The Physiological and Psychological Effects of Pregnancy Revised 9/7/10 Debbie Perez RN, MSN, CNS

1. The Physiological and Psychological Effects of PregnancyRevised 9/7/10Debbie Perez RN, MSN, CNS

2. Patient Education and Normal Pregnancy • It is important to discuss normal physiological changes and adaptations to pregnancy with couples. • Why??

3. 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 of the endometrium • isthmus of uterus softens-- Hegar’s sign • uterine souffle is heard with doppler • Patient teaching Braxton-Hicks contractions and how to distinguish from true labor

4. Cervix • softens - Goodell’s sign • fills with a mucus plug • increase in discharge, leukorrhea • Vagina • increase in vascularity - Chadwick’s sign • increase in discharge, leukorrhea • pH rises, acidic • more susceptible to yeast infections Mrs. Andrews complains of a whitish discharge. What is the teaching regarding vaginal discharges?

5. 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 ?

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

7. Oxygenation 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. • RBC -- ~5.7million which is about a 17% increase.

8. Nursing Care • Avoid supine hypotension • Arise slowly from a lying position • Wear support hose to avoid varicose veins and promote venous return • Instruct that palpitations may be felt and are normal

9. Respiratory changes • Related to: • Thoracic cage is pushed upward and the diaphragm is elevated as uterus enlarges • Oxygen consumption is increased to due to fetal needs • Lower thoracic cage widens to increase tidal volume • Nursing Care • Instruct to: • sleep in an upright position • avoid eating large meals • stop smoking! • Nasal stuffiness and epistaxis is 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. Heartburn and Indigestion • Related to: • Decreased motility and digestion due to effects of progesterone • Relaxation of cardiac sphincter results in reflux • Stomach displaced by enlarged uterus • Nursing Care • avoid large meals • sit upright after meals • use good posture • Take low Sodium antacids --

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

13. Constipation • Related to: • slowing of motility • intestinal compression • oral iron supplement • Nursing Care • increase water and fiber in diet • moderate exercise • No laxatives or enema without a doctor’s permission • Hemorrhoids • Related to : • pelvic congestion • straining with stool • Nursing Care • avoid constipation • apply topical agents to area • Increase fluids and fiber

14. Urinary System Changes • Renal Changes • Related to: • Kidneys increase in size and weight to due to increased filtration needs • Enlarged uterus presses on kidneys and ureters reducing effective flow • Ureters dilate • Urinary stasis occurs • Urinary frequency and urgency • Related to: • pressure of uterus on bladder first and last trimester Nursing care Kegel’s exercises Limit fluid intake before bedtime Report dysuria or burning

15. Integumentary Changes • Skin changes • Increase pigmentation R/T increase in production of melanotropin • face = chloasma • breasts = areola darkens • abdomen = linea nigra • Spider nevi on face and upper trunk • Striae gravidarum

16. Musculoskeletal Changes • Joints, bones, and teeth • Softening of pelvic cartilage and exaggerated elasticity of connective tissue • Posture changes • Leg cramps • Carpal tunnel syndrome • Teeth--there is no demineralization • Exercise, Leisure • May attend regular prenatal exercise classes • Don’t take up a new sport • Travel--wear seat belt

17. Endocrine Changes • The placenta produces new hormones that help to maintain pregnancy • Inhibition of menses

18. Regulatory Need • Mrs. Andrews states that she is employed as a bank teller on a full time basis. • She asks whether she can continue to work throughout her pregnancy.

19. Regulatory Changes • Employment • Criteria for work: • safe environment for the fetus • can woman carry out work commitments without undue stress • What other teaching is necessary regarding work and breaks?

20. Safety with Seat Belts Wear shoulder belt over top of abdomen Wear lap belt low over the hips

21. Safety • Clothing • Bathing • Immunizations

22. Nutrition Adaptations • Increase in calories • Increase in protein • May have food cravings or Pica Nursing care: • Teach to take prenatal vitamins and iron • Teach about normal weight gain ~ 25 lbs.

23. Psychological Tasks of Pregnancy Mr. Andrews says they are excited about having the baby but he has just taken a new job and is concerned. Is this Normal?

24. The First Trimester • Major Feelings are: • Disbelief / Uncertainty • Much time is devoted to confirmation of the pregnancy • Ambivalence • Feelings can fluctuate between acceptance and rejection of the pregnancy

25. The First Trimester • How the Nurse Can Assist the Woman to Adjust: • Assist her to confirm that she is Pregnant • Recognize that it is ok to be self-centered • Focus on Current Events • Provide opportunities for her to discuss concerns • Guide her to appropriate community resources

26. The Second Trimester The Major Task is to: Perceive the Fetus as a Growing Infant be able to say: “I am Going to have a Baby”

27. The Second Trimester • Major Feelings are: • Woman feels better • Feels good about herself • Concerned with producing a healthy baby • Self- Centered and Introverted • Visualizes the infant as a separate being • Views body image changes as positive sign that the baby is doing O.K.

28. The Second Trimester • Ways Health Care Worker can assist the woman to adjust: • Take advantage of the Prime Time for Teaching • Individual Care • Nutrition • Clothing • Exercise • Baby Care • Confirm that the baby is Growing and Doing Well • Praise her on following Prenatal Recommendations

29. The Third Trimester The Major Task is to Prepare for the end of Pregnancy and be able to say “I am Going to Be a Parent”

30. The Third Trimester • Major Feelings are: • Vulnerable • Fears loss of the baby • Fantasies about harm coming to the baby • Dependent • Needs satisfaction that partner / support person is there • Concerned with how to cope with labor and delivery • Need to Prepare for Parenthood

31. The Third Trimester • Ways in which the Health Care Worker can assist the woman to adjust: • Assure her of the baby’s well- being • Be a Good Listener • Nurture her by reassuring • Provide information about childbirth classes • Assist with contacting appropriate agencies that may assist in caring for infant after birth

32. The Andrews ask the nurse how long they can continue to have intercourse? What would the nurse base her response?

33. Sexual Changes • First trimester – decrease in sex drive • Second trimester – return of sex drive • Third trimester – decrease in sex drive • Exceptions – those women who are prone to preterm labor.

34. Special Needs in Pregnancy-Teen Pregnancy • Enter prenatal care late • Ecomonics can be a contributing factor

35. Effects on Teen Maternal Health • Client will be at increased risk for complications • Risk for alteration in nutritional needs • Risk for STI’s (sexually transmitted infections)

36. Nursing Intervention • What additional screening may be needed for the pregnant teen? • What teaching should be included for the first visit?

37. Psychosocial Impact • Sex Education • Prenatal Education and Economics • Impact on Parenting • Options

38. Client Teaching • Prenatal Care *Cognitive level * Welcoming and open-minded * Transportation • Parenting * Include important family members (Mom) * Include FOB where appropriate

39. Substance Abuse in Pregnancy • Maternal Effects * Cocaine * Tobacco * Marijuana • Fetal Effects * SGA * Delayed development * Sudden Infant Death Syndrome

40. Assessment and Management • Obtain a thorough health history • Patient teaching • Community resources

41. Legal and Ethical Implications • Nurse’s attitude • Legal Obligations

42. Family Violence in Pregnancy • Effects on maternal and fetal well-being and health * Risk to mom * Risk to fetus

43. Assessment and Management Disclosure • Assessment of contributing factors • Characteristics of the Abuser • Behaviors of the abused

44. Community Resources • Provide Emergency Contacts • Identify safe route out of the home • Identify safe non-emergency contacts

45. Nurse’s Role • Prevention and Management *Empower the victim * Make plans

46. The End