Chapter 10: Nursing Care Related To Psychological and Physiologic Changes of Pregnancy

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Chapter 10: Nursing Care Related to Psychological and Physiologic

Changes of Pregnancy
Nursing Process Overview
Assessment
 Evaluate a woman’s overall health status, nutritional intake and lifestyle
 Identify any potential problems
 Identify a woman’s understanding and expectations of conception, pregnancy, and
parenthood.
 Be certain you establish a trusting relationship with a woman
 Continue to assess a woman’s health and nutritional status
Nursing Diagnosis
 Altered breathing patterns related to respiratory systems changes of pregnancy
 Disturbed body image related to weight gain from pregnancy
 Deficient knowledge related to normal changes of pregnancy
 Imbalanced nutrition, less than body requirements, related to early morning nausea
 Powerlessness related to unintended pregnancy’
 Possible impaired health and prenatal care behaviors associated with cultural beliefs
Outcome Identification and Planning
 Plan to review the common concerns women have about being pregnant before
changes occur, so there are no surprise
Implementation
 Help women at prenatal visits to voice their concerns about the changes happening to
them so any worry brought on by these changes does not lead to stressful 9 months
Outcome Evaluation
 Patient states she is able to continue her usual lifestyle throughout pregnancy
 Family members adjusted their lifestyle to accommodate the mother’s pregnancy
 Couple states they appreciate physiologic changes even though it cause discomfort and
know these are healthy changes

A. Psychological Changes of Pregnancy


1. Social Influence
How pregnant woman and her partner feel and how they are prepared to meet the
challenges this new responsibilities
Experiences reported by friend
Current plethora of information available on the internet

2. Cultural Influences
Cultural background can influence how active a role she wants to take in her
pregnancy
Support these beliefs because it shows respect for the individuality of a woman and
her knowledge of good health

3. Family Influences
Siblings or parent can affect in the way of how they view a family’s pregnancy

4. Individual Differences
Differences such as how woman’s ability to cope with or adapt to stress, the extent to
which a woman feels secure in her relationship with the people around her, and how
women perceive pregnancy as positive or negative experiences

5. Partner’s Adaptation
Able to form a close relationship with each other

B. The Psychological Tasks of Pregnancy


1. First Trimester: Accepting the Pregnancy
Woman and her partner both spend time recovering from the surprise of learning they
are pregnant
Concentrate on what it feels like to be pregnant
Woman feels ambivalence, both pleased and not pleased
Man should accept the certainty of pregnancy, reality of child to come and partner
changes state

2. Second Trimester: Accepting the fetus


Couple moves through emotion such as narcissism and introversion as they
concentrate on what it feels like to be a parent.
Pole -playing and increased dreaming are common
Man show that woman is not the only one capable of creating something through
working

3. Third Trimester: Preparing for the Baby and End of Pregnancy


Couple prepare clothing and sleeping arrangements for the baby or known as nest
building. It also grows impatient as they ready themselves for birth.

4. Additional Preparation Work to Complete in Pregnancy


a. Reworking Developmental tasks
 Gaining sense of identity is establishing working relationship with parents
 Pregnant teen: resolve the double conflict of still establishing a sense of
identity
 Partner needs to do same reworking of old values and forgotten
developmental tasks
b. Role-Playing and Fantasizing
 Spending time with other pregnant women or mother of young children to
learn how to be a mother
 Partner may change view of being a significant member of a family unit
5. Emotional responses that can cause Concern in Pregnancy
a. Grief: she will never be the woman she has been the exactly the same way again.
b. Narcissism: self-centered and it may reveal by changes in activity such as
unconsciously protect her body and more interested in doing things for her
c. Introversion vs. Extroversion
d. Body Image and Boundary: Woman may walk away from object to avoid
bumping and perceive herself as needing body boundaries as if her body were
delicate and easily harmed
e. Stress
f. Depression
g. Couvade Syndrome: Experience physical symptoms such as nausea, vomiting and
backache that causes stress, anxiety and empathy for a pregnant woman
h. Emotional Lability: mood swings
i. Changes in Sexual Desire: 1st trimester=decreased libido, 2nd trimester= libido
rise, 3rd trimester=libido remain high
j. Changes in the Expectant Family

C. The Confirmation of Pregnancy (pp. 211, Table 10.2)


1. Presumptive (Subjective) Symptoms
Experienced by the woman but cannot be documented by examiner such as breast
changes, nausea, vomiting amenorrhea, frequent urination, fatigue, uterine
enlargement, quickening, linea nigra, melasma, and striae gravidum

2. Probable Signs
Objective and can be verified by an examiner; more reliable than presumptive
symptoms.
Maternal serum test, Chadwick’s sign, Goodell’s sign, Hegar’s sign, sonographic
evidence of gestational sac, ballottement, Braxton Hicks contraction and fetal outline
felt by examiner.

3. Positive Sign of Pregnancy


a. Demonstration of a Fetal Heart Separate from the Mother’s
 5th weeks= echocardiography demonstrate heartbeat
 6th to 7th weeks= ultrasound can reveal a beating fetal heart
 Fetal heart rate ranges between 120 and 160 bpm
 Heard best by palpation and stethoscope is placed over the area of fetal
back
b. Fetal Movements Felt by an Examiner
 16th to 20th weeks= fetal movements can be felt by woman
 20th to 24th weeks= examiner discern fetal movements
c. Visualization of the Fetus by Ultrasound
 4th to 6th weeks=gestational sac revealed on an oscilloscope screen
 8th weeks= fetal outline can be seen clearly that the crown to rump length

D. Physiologic Changes of Pregnancy


1. Reproductive System Changes
a. Uterine Changes (increased)
 Length= 6.5 cm to 32 cm
 Depth= 2.5 cm to 22 cm
 Width= 4 cm to 24 cm
 Weight= 50 to 1000g
 Uterine wall’s thickness= 1 cm to 2 cm
 Volume of uterus= 2ml to more than 1000 ml
b. Amenorrhea
Absence of menstrual flow, occurs with pregnancy because of suppression of
follicle stimulating hormones by rising estrogen levels
c. Cervical Changes
Becomes more vascular and edematous than usual.
An operculum forms that seal bacteria and prevent infection in fetus and
membranes
d. Vaginal Changes
Increase in size, color change from pink to deep violet (Chadwick’s sign)
e. Ovarian Changes
Ovulation stops because of active feedback mechanism of estrogen and
progesterone produced

2. Changes in the Breasts


 6th weeks= first physiologic changes in pregnancy a woman notice
 Areola of nipple= darkens, diameter 3.5 cm to 5 cm or 7.5 cm

3. Systemic Changes
a. Endocrine System
Increases to support fetal growth
b. Immune System
Decreases to prevent a woman’s body rejecting fetus; IgG decreased
c. Integumentary System
Abdominal wall stretches; striae gravidum, diastasis, linea nigra and melasma
occurs
d. Respiratory System
Rapid breathing rate (18 to 20) and chronic feeling of shortness of breathe
e. Temperature
Increases slightly
f. Cardiovascular System (pp.219, table 10.6)
Increases, need large amount blood volume
g. Gastrointestinal System
Morning sickness, nausea and vomiting
h. Urinary System (pp. 22, table 10.7)
i. Musculoskeletal System
Calcium and phosphorus increased

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