE OF
    BLOOD/LYMPH FROM BLADDER
    KIDNEY/URETER DILATION
    INCREASED GFR, RPF
    GLYCOSURIA
    LOWER BUN VALUE, CREATININE
    CLEARANCE MORE ACCURATE

    SKIN AND HAIR CHANGES

    LINEA NIGRA
    CHLOASMA
    AREOLA, NIPPLES, VULVA, PERIANAL
    DARKER
    INCREASED SWEATING
    STRIAE
    SPIDER NEVI
    DECREASED HAIR GROWTH, SHEDDING
    POSTPARTUM

    MUSCULOSKELETAL
    CHANGES

    NO DENTAL CHANGES
    JOINTS OF PELVIS RELAX
    LUMBODORSAL CURVE INCREASED
    PARESTHESIAS OF EXTREMITIES
    DIASTASIS RECTI

    METABOLISM CHANGES

    MOST ARE ACCELERATED

    TISSUE REPLACEMENT
    FETAL NEEDS
    PREP FOR LABOR/LACTATION

    NUTRIENT CHANGES

    INCREASED LIPIDS, CHOLESTEROL


    INCREASED DEMAND FOR CHO
    INCREASED DEMAND FOR IRON
    IRON TRANSFER TO FETAL LIVER
    INSULIN REQUIREMENT INCREASES
    GLYCOSURIA: DIABETES VS.
    PHYSIOLOGIC CHANGE GFR HIGHER

    SIGNS OF PREGNANCY

    PRESUMPTIVE: SUBJECTIVE
    PROBABLE: OBJECTIVE
    DIAGNOSTIC: POSITIVE

    PRESUMPTIVE CHANGES

    AMENORRHEA
    NAUSEA/VOMITING
    EXCESSIVE FATIGUE
    URINARY FREQUENCY
    BREAST CHANGES
    QUICKENING

    PROBABLE SIGNS

    GOODELLS SIGN-SOFTENING OF CERVIX


    HEGARS SIGN-SOFT ISTHMUS
    CHADWICKS SIGN-BLUE TINT
    UTERINE ENLARGEMENT
    UTERINE SOUFFLE
    SKIN CHANGES
    FETAL OUTLINE PALPABLE
    PREGNANCY TESTS

    DIAGNOSTIC CHANGES

    FHT
    FETAL MOVEMENT PALPATED
    VISUALIZATION BY U/S

    PSYCHOLOGIC RESPONSE

    AMBIVALENCE
    ACCEPTANCE
    INTROVERSION
    MOOD SWINGS
    BODY IMAGE CHANGES

    FATHERS RESPONSE

    AMBIVALENCE
    RECOGNITION AS FATHER/PARENT
    FINANCIAL ISSUES
    FEAR RE: BABYS HEALTH
    FEAR RE: MOTHERS HEALTH
    ROLE IN LABOR
    FEAR OF HURTING BABY/MOM W/SEX
    MAY DEVELOP PREGNANCY SYMPTOMS

    SIBLING RESPONSE

    SIBLING RIVALRY
    CONSISTENCY IMPORTANT,
    REASSURANCE
    REGRESSION

    PRENATAL: BRING TO VISITS, FAMILY


    AFFAIR
    POST-PARTUM: INVOLVE CHILDREN,
    VISIT AT HOSPITAL

    DEFINITIONS

    ABORTION: BEFORE END OF 20


    WKS
    GESTATION: #WEEKS POST LMP
    TERM: 38-42 WKS
    PRETERM: 20-37 WKS
    POST-TERM: AFTER 42 WKS

    GRAVIDA

    GRAVIDA
    NULLIGRAVIDA
    PRIMIGRAVIDA
    MULTIGRAVIDA

    PARITY

    PARA: BIRTH AFTER 20 WK


    NULLIPARA
    PRIMIPARA
    MULTIPARA

    ALL REFER TO # PREGNANCIES, NOT


    # OF CHILDREN BORN

    TPAL FOR PARITY

    T: TERM INFANTS BORN


    P: PRETERM INFANTS BORN
    A: ABORTION
    L: LIVING CHILDREN (CURRENTLY)

    INITIAL HISTORY

    CURRENT PREGNANCY
    PAST PREGNANCIES
    GYN/MENSTRUAL HX
    CURRENT MEDICAL HX
    PAST MED HX
    FAMILY MED HX
    SOCIAL, PERSONAL, OCCUPATION,
    PERSONAL
    RELIGION, CULTURE, LANGUAGE
    PARTNER HX

    HIGH RISK DESIGNATION

    VARY WITH TIME OF PREGNANCY

    MEDICAL-PREEXISTING, CURRENT
    PSYCHOSOCIAL
    NUTRITION
    OBSTETRIC
    EDUCATIONAL

    INITIAL LABS

    CBC
    BLOOD TYPE, RH FACTOR
    RUBELLA
    SYPHILIS, CHLAMYDIA, GONORRHEA
    ANTIBODY SCREEN
    HEPATITIS B/C
    PAP SMEAR
    U/A
    HIV RECOMMENDED

    ADDITIONAL POSSIBLE
    LABS

    HGB ELECTROPHORESIS
    AFP/QUADRUPLE SCREENING
    1 HR PGT or 2 HR 75 OGT
    TOX SCREEN
    GROUP B STREP
    ADDL HCT/HGB, STI SCREEN,
    GLUCOSE (individualized to pt)

    PSYCHOSOCIAL
    ASSESSMENT

    REACTION TO PREGNANCY
    SUPPORT SYSTEM, FAMILY ISSUES
    FINANCIAL ISSUES
    LIVING CONDITIONS
    HISTORY
    ABUSE
    CUSTOMS, CULTURE

    EDUCATIONAL
    ASSESSMENT

    EDUCATIONAL LEVEL
    PREFERRED WAYS TO LEARN
    DESIRE FOR INFO
    HX, EXPERIENCE
    LANGUAGE

    NUTRITIONAL
    ASSESSMENT

    PREGRAVIDA WEIGHT
    HEIGHT, WEIGHT, BMI
    FAMILY/PERSONAL MEDICAL HX
    DIET RECALL
    LAB REVIEW
    FINANCES, WIC, FOOD STAMPS

    STANDARD DAILY FOOD


    PLAN

    DAIRY: 4 SERVINGS
    PROTEINS: 3 2-OZ SERVINGS (6 0Z)
    GRAINS: 6-11
    FRUITS: 2-4, MIN 1 VIT C RICH
    VEGETABLES: AS DESIRED
    FATS: 3-5
    FLUIDS: 8-10/DAY, MIN 4-6 H2O

    RECOMMENDED WEIGHT
    GAIN GENERAL GDLNS

    VARIES WITH STARTING WEIGHT


    LOW: 28-40 LBS
    NML: 25-35
    OVER: 15-25
    OBESE: 15

    WEIGHT GAIN PATTERN

    NML WEIGHT PATIENTS:

    3.5-5 LB (1.6-2.3 KG) 1ST TRIMESTER


    1 LB (O.5 KG)/WEEK TILL TERM
    TWINS: 1.5 LB/WEEK 2ND/3RD/ TRIMESTER
    LOW WEIGHT GAIN ASSOC WITH PRETERM
    BIRTHS, IUGR, LBW INFANTS
    HIGH WT GAIN ASSOC WITH LGA INFANTS,
    BIRTH COMPLIC, POSS MALFORMATIONS OF
    CNS

    CALORIE
    RECOMMENDATIONS

    1ST TRIMESTER: NO INCREASE


    2ND/3RD: +300 KCAL/DAY
    TWINS: +600 KCAL/DAY
    BREASTFEEDING: +200 KCAL OVER
    PREGNANCY INTAKE

    FACTORS AFFECTING DIET

    CULTURE, FAMILY
    FINANCES, PSYCHOSOCIAL
    FOOD PREFERENCES, INTOLERANCE
    PREGNANCY DISCOMFORTS
    EATING DISORDERS
    EDUCATION, KNOWLEDGE LEVEL
    VEGETARIANISM

    FACTORS AFFECTING
    PREGNANT TEENS DIET

    PSYCHOSOCIAL DEVELOPMENT
    SELF IMAGE, BODY IMAGE
    DENIAL OF PREGNANCY
    LIFESTYLE, PREPREGNANT DIET
    ANEMIA COMMON, CALCIUM INTAKE
    AGE PAST MENARCHE

    LESS THAN 4 YRS PAST, TEEN STILL


    GROWING, NEED HIGHER KCAL TO HAVE
    NML WT INFANT

    FOLLOW-UP VISITS

    ANY PROBLEMS, COMPLAINTS


    REVIEW DANGER SIGNS
    WT, BP, URINE PROTEIN, SUGAR,
    KETONES
    LABS PRN
    FHT, MEASUREMENT
    EDEMA, PHYSICAL CHANGES
    EDUCATION APPROPRIATE FOR GA

    FAMILY INVOLVEMENT

    INVOLVE FOB,
    SIGNIFICANT FAMILY,
    FRIENDS IN VISITS
    ENCOURAGE
    PARTICIPATION IN
    VISITS, CLASSES
    ANSWER
    QUESTIONS OF ALL
    PRESENT

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