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50 Cards in this Set
- Front
- Back
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signs of pregnancy
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presumptive
propable positive |
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presumptive signs of pregnancy
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amenorrhea, n/v, urinary frequency, breast and skin changes, fatigue, quickening
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propable signs of pregnancy
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abdominal enlargement
ballottement braxton-hicks fetal outline goodells sign hegars sign chadwicks sign pregnancy test |
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positie signs of pregnancy
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fetal heartbeat
ultrasound fetal movement felt by trained examiner |
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changes in uterus during pregnancy
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change in weight and capacity
change from almost solid structure to thin muscluar sack shange from pear shape to globular change in location from pelvis to abd cavity 20% of cardiac output supplies uterus/pelvic cavity alone |
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when can uterus be felt above pubic symphisis
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12 weeks
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when can uterus be belt at umbilicus
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20 wks, then rises 1 cm/week
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cervix changes
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softening and thickening. mucus plug forms; seals opening to uterus to reduce riks of infection to fetus
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changes in vagina
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leukorrhea is normal
irritation, inflammation is not normal acidity decreases change of bacterial infection higher risk for yeast infections |
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changes in breasts
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become heavier, larger, fuller, more sensetive. increased estrogen and progesterone. nipples/areola enlarge and darken.
stretch marks may appear veins may be more prominent |
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when does colostrum production begin
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in 2nd trimester. may secrete small amts during pregnancy
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changes in abdoment
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pelvis widens to accommodate fetus
adb protrudes as uterus grows as fetus grows, pressure on femoral veins occurs; decreases venous return, causes edema, can cause varicosities and hemmorrhoids |
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changes in wbcs
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start to rise in 2nd month in response to stress of pregnancy. helps protect from infection. 14000-18000 is normal
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changes in thyroid
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increased t3 and t4
increased meetabolism increased parathyroid activity |
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changes in pituitary
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fsh and lh suppressed
preogesterone/estrogen eleveated thru out pregnancy oxytocin released near end to stimulate uterus prolactin secreted to stimulate milk production |
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hormonal changes in pregnancy: estriol level
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form of estrogen. rises ~7-8 wks
stimulates uterine development rising levels indicates fetal growth decreasing levels indicate fetal death, SAB, IUGR |
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hormonal changes: progesterone
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major role in maintianing pregnancy
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hcg
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secreated from surface of embryonic placental membrane
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hpl
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human placental lactogen. released from placenta. gradually rises until 36 wks. potent insulin antagonist
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relaxin
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relexes uterine and cervical tissue
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prostaglandins
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full role unknown but they rise in pregnancy. plays a role in stimulating labor
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blood volume increases by
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40-50%
so 2000ml |
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red blood cell volume increases up to
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30%
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plasma volume increases by
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50%
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hemoglobin
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chnges to 11-12g/100ml. should stay >/=10.5-11
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hct
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>33%
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pulse
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increases 10-20bpm
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sbp
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drops slightly 24-32 wks, then returns to normal
>/=140/90 is cause for concern |
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other cardiovascular changes
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increased cardiac output
heart enlargement may occur silent murmurs may become audible |
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o2 demans
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increase 15-20%. take in more o2, excrete more co2
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tidal volume
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increasses 30-40%
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respiratory changes
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elevated diaphragm, nasal stuffiness and epistaxis may occur due to hormonal changes and increased blood flow to upper resp tract
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changes in skin
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acne vulgaris: estrogen increases oiliness of skin
hair growth-esp facial hair dermatits: skin becomes more sensitive for some due to hormonal changes |
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integumentary changes during pregnancy
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chloasma
linea nigra striae |
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chloasma
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mask of pregnancy. brown blotchy areas on the forehead, cheeks, and nose
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linea nigra
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the skin in the middle of the abd may develop a darkened line
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striae
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stretch marks. may develop on the abd in response to elevated glucocorticoid levels
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presumptive changes in pregnancy
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linea nigra, chloasma, spider angiomas
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musculoskeletal changes in pregnancy
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muscles and bones make accommodations. center of gravity moves forward
lordosis increases to maintain balance increases stress on vertebrae and muscles of lower back, causes backache and fatigue increased breast size/wt caues stress on thoracic and neck muscles relaxin causes cartilage and connective tissus of pelvic joints to soften, helps with delivery but affects gait round ligament pain |
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pregnancy issues
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pressure on bladder
pressure on diaphragm pressure on intestines pressure on aorta and vena cava |
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lordosis
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increased curvature of the spine. can result in low backache
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diastasis recti abdominis
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separation of the recus absominis muscle
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GI changes in pregnancy
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n/v due to increased levels of hcg
tender, easy friable gums, ginivitis due to increased blood flow. increased saliva indigestion may occur 3rd trimester due to acid reflux decreased motilityy decreased emptying time of gallbladder constipation |
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urinary/renal changes
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frequency in 1st and 3rd trimester
water retention-now considered helpful decreased renal thhreshold for glucose glucosuria doesnt diagnose DM, must do GTT increased GFR with increased UO; 60-80% decreased bladder tone increased chance for stasis and uti |
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psychological adaptation to pregnancy
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1st: accept the pregnancy
2nd: accept the baby 3rd: prepare for parentthood |
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nursing practice in pregnancy
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assessment: monitor adaptation of family to pregnany crisis
assess prenatal attachment |
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parenting assessment
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perceptions aboutt parenting: desire for baby, concerns about role
attachment: feelings about sex of baby, attributes, etc, fantasies. acceptance by self and others health seeeking behaviors |
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planning/interventions
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provide info: developmental tasks, emotional changes, role transition
discussion of resources: support systems, classes social services, support groups family preparation therapeautic communication |
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evalutation
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family verbalizes concersn/emotions
family completes developmental tasks |
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risk factors
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substance abuse
smoking -12% of pregnant women need increased b12, c, folic acid, iron, zinc, amino acids etoh, drugs socioeconomic status cultural concersn |
