Physiological and Psychological Changes of Pregnancy

1. Physiological and Psychological Changes of Pregnancy

2. Reproductive Organ Changes • Uterus • enlargement -- 2 ounces to 2 pounds • rises out of pelvic area and displaces the intestines • changes in tissue • increase in vascularity • hypertrophy • isthmus of uterus softens - • uterine souffle • Patient teaching • Braxton-Hicks contractions Hegars Sign

3. Cervix • softens - Goodells sign • fills with a mucus plug • increase in discharge, leukorrhea • Vagina • increase in vascularity - Chadwicks sign • increase in discharge, leukorrhea • pH rises and become more susceptible to yeast infections Mrs. Andrews complains of a whitish discharge. What is the teaching regarding vaginal discharges?

4. Perineum • increased vascularity and pressure causes vulvar varicosities • What should the nurse teach regarding decreasing the pressure in the perineal area? • Ovaries • corpus luteum remains functioning and there is NO ovulation or menstruation. Mrs. Andrews asks why she stops having menstrual periods while pregnant. What is the nurses response ?

5. Breasts • Growth of alveolar tissue • Nipples become more pigmented • Mrs. Andrews states that her breasts are more full and have become very heavy. What teaching should the nurse include?

6. Respiratory Changes • The body adjusts to meet the oxygenation needs by: • Thoracic rib cage is pushed upward and the diaphragm is elevated as uterus enlarges • Lower thoracic cage widens to increase tidal volume • Oxygen consumption is increased to support fetus • Vasodilation of vessels in nose causing epistaxis and nasal stuffiness

7. Respiratory Changes • Nursing Care • Instruct that because of shortness of breath and dyspnea may need to: • sleep in an upright position • avoid overloading the stomach • stop smoking! • Nasal stuffiness is normal because of increase in hormones

8. Cardiovascular Changes • Circulatory System • Related to: • cardiac enlargement • vasodilation • increase blood volume, hemodilution • increase cardiac output – 30-50% • Variations in common laboratory tests • Hgb – 12 – 16 g/dl – stays about the same • Hct -- 37% decreases RT hemodilution. There is an increase of about 1500 cc . Over 1000 cc of that is plasma. • RBC -- ~5.7million which is about a 17% increase.

9. Cardiovascular Changes Nursing Care • Avoid supine hypotension by side lying • Arise slowly from a lying position • Wear support hose and avoid constipation to decrease formation of varicose veins • Instruct that palpitations may be felt and are normal

10. Gastrointestinal Changes • Nausea and Vomiting • Related to: • increased levels of HCG • changes in CHO metabolism • fatigue • Nursing Care • Avoid offending odors • eat dry CHO (crackers) upon wakening • Eat 5-6 small meals per day • Avoid spicy, gas forming foods • Drink carbonated beverages

11. Gastrointestinal Changes • Heartburn and Indigestion • Related to: • slowing of motility and digestion because • of progesterone • relaxation of cardiac sphincter, regurgitation occurs • stomach displaced upward and compressed by • enlarged uterus • Nursing Care • avoid large meals • use good posture • Take low Sodium antacids --

12. Gastrointestinal Changes • Constipation • Related to: • slowing of motility • intestinal compression • oral iron supplement • Nursing Care • Increase water and fiber in diet • moderate exercise • **Don’t take laxatives or enema without a doctor’s permission

13. Gastrointestinal Changes • Hemorrhoids • Related to : • pelvic congestion • straining with stool • Nursing Care • avoid constipation • Apply topical agents to area

14. Review • Mrs. Andrews says that she just mixes up some baking soda and that takes care of her indigestion. • Is there any teaching that needs to be done in this situation?

15. Urinary Changes • Renal Changes • Related to: • Kidneys increase in size and weight to enable greater filtration • Enlarged uterus presses on kidneys and ureters reducing effective flow. • ureters dilate • Urinary stasis

16. Urinary Changes • Urinary frequency and urgency • Related to: • pressure of uterus on bladder Nursing care Kegels exercises Limit fluid intake before bedtime Report dysuria or burning

17. Skin and Hair Changes • Skin • Increase pigmentation RT increase in production of melanotropin • face = chloasma • breasts = areola darkens • abdomen = linea nigra • Spider nevi on face and upper trunk • Striae gravidarum • Hair • Increase in hair growth

18. Musculoskeletal Changes • Joints, bones, and teeth • Softening of pelvic cartilage and exaggerated elasticity of connective tissue can lead to unstable gait • Posture changes • Leg cramps • Carpal tunnel syndrome • Teeth--there is no demineralization • Nursing Care • Wear low heel shoes for support • Exercises • Walk leading with the heel of the foot • Wrist supports until after delivery assist with pain related to carpal tunnel syndrome. Goes away after delivery.

19. Weight Gain Normal weight gain is about 25 lbs. Be sure to teach about good nutrition

20. Hormones • Endocrine • The placenta produces new hormones: • Human chorionic gonadotropin – maintain pregnancy • Human placental lactogen – antagonist of insulin • Estrogen – stimulates development of uterine lining • Progesterone – maintains pregnancy • Relaxin – aids in softening the cervix

21. The End return