Lecture No. 3-A Nursing Role During Pregnancy

8/3/2019 Lecture No. 3-A Nursing Role During Pregnancy

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PREGNANCY





estimated birth of date

NAGELE’S RULE

Get the first day of the lastmenstrual period, subtract 3

months, add 7 days, and add 1year.



the psychologic tasks of pregnancy

FIRST TRIMESTER

- accepting the pregnancy

SECOND TRIMESTER

- accepting the baby

THIRD TRIMESTER- preparing for parenthood



1. reproductive tract changes

2. integumentary changes

3. systemic changes



a. uterine changes

b. amenorrheac. cervical changes

d. vaginal changese. ovarian changes



- increase in length, depth, width,

and weight- length from 6.5 to 32 cm

- depth from 2.5 to 22 cm

- width from 4 to 24 cm

- weight from 50 to 1000 g

- this growth is due to muscle

fibers which aids in thestretching





Lightening is

the settling of

the fetal head

to prepare for

birth.



Fundus of the uterus

usually remainsmidline duringpregnancy, but maybe pushed slightly to

the right due to larger bulk of sigmoid colonon the left.



Bimanual examination

by week 6 of pregnancy would

reveal an extreme

softening of the lower uterine segment called

hegar’s sign.



During week 16 to

20 of pregnancy,ballottement (from

the french word

balloter, meaning “totoss about”) may be

demonstrated.



BRAXTON HICK’S CONTRACTIONS

- uterine contractions which beginas early as week 12, and ispresent throughout the rest of thepregnancy

- may be mistaken for true labor contractions and is often calledfalse labor





DURING PREGNANCY

- due to suppression of FSH- impregnation has occurred

WITHOUT PREGNANCY

- heralds onset of menopause- uterine infection, climate change,

chronic illness, or stress



In pregnancy, cervixbecomes more vascular and edematous. Atenacious coating of mucuscalled operculum fills thecervical canal which sealout bacteria duringpregnancy and helpprevent infection in the

fetus and membrane.



Softening of

the cervixduring

pregnacy iscalled

goodell’s sign.



Vagina during pregnancy become hypertrophic and

is enriched with glycogen, which results in whitedischarges.

Vaginal secretions during pregnancy fall from a pHof over 7 to 4 or 5, which, unfortunately, favors thegrowth of candida albicans.

Vaginal walls during pregnancy changes from lightpink to deep blue, called chadwick’s sign.



Ovulation stops due to

active feedbackmechanism of estrogen

and progesterone.

1. corpus luteum early

in pregnancy

2. placenta later in

pregnancy

http://embryology.med.unsw.edu.au/histology/reproductive/clu01he.jpg



a. striae gravidarum

b. diastasis

c. umbilicusd. extra pigmentation

e. vascular spiders

f. activity of sweat glands

g. changes in breasts



Pink or reddish streaks

appearing on the sides of abdominal wall or thighs.

Due to rupture and atrophy of

small segments of connective

layer of skin as the abdominalwall stretches.

Lightens to a silvery-white color

weeks after birth.



Separation of the rectus

muscle due to difficultyof the abdominal walls

to stretch.

Appears as a bluish

groove after pregnancy.



May appear to

be protruding asa round bump at

the center due tostretching of the

abdomen.



Linea nigra is abrown line fromthe umbilicus to

the symphysispubis.



Melasma aredarkened areason face,

particularlycheeks and

nose.



Small and fiery-red

branching spotsparticularly on thighs.

Result from increasedestrogen in the body.

May fade but notcompletely disappear after birth.



Increased perspiration.

Palmar erythema on hands.

Increased hair growth.



May experience feeling of fullness, tingling, or tenderness due to increased stimulation of breast tissue by high estrogen level in the body.

Breast size increases, due to hyperplasia of mammary alveoli and fat deposits.

Areola darkens in color, and diameter increasesfrom 3.5 to 5 or 7.5 cm.

Blue veins may become prominent over the surface

of the breasts.Sebaceous glands of areola enlarge and become

protuberant.

Colostrum can be expelled from the nipples as early

as 16th week.



a. respiratory system

b. temperature

c. circulatory system

d. gastrointestinal systeme. urinary system

f. skeletal system

g. endocrine system

h. carbohydrate metabolismi. adrenal glands

J. immune system



Feelings of shortness

of breath due toenlargement of the

uterus.

This causes a greatdeal of pressure on

the diaphragm and

lungs.



early in pregnancy:

- body temperature slightly increases

- due to progesterone from the CL

from 16 weeks onward:- temperature decreases to normal

- due to placental take-over



1. BLOOD VOLUME

2. PALPITATIONS

3. BLOOD PRESSURE

4. SUPINE HYPOTENSION SYNDROME5. BLOOD CONSTITUTION



1. BLOOD VOLUME

- increases from 30% to 50%- after birth, blood loss is

about 300 to 1000 ml

- woman may have

pseudoanemia

- all pregnant women neediron supplements



2. PALPITATIONS

- common duringpregnancy

- due to increased SNS

stimulation andincreased thoracicpressure



3. BLOOD PRESSURE

Despitehypervolemia, BPdoes not normally

rise due toincreased action of the heart.



4. SUPINE HYPOTENSION SYNDROME

Causes lightheadedness,faintness, and palpitations.

Weight of the growing uterus

presses the vena cava

against the vertebrae,obstructing blood flow from

the lower extremities

Suggest left side-lying position.



5. BLOOD CONSTITUTION

- fibrinogen, factor 7, 8, 9, and 10,

and platelet increases

- WBC increases

- lipids and cholesterol increases- protein decreases



Slow intestinal peristalsis and emptying time leads to heartburn,

constipation, and flatulence.

Decrease gastric motility due to presence of the relaxin hormone

during pregnancy.

Morning sickness due to increasing levels of HCG and

progesterone.

Subclinical jaundice or symptom of generalized itching due to

reabsorption of biliburin into the maternal bloodstream.

May have hypertrophy of gums, bleeding of gingival tissue when

brushing, and hyperptyalism.



Urine output

increases from about60% to 80% during

pregnancy, whiletotal body water

increases.



Calcium and phosphorus needs are

increased.Gradual softening of pelvic ligaments

due to relaxin and progesterone.Has the pride of pregnancy stance and

lordotic gait



The most striking change is the addition of the placenta.



Maternal glucose level should be maintainedhigh to prevent fetal hypoglycemia.

Though the fetal pancreas secretes

increased insulin, it appears to be not aseffective, that is why fat stores andglucose of the woman are utilized.



Activity of the adrenal

glands duringpregnancy increases.

Believed to suppress an

inflammatory reactionagainst the foreign

protein of the fetus.



Immunologic competency

decreases to

prevent rejecting the

fetus as foreign.

The IgG decreases, but

WBC increases.



WEEKS AOG PRESUMPTIVE SIGNS PROBABLE SIGNS POSITIVE SIGNS

1 ~ serum laboratory tests

2 ~ breast changes

~ amenorrhea

3 ~ frequent micturition

6 ~ chadwick’s sign

~ goodell’s sign

~ hegar’s sign

~ sonographic evidence of

gestational sac

8 ~ sonographic evidence offetal outline

10 ~ fetal heart audible

12 ~ fatigue

~ uterine enlargement

16 ~ ballottement

~ fetal outline

18 ~ quickening

20 ~ braxton hick’s sign

~ fetal outline felt by examiner

~ fetal movement felt by

examiner

24 ~ linea nigra

~ melasma

~ straie gravidarum



THE GROWING FETUS

1.FERTILIZATION

2.IMPLANTATION

3.FETAL DEVELOPMENT









MESODERM ~ supporting structures of the body

~ upper portion of the urinary system

~ reproductive system~ heart

~ circulatory system

~ blood cell

ENTODERM ~ lining of the GIT, respiratory tract, tonsils, parathyroid, thyroid,

thymus glands~ lower urinary system

ECTODERM ~ nervous system

~ skin, hair, nails

~ sense organs

~ mucous membranes of the anus and mouth



- rapidly growing embryo

- spinal cord has formed and fused at the

midpoint- head becomes prominent

- back is bent

- the rudimentary heart (fetal circulation and

fetal hemoglobin) appears as a prominentbulge on the anterior surface

- rudimentary eyes, ears, and nose arediscernible

- length is 0.75 to 1 cm and weight is 400 mg



- length is about 1 inch and weighs 20 g

- organogenesis is complete

- the heart beats rhythmically- genitalia is present, though not

discernible

- primitive tail is undergoing retrogression

- abdomen appears large- a sonogram would demonstrate a

gestational sac and is diagnostic of pregnancy



- length is 7 to 9 cm and weighs 45 g

- capable of spontaneous

movements though not felt by themother

- some reflexes such as babinski ispresent

- ossification of bones and toothbuds are formed

- kidney secretion has begun

- heart beat is audible by a doppler



- length is 10 to 17 cm and

weighs 55 to 120 g

- fetal heart tones can be heard

through a stethoscope

- formation of lanugo

- liver and pancreas are

functioning

- starts the swallowing reflex



- length is 25 cm and weighs

223 g

- mother feels the movement

- capable of antibody

production

- meconium is present

- definite sleep and activity

pattern



- length is 28 to 36 cm

and weighs 550 g

- vernix caseosa is

produced

- active production of

lung surfactantbegins

- the eyes can open



- length is 35-38 cm and weighs

1200 g

- lung alveoli begin to mature

- in the male, testes begin to

descend in the scrotal sac

- blood vessels of retina are

extremely susceptible to damage

from high oxygen concentrations



- length is 38-42 cm and

weighs 1600 g

- subcutaneous fats

begins to be deposited

- fetus is aware of the

sounds outside

- has an active moro

reflex



- length is 42 to 49 cm

and weighs 1900 to

2700 g

- amount of lanugo

begins to diminish

- most babies turn into avertex or head-down

presentation



- length, crown to heel, 48 to 52 cmand weighs 3000 g

- fetus kicks actively- fetal hemoglobin begins to

transform into adult hemoglobin

- vernix caseosa is fully formed- the sole creases covers 2/3 of the

foot’s surface

- lightening is felt



MATERNAL AND FETAL HEALTH

1. pre-natal check up

2. proper maternal nutrition

3. assessing fetal well-being



Documents

Lecture No. 3-A Nursing Role During Pregnancy