Chapter 13



Chapter 14

Physical and Psychologic Changes of Pregnancy

Resource Library

Prentice Hall Nursing Medialink DVD-ROM

Audio Glossary

NCLEX Review

Videos:Through the Eyes of a Nurse—

The First Trimester;Through the Eyes of a Nurse—

The Second Trimester;Through the Eyes of a Nurse—

The Third Trimester;Through the Eyes of a Nurse—

Welcoming the NewArrival at the Postpartum Visit

Companion Website

Additional NCLEX Review

Case Study: Prenatal Education

Care Plan Activity: Preparing Siblings for New Baby

Applications: Endocrine Hormones; Internet

Pregnancy Information

Critical Thinking

Learning Objective 1

Identify the anatomic and physiologic changes that occur during pregnancy.

Concepts for Lecture

1. Uterine Changes

• Enlargement due to hypertrophy (Figure 14.6)

• Thickening of the walls

• Increase in vascular and lymphatic system

2. Cervical Changes

• Development of mucous plug

• Goodell’s sign—softening

• Chadwick’s sign—bluish-purple discoloration

3. Vaginal Changes

• Hypertrophy, increased vascularization, hyperplasia due to estrogen

• Increase in secretions, loosening of connective tissue

4. Breast Changes

• Glandular hyperplasia and hypertrophy

• Areolae darken, superficial veins prominent

• Striae may develop

• Colostrum is secreted

5. Respiratory Changes

• Tidal volume increases

• Oxygen consumption increases

• Breathing changes from abdominal to thoracic

• Vascular congestion of nasal mucosa

6. Cardiac Changes

• Blood volume increases 40% to 45%

• Decrease in systemic and pulmonary vascular resistance

• Increase in cardiac output

7. GI Changes

• Nausea and vomiting

• Hyperemia, softening and bleeding of gums

• Constipation

• Heartburn

• Hemorrhoids

8.Urinary Changes

• Pressure on bladder causes frequency

• Dilatation of kidneys and urine

• Increased GFR and renal plasma flow

9. Skin Changes

• Hyperpigmentation

• Striae

• Chloasma

• Vascular spider nevi

• Decreased hair growth

• Hyperactive sweat and sebaceous glands

10. Musculoskeletal Changes

• Pelvic joints relax

• Center of gravity changes

• Separation of rectus abdominus

11. Eye, Cognitive and Metabolic Changes

• Decreased intraocular pressure

• Thickening of cornea

• Reports of decreased attention, concentration, and memory

• Extra water, fat, and protein are stored

• Fats are more completely absorbed

12. Endocrine Changes

• T4 and BMR increase, TSH decreases

• Concentration of parathyroid hormone increases

• Thyrotropin and adrenotropin alter maternal metabolism

• Prolactin is responsible for lactation

• Secretion of oxytocin and vasopressin

• Increased aldosterone

Learning Objective 2

Relate the physiologic and anatomic changes that occur in the body systems during pregnancy to the signs and symptoms that develop in the woman.

Concepts for Lecture

1. Physical Symptoms of Pregnancy

• Braxton Hicks

• Increased vaginal discharge and risk of infection

• Leaking of colostrum

• Hyperventilation

• Nasal stuffiness and nosebleeds

• Lower extremity edema

• Postural hypotension

• Supine hypotensive syndrome (Figure 14.1)

• Nausea and vomiting

• Bleeding of gums

• Constipation and hemorrhoids

• Pruritus

• Urinary frequency

• Hyperpigmentation (Figure 14.2)

• Striae

• Vascular spider nevi

• Decreased rate of hair growth

• Heavy perspiration, night sweats, acne

• Waddling gait

• Backache

• Difficulty wearing contact lenses

Learning Objective 3

Compare subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy.

Concepts for Lecture

1. Presumptive Signs of Pregnancy

• Amenorrhea

• Nausea and vomiting

• Excessive fatigue

• Urinary frequency

• Breast changes

• Quickening

2. Probable Signs of Pregnancy

• Changes in the pelvic organs (Figures 14.4 and14.5)

• Enlargement of the abdomen

• Braxton Hicks contractions

• Abdominal striae

• Uterine souffle

• Changes in the pigmentation of the skin

• Ballottement

• Positive pregnancy tests

4. Positive Signs of Pregnancy

• Auscultation of fetal heartbeat

• Fetal movement

• Visualization of the fetus

Learning Objective 4

Contrast the various types of pregnancy tests.

Concepts for Lecture

1. A hemagglutination-inhibition test is a urine pregnancy test that uses hCG-sensitized red blood cells of sheep. The latex agglutination test is also a urine pregnancy test that is based on the fact that latex particle agglutination is inhibited in the presence of hCG. Avery accurate serum pregnancy test is b-subunit radioimmunoassay (RIA), which uses an antiserum with specificity for the b-subunit of hCG in blood plasma. It permits diagnosis of pregnancy a few days after implantation. Another serum pregnancy test is the immunoradiometric assay (IRMA), which uses a radioactive antibody to identify the presence of hCG in the serum.The enzyme-linked immunosorbent assay (ELISA) can detect hCG levels as early as 7 to 9 days after ovulation and conception. Another serum pregnancy test is the fluoroimmunoassay (FIA) that uses an antibody tagged with a fluorescent label to detect serum hCG.

2. Home pregnancy tests are quite sensitive and detect even low levels of hCG in urine. There is a low false-positive rate and a higher false-negative result.

Learning Objective 5

Discuss the emotional and psychologic changes that commonly occur in a woman, her partner, and her family during pregnancy.

Concepts for Lecture

1. Mother’s Response to Pregnancy

• Ambivalence

• Acceptance

• Introversion

• Mood swings

• Changes in body image

2. Rubin’s (1984) Tasks of Pregnancy

• Ensuring safe passage through pregnancy, labor, and birth

• Seeking of acceptance of this child by others

• Seeking of commitment and acceptance of self as mother to the infant (binding-in)

• Learning to give of oneself on behalf of one’s child

3. Father’s Response to Pregnancy

• Confused by partner’s mood changes

• Feels left out of pregnancy

• Resents attention given to the woman

• Resents changes in their relationship

• Needs to resolve conflicts about fathering

• Couvade

4. Family Response to Pregnancy

• Siblings

° Rivalry

° Fear of changing parent relationships

• Grandparents

° Closer relationship with expectant couple

° Increasingly supportive of couple

Learning Objective 6

Summarize cultural factors that may influence a family’s response to pregnancy.

Concepts for Lecture

1. An important aspect of prenatal care is a cultural assessment in which the nurse needs to identify family beliefs, values, and behaviors that relate to pregnancy and childbearing. Information about ethnic groups, patterns of decision making, religious preferences, language, communication style, and common etiquette practices are important, as well as expectations of the healthcare system.

Cultural Factors

• Identify beliefs, values, and behaviors

° Ethnic background

° Patterns of decision making

° Religious preferences, language, communication style

° Common etiquette practices

° Expectations of healthcare system

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