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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph
Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

MODULE 3
Physiologic Adaptation of the Mother

Module Description

Pregnancy brings physical as well as physiologic changes which occurs gradually and
eventually affects all organ system. This module, deals with the different physiologic changes
that happens in a pregnant woman. As nurse it is important for us to know this changes in order to identify
the warning signs of ineffective anatomic and physiologic adaptations to pregnancy

Learning Outcomes

At the end of the module, students will be able to create a safe, appropriate, and holistic
care to the individuals, families, population groups and community utilizing nursing process
students will be able to:

a. identify and determine physiologic changes that happens in the body

b. determine what is not a normal physiologic occurrence during pregnancy
c. will learn how to management the different physiologic changes
d. care holistically for the pregnant mothers

CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)

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Topic 1 Physiologic Adaptation of the Mother

Systemic

I. Reproductive
a. Ovaries – positive feedback mechanism – non-release of FSH and LH
b. Uterus -Increases in size and weight (2 oz to 2 lbs), softens and becomes elastic to
accommodate the baby
 Hegar’s sign– softening of the lower uterine segment
 Braxton Hicks – periodic uterine tightening
 Ballotement – bouncing of the fetus against examiner’s hand
 Uterine soufflé – blowing sound heard over the pregnant uterus that is synchronous
with the mother’s heartbeat and is due to the rush of blood through the large
uterine vessels
c. Cervix
 operculum – mucus plug to seal out bacteria and help prevent infection
 Goodell’s sign – softening of the cervix

d. Vagina
 Chadwick’s sign – color change of the vagina from pink to violet
 Leukorrhea – whitish vaginal discharge

e. Breast
 Enlargement and darkening of the areola
 Tenderness, fullness, or tingling

II. Cardio vascular system-

 increase blood volume- 30-50%= 1,500cc of blood
 easy fatigability
 increase heart workload
 slight hypertrophy of the ventricles
 epistaxis- due to hyperemia of nasal membranes
 palpitations
 blood flow to uterus and placenta improves when pt is in a left side lying position

*Pathogenic Anemia- Iron Deficiency anemia- most common hematological disorder

Affects 20 % of pregnant women
Assessment:
Normal Values:
 pallor, constipation
Women
 slowed capillary refill
 concave finger nails Hct - 32- 42%
Hgb- 10.5 – 14g/dL

CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)

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Nursing Care:

 Nutritional instruction- green leafy- alugbati, saluyot, malunggay, ampalaya, liver.

 Iron supplement- ( ferrous sulfate 0.3g 3x a day) empty stomach 1 hr before/2 hrs after,
black stool, constipation
 Parenteral Iron- ( Imferon) severe enemia, given IM, Z track, - can cause hematoma
 Monitor for hemorrhage

Note:

Iron is best absorbed when taken with vitamin C

III. Respiratory system

 shortness of breath (SOB) -is the most common problem is due to the enlarged uterus and
increased oxygen demand
 residual volume- (the amount of air remaining in the lungs after expiration) decreased up to 20%
by the pressure of the diaphragm
 Tidal volume – ( volume of air inspired) is increased by 30%-40%
 total oxygen consumption increases by as much as 20%
Management:
Position- side-lying lateral expansion of the lungs
elevate head of bed

IV. Gastrointestinal
 Morning sickness- N&V due to increased HCG
 Eat dry crackers or dry CHO diet 30 mins before arising bed
 Small frequent feeding
*Vomiting in pregnancy -excessive- hyperemesisgravidarum
- metabolic alkalosis, F & E imbalance
Mngt: -replace fluid
- monitor I & O
 Constipation- progesterone, decreased activity, slow peristalsis
Increase fiber in the diet; fruits ( papaya, mango, pineapple,watermelon etc except
guava)
Exercise
Increased fluid intake
 Flatulence-
Avoid gas forming food like- cabagge, bread,
 Heartburn- pyrosis, the reflux of the gastric content to the esophagus
Small frequent feeding, avoid 3 full meals, avoid fatty and spicy food, sips of milk
Avoid lying after eating, remain upright for atleast 30mins

*ptyalism- increase salivation –- mngt, mouth wash

CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)

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 Hemorrhoids- pressure of the gravidarus

Hot sitz bath
Avoid prolonged standing, walking
Avoid carrying heavy objects
eat fiber rich foods to prevent constipation

V. Urinary System
 frequency during the 1st and 3rd tri, due to pressure on the bladder
 nocturna- (urination at night) avoid drinking water before going to sleep

VI. Muskulo skeletal

 LORDOSIS- the pride of pregnancy
 Waddling gait- awkward walking due to relaxation. Causes softening of joints and knees,
prone to falls- wear low heeled shoes
 Leg cramps- pronged standing, over fatigue, Ca & phosphorus imbalance,
Mngt: increase Ca in the diet- 1pint/day or 3-4 servings/day ( cheese, yogurt, head
of fish, broccoli,
Vit D for increased Ca absorption
Exercise- dorsiflexion

VII. Integumentary System

 Striae gravidarum- pink or reddish streak appearing on the sides of the abdominal wall
and sometimes on the thighs due to stretching and rupture of the connective tissue of the
skin
 linea nigra – a narrow brown line running from the umbilicus to symphysis pubis
 melasma – ( chloasma) the “mask” of pregnancy, darken areas that may appear on the
face as well on the cheeks and across the nose; this is due to increased melanocyte-
stimulating hormone
 vascular spiders – (telangiectases) fiery-red branching spots seen on skin of pregnant
women particularly on the thighs

Striae Gravidarum linea nigra

CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)

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vascular spiders
Melasma

TOPIC 2 PSYCHOLOGICAL ADAPTATION/ PSYCHOSOCIAL CHANGE

- it occur in response to physiologic changes

CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)

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Trimesters in pregnancy

1st trimester- 1-3 months

2nd trimester- 4-6 months
3rd trimester- 7-9 months

DIAGNOSIS OF PREGNANCY

CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)

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Duration of Pregnancy
Full-term- 38-40 weeks
pre-term- < 37 weeks
post term- > 40 weeks
abortion - < 24 weeks

CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)

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CABIDES,ANICAS, JOVEN ET.AL (UNP-CN FACULTY) NCM 107 (OB LEC)