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112 Cards in this Set

  • Front
  • Back
Normal changes are influenced by which
hormones during pregnancy?
ESTROGEN and PROGESTERONE
the UTERUS Increases its volume carrying ability from what to what?
10 ml to 5000 ml
The enlargement of the uterus is a result of an increase in?
size (hypertrophy) of the preexisting
myometrial cells.
• Only a limited increase in cell number (hyperplasia) occurs
In general, the uterus enlarges more around which area?
the placental insertion site and in the upper portion of the uterus which is the fundus.
Braxton Hicks Contractions
Irregular •Palpated bimanually about 4th month •Stimulate the movement of blood through
the intervillous spaces of the placenta •In late pregnancy, may be uncomfortable and Confused with true labor
Mucous plug in the cervix
-seals the endocervical canal
and prevents the ascent of bacteria into the uterus
Goodell’s sign
softening of the cervix
Chadwick’s sign
blue-purple discoloration
of the cervix
Ovaries
Cease ovum production during pregnancy •Follicles develop temporarily •Thecal cells lining these follicles become active in hormone production
During early pregnancy, hCG-human chorionic gonadotropin maintains what organ?
the corpus luteum which produces hormones
until about weeks 6-8 of pregnancy
Corpus Luteum
Engulfs approximately a third of the ovary. •secretes progesterone to maintain the endometrium until the
placenta produces enough progesterone to maintain the pregnancy. • Then it disintegrates slowly.
Vagina
Hypertrophy and hyperplasia during pregnancy •These changes are estrogen induced
• Result in a thickening of the mucosa •Increase in vaginal secretions-thick-white
and acidic
Moniliasis
common vaginal infection
during pregnancy
BREASTS
Estrogen and Progesterone
• Increases in size and nodularity •Tenderness
• By end of the second month, superficial veins are prominent and hyperpigmentation of the areola and Striae
Colostrum
expressed manually by 12th week and may leak during the last trimester
THORAX and LUNGS
progesterone influences the relaxation of the ligaments and
joints which allows the ribcage to flare,thus
increasing the anteroposterior and transverse diameters.
increase in the anteroposterior and transverse diameters is because of what?
• This accommodation is necessary as pregnancy
progresses and the enlarging uterus pushes up on the diaphragm.
Respiratory system
30%-40% rise from non pregnant values • Between weeks 16 and 40, oxygen
consumption increases 15%-20% to meet the needs of the mother as well as the fetus and the placenta
LUNGS
Shortness of breath is a common complaint during last trimester •Deep respirations
• More frequent sighing
• Pulmonary requirements increase
why do Oxygen requirements increase during pregnancy?
because of the additional cellular growth of the body
and the fetus
Epistaxis
(nosebleeds)-result of estrogen induced edema and vascular congestion of the
nasal mucosa
what happens to the Circumference of the chest during pregnancy?
it may increase
what do Measurements of airway resistance show during pregnancy?
a marked decrease in response to elevated progesterone levels.
Pulmonary function during pregnancy?
is not impaired by
pregnancy
HEART
is required to pump much harder •Actually increases in size •Heart rate may increase by 10-15 bpm •Systolic murmers may be heard
Blood volume
increases to 40-45% above
nonpregnant levels near term-
Cardiac Output
begins to increase early and
peaks at 20-24 weeks at 30-50% prepregnant levels
Femoral venous pressure
slowly rises as the uterus exerts increasing pressure on return blood flow.
BLOOD PRESSURE
Decreases slightly during pregnancy
when does blood pressure Reach its lowest point during pregnancy?
the second trimester
what happens to blood pressure during the third trimester/
increases during the
third trimester
What happens to the blood pressure of a pregnant woman at term?
it is near prepregnant
levels
Femoral venous pressure during pregnancy
slowly rises as the uterus exerts increasing pressure on
return blood flow.
Postural Hypotension
Increased blood volume in lower extremities Resulting dependent edema and tendency toward varicose vein formation in the legs,
vulva, and rectum late in pregnancy
Supine Hypotensive Syndrome
• Vena Caval Syndrome
• Aortocaval Compression
Enlarging uterus puts pressure on Vena Cava when woman is supine interfering
with maternal blood flow
• Produces ↓ B/P, dizziness
• Have woman lie on her left side
what is a PHYSIOLOGIC ANEMIA during pregnancy?
Incr in maternal bld vol but not a proportionate incr in RBC production •Psuedoanemia plasma vol incr • RBC vol incr This changes occur by 30-34 wks gestation
Pulse Rate
Frequently incr's
Varies from almost no incr to an incr of 10-15 beats per min
PLASMA BLOOD VOLUME
AS PBV increases, blood vesselsaccommodate for this vol. • 2nd trimester-clients feel light-headed and dizzy
• Peak 32-34 weeks
what does Progesterone do to lood vessles during pregnancy?
acts on the vessels to make them relax and dilate
what happens to the ABDOMEN during pregnancy?
Abdominal muscles stretches as the
uterus enlarges. Expanding uterus exerts pressure on the
bladder,kidneys,and ureters
Rectus abdominis muscles
stretch to the point that permanent separation occurs
what is Lower pelvic discomfort during pregnancy?
stretching of the round ligaments
what causesDECREASED GASTRIC MOTILITY during pregnancy
Enlarging uterus puts pressure and displaces the sm int •This pressure along w/ the secretion of progesterone decr gastric motility •Gastric tone is decr •Emptying time of stomach is decr
FIRST TRIMESTER-GI
n & v are assoc w/ the hCG secreted by the implanted blastocyst and w/ a change in carbohydrate metabolism that occurs in early pregnancy
Second half of pregnancy- GI
Pressure of growing uterus
Heartburn-pyrosis-reflux of acidic secretions •Hemorrhoids
• Prolonged emptying of the gallbladder
how does progesterone change smooth muscles during pregnancy?
it relaxes them
Basal metabolic rate
Increases up to 30%
Thyroxine increases
BMR, heart rate, heat intolerance, cardiac output,
vasodilation
what happens to the Gums during pregnancy?
Gingival bleeding when brushing, best time to go to the dentist is the 2nd trimester
What causes Nasal stuffiness-epistaxis during pregnancy
estrogen induced edema and vascular congestion of the nasal mucosa and sinuses
what causes Vocal changes during pregnancy?
edema of the larynx
Urinary Frequency
common complaint of
the 1st and 3rd trimesters
bladdar pressure During the 2nd trimester
subsides and urinary frequency is relieved by the uterus enlarging and being lifted out of the pelvic area
linea nigra
a dark line extending from the umbilicus to the mons pubis
cholasma
a darkening of the skin on the
face-Women who take contraceptives have this because of the hormones in the medicine
what are some SKIN CHANGES during pregnancy?
Darkening of the aerola and
nipples,axillae,umbilicus, and perineum, Scars and moles
• Vascular changes-spider nevi-elevate estrogen levels
•Palmar erythema •Hair and nail growth incr
what are some MUSCULOSKELETAL changes during pregnancy?
Lordosis •Uterine growth pulls the pelvis forward •Spine curvesforward
•Progesterone and relaxin influence then pelvic joints and ligament to relax
PERIPHERAL VASCULAR
SYSTEM
Swelling of lower extremities in the third trimester
• Pregnant women are more prone to thrombophlebitis because of the hypercoagulabe state of pregnancy
NEUROLOGICAL
Pain and tingling in the thigh
• Carpal tunnel syndrome
• Leg Cramps
• Supine Hypotensive Syndrome
what happens to the Thyroid during pregnancy?
pregnancy influences size &
activity
Total serum Thyroxin
increases in early pregnancy
Thyroid Stimulating Hormone
decreases
hCG
stimulates progesterone and
estrogen production till placenta develops
Estrogen
stimulates uterine development
Progesterone
inhibits spontaneous uterine
contractility, & maintains pregnancy
Relaxin
aids in softening of cervix and
inhibits uterine activity
Human Placental Lactogen
Antagonist of insulin – Decr maternal metabolism of glucose to favor fetal growth
when is Estrogen produced during pregnancy?
produced at 7th week of
pregnancy
Subjective (Presumptive) Changes
Amenorrhea, N&V
Excessive Fatigue, Urinary Frequency, Changes in the breasts, Quickening
Objective (Probable Signs)
Changes in Pelvic organs, Enlargement of the Abdomen, Braxton Hicks contractions, Uterine Souffle, Changes in pigmentation of the skin, Clinical pregnancy tests, Over the counter pregnancy tests
Diagnostic (Positive) Changes
Fetal heartbeat, Fetal movement, Visualization of the fetus
Psychologic Response
Ambivalence,Acceptance-develops self-confidence
• Rubin-4 tasks
Rubin-4 tasks
Safe Passage, Seeking of Acceptance, Binding-In, Giving of oneself
Gravida and para
term refers to pregnancies
Gravida
any pregnancy regardless of
duration including present pregnancy
Para
Birth after 20 weeks’ gestation
regardless if infant is born alive or dead.
Term
38-42 weeks of gestation
Preterm
after 20 weeks and before 37
weeks of gestation
Postterm
after 42 weeks of gestation
TPAL
Term, Preterm, Abort,Living Child
1st trimester
1-12 wks
2nd trimester
13-24 wks
3rd trimester
25-37 wks
normal recommended weight gain during pregnacy?/ if over weight?/ and if underweight?
20-25 lbs. if over weight- 15 lbs if under weight gain ideal weight and add 11.5-16 lbs
*3.5-5lbs then 1lb per week
normal weight gain during 1st trimester?
3.5-5 lbs.
normal weight gain during 2nd trimester?
12-15 lbs
normal weight gain during 3rd trimester?
12-15 lbs
CBC; H&H?
Hemoglobin 12-16g/dl;Hematocrit-38-47%
– RBCs ; WBCs
Fundal Height assessment
Centimeters & weeks of gestation correlate, Woman must empty her bladder, Maternal position
Quickening
fetal movements-approx 20
wks
when is Fetal heartbeat assessed?
10-12 weeks gestation
Common Discomforts of Pregnancy
• 1st Trimester
N&V,Urinary Frequency,
Fatigue, Breast tenderness, Incr vaginal dc, Nasal stuffiness and nosebleeds, Ptyalism
Common Discomforts of Pregnancy
• 2nd and 3rd Trimesters
Heartburn, Faintness, Ankle Edema, Dyspnea, Varicose Veins, Flatulence, Hemorrhoids, Carpel Tunnel Syndrome, Constipation, Backache, Leg Cramps
Inactivated Virus Vaccines
Influenza, Hepatitis A&B
Toxoids
Tetanus
Live Virus Vaccines-Contraindicated
Measles, Mumps, Rubella, Varicella Zoster, Smallpox
Expectant Couple over 35
Financial concerns, Planned vs.unexpected •Amniocentesis •Medical Risks
Amniocentesis
14 weeks for
chromosomal studies
Medical Risks Couple over 35
Cesarean Birth Rate is incr, Down Syndrome/congenital malformations, Placenta previa, Placenta abruptio, Low-birth weight, Preterm, Spontaneous abortion
Adolescent Pregnancy
Puberty, Psychosocial Development, Peer pressure, Lack of knowledge about sexuality, Lack of knowledge about contraception, Socioeconomic factors
Physiologic Risks-
Adolescent Pregnancy
Preterm births, LBW infants, Preeclampsia/eclampsia, Iron deficiency anemia, CPD (cephalopelvic disproportion), Prenatal care-critical factor, Psychological & Sociologic Risks
Substance Abuse Cocaine
Feeding difficulties, extreme irritability in Breastfeeding NB
Substance Abuse Heroin
IUGR; shrill high pitch cry, Withdrawal-72 hours, Methadone
Placenta previa
Painless vaginal bleeding after 20 wks
gestation
Abruptio placentae
Painful, may or may not be accompanied by bleeding, occurs before birth usually during labor process
Hyperemesis Gravidarium
Severe nausea, affects hydration and nutritional status
Hypovolemia during pregnancy leads to:
hypertension, incr pulse rate, hematocrit, and BUN, decr urine output, Weight loss of 5% of prepregnancy weight
PROM
After 37 weeks but before the onset of labor
Prolonged ROM-
more than 24 hours before
birth
Betamethasone
Celestone Soluspan
Preterm Labor-
Occurs between 20-37 weeks of pregnancy
RH incompatibility
Screening at 28 weeks gestation
ABO incompatability
Type O mothers with Type A or B fetus, Hyperbilirubinemia