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Chapter 10-13

Psychological and Physiologic


Changes of Pregnancy
Prenatal Care
Promoting Fetal & Maternal Health
Maternal Nutrition
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Psychological Changes
Social
Cultural
Family
Individual

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Psychological
Tasks

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Diagnosis of Pregnancy
Presumptive signs of pregnancy

Probable signs of pregnancy

Positive signs of pregnancy


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Diagnosis

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Physiologic Changes
Reproductive changes
Uterine changes
Amenorrhea
Cervical changes
Vaginal changes
Ovarian changes

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Physiologic Changes (contd)

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Figure 9-3 Postural changes during pregnancy. Note the increasing lordosis of the lumbosacral spine and the increasing
curvature of the thoracic area.

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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physiologic Changes (contd)


Changes in breasts
Systemic changes
Integumentary system
Respiratory system
Temperature

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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physiologic Changes (contd)


Cardiovascular system
Blood volume
Iron needs
Heart
Blood pressure
Peripheral blood flow
Supine hypotension syndrome
Blood constitution
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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physiologic Changes (contd)


Gastrointestinal system
Urinary system
Fluid retention
Renal function
Ureter, bladder function

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Physiologic Changes (contd)


Skeletal system
Endocrine system
Placenta
Pituitary gland
Thyroid, parathyroid gland
Adrenal glands
Pancreas
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Physiologic Changes (contd)


Immune system
Competency decreases
IgG is decreased
Increase in WBC

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Health Promotion During Pregnancy


Preconceptual visit
Health history
Pelvic exam
Pap test
Labs

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Pregnancy Classification
GPTPALM
G-Gravida
P-Para
Term-full term infants at or > 37 weeks
Preterm-infants born < 37 weeks
A-spontaneous miscarriages or therapeutic
abortions
L-# of living children
M-multiple pregnancies
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Terms
Gestation: # weeks since LMP
Abortion: birth prior to 20 weeks/500 gm
Antepartum: Conception to onset of labor
Intrapartum: Onset of true labor to birth of
infant & placenta
Postpartum: Delivery of placenta until
womans body returns to pre-pregnant state
Stillbirth: infant born dead after 20 weeks
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Calculate GPTPALM

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GPTPALM
A pregnant woman who has a boy who was
born at 39 weeks 4 years ago, a girl born at
40 weeks 3 years ago, a girl born at 33
weeks 1 year ago and all are alive.
A woman who just delivered a baby girl at 32
weeks who is in the NICU and who has a son
at home who was born at 38 weeks.

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GPTPALM
A woman who just delivered twins at 34
weeks has a daughter at home who was born
at 39 weeks. She also had a miscarriage at
13 weeks 3 years ago.
A pregnant woman just found out she is
carrying twins. She has a son who was born
at 39 weeks and twin girls who were born at
38 weeks at home.
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Health Promotion During Pregnancy


(contd)
Choosing a health care provider
Provides care throughout pregnancy, birth
Initiate prenatal care early
Nurses role
Educate
Listen
Counsel

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Heath Assessment (contd)


Laboratory assessment
Blood studies
Urinalysis
Tuberculosis screening
Ultrasonography

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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Signs Indicating Complications


Vaginal Bleeding
Persistent Vomiting
Chills & Fever
Sudden Escape of Fluid from Vagina
Abdominal or Chest Pain
Pregnancy Induced Hypertension
Increase or Decrease in Fetal Movement
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Nursing Process
Assessment
Health history
Physical examination
Laboratory data
Environmental risk factors

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Nursing Process (contd)


Nursing diagnosis
Health-seeking behaviors
Anxiety
Risk for deficit fluid
Constipation
Disturbed body image
Risk for altered sexuality patterns
Disturbed sleep pattern
Fatigue
Risk for fetal injury
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Nursing Process (contd)


Outcome identification, planning
Set realistic goals
Short-term goals
Teaching
Direct application

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Nursing Process (contd)


Implementation
Pregnancy education
Role modeling

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Nursing Process (contd)


Outcome evaluation
Are identified goals being met?

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Health Promotion During Pregnancy


Self-care needs
Bathing
Breast care
Dental care
Perineal hygiene
Sexual activity
Exercise
Sleep
Employment
Travel
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Health Promotion During Pregnancy


First trimester discomforts
Breast tenderness
Palmar erythema
Constipation
Nausea, vomiting, pyrosis
Fatigue
Muscle cramps
Hypotension
Varicosities
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Health Promotion During Pregnancy


(contd)
First trimester discomforts
Hemorrhoids
Heart palpitations
Frequent urination
Abdominal discomfort
Leukorrhea

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Health Promotion During Pregnancy


(contd)
Middle- to late-pregnancy discomforts
Backache
Headache
Dyspnea
Ankle edema
Braxton Hicks contractions

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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Teratogens
Any factor than adversely affects fertilized
ovum, embryo, or fetus

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Teratogenic Fetal Exposure


Maternal infections
Toxoplasmosis
Rubella
Cytomegalovirus
Herpes simplex virus
Syphilis
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Teratogenic Fetal Exposure (contd)


Lyme disease
Infections
Vaccines
Drugs
Alcohol
Cigarettes
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Teratogenic Fetal Exposure (contd)


Environmental
Metal, chemical
Radiation
Hyperthermia, hypothermia
Maternal stress

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Preparing for Labor


Lightening
Show
Rupture of membranes
Excess energy
Uterine contractions

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Nutrition During Pregnancy


National Health Goals
Weight gain During Pregnancy
Assessment of Nutritional Health

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Hyperemesis Gravidarum
Assessment
Prevention
Treatment

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