Chapter 10 Physiological Psychological Changes in Pregnancy

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<ul><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 1/48</p><p>Psychological and Physiologic</p><p>Changes in Pregnancy</p><p>Pregnancy brings both psychological andphysical changes to the woman and her</p><p>partner.</p><p>Physiologic changes occur gradually buteventually affect all organ systems of a</p><p>womans body.</p><p>Psychological changes occur in response to</p><p>physiologic alterations.</p><p>Pregnancy represents wellness not illness.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 2/48</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 3/48</p><p>Diagnosis of Pregnancy</p><p>Marks a major milestone.</p><p>Presumptive Signs of Pregnancy:</p><p> least indicative of pregnancy, could indicate</p><p>other conditions</p><p> subjective-experienced by the woman</p><p>breast changes, nausea, vomiting,</p><p>amenorrhea, frequent urination, fatigue,uterine enlargement, quickening, linea</p><p>nigra, melasma, stria gravidarum.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 4/48</p><p>Probable Signs of PregnancySigns that can be documented by the examiner</p><p>Serum laboratory tests:</p><p> hCG in urine or blood serum of the women.</p><p> accurate 95% to 98 % of the time.</p><p> home pregnancy tests are 97% accurate.</p><p> women taking psychotropic drugs may have</p><p>a false positive result on pregnancy test. discontinue oral contraceptives 5 days</p><p>before the test.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 5/48</p><p> Chadwicks sign</p><p> Goodells sign Hegars sign</p><p> Sonographic evidence of gestational sac</p><p> Ballottement</p><p> Braxton Hicks sign</p><p> Fetal outline felt by examiner</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 6/48</p><p>Positive Signs of Pregnancy</p><p> Sonographic evidence of fetal outline</p><p>week 6-8 Fetal heart audible</p><p>week 18-20</p><p> Fetal movement felt by examiner</p><p>week 20-24</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 7/48</p><p>Psychological Changes of Pregnancy</p><p>Psychological Changes of Pregnancy:</p><p>The womans attitude toward the pregnancy dependson the environment in which she is raised.</p><p>Social influences</p><p> Pregnancy is not an illness, now the family isincluded.</p><p> Use of birthing centers has increased.</p><p> Demedicalize childbirth.</p><p>Cultural influences How active a role she wants to take.</p><p> Certain beliefs and taboos may place restrictionson her behaviors and activities.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 8/48</p><p>Psychological Changes of Pregnancy</p><p>Family influences</p><p> Viewed in a positive or negative light.</p><p> Stories about pain and endless suffering in</p><p>labor.</p><p> People love as they have been loved.</p><p>Individual influences</p><p> Ability to cope with or adapt to stress. Secure in her relationship.</p><p> Pregnancy takes away her freedom.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 9/48</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 10/48</p><p>Psychological Tasks of Pregnancy</p><p>1st Trimester:</p><p>Accepting the Pregnancy</p><p> 50% of all pregnancies are unintended,</p><p>unwanted or mistimed. Surprise!</p><p> Women sometimes experience</p><p>disappointment, anxiety or ambivalence.</p><p> Partner may go through some changes also.</p><p> Partner should give emotional support.</p><p> May feel proud, happy, jealous or loss.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 11/48</p><p>Psychological Tasks of Pregnancy</p><p>2nd Trimester</p><p>Accepting the Baby:</p><p> Second turning point is often quickening.</p><p> Proof of the childs existence.</p><p> Anticipatory role playing.</p><p> May accept at conception, at birth or later.</p><p> How well she follows prenatal instructions. Partner may feel left out, he may increase</p><p>his work, he has misinformation.</p><p> Educate both partners. </p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 12/48</p><p>Psychological Tasks of Pregnancy</p><p>3rd Trimester:</p><p>Preparing for Parenthood</p><p> nest building</p><p> attending prenatal classes or parentingclasses.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 13/48</p><p>Reworking Developmental Tasks</p><p> working through previous life experiences.</p><p> womans relationship with her parents,particularly her mother.</p><p> fear of dying.</p><p> Needs confidence in health care providers. Men may need to reconcile feelings toward</p><p>fathers and learn a new pattern of behavior.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 14/48</p><p>Psychological Tasks of Pregnancy</p><p>.</p><p>Role-playing and Fantasizing:</p><p> Second step in preparing of parenthood.</p><p> Spend time with other mothers to learn how</p><p>to be a mother. Needs good role models.</p><p> Father may need to change his carefree</p><p>individual to a member of a family unit.</p><p> Nurturing roles.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 15/48</p><p>Emotional Responses to Pregnancy</p><p> Ambivalence</p><p> Grief Narcissism</p><p> Introversion versus Extroversion</p><p> Body Image and Boundary</p><p> Stress</p><p> Couvade Syndrome</p><p> Emotional Lability</p><p> Changes in Sexual Desire</p><p> Changes in the Expectant Family </p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 16/48</p><p>Physiologic Changes of Pregnancy</p><p>Local changes - confined to the reproductive</p><p>organs.</p><p>Systemic changes - affecting the entire body.</p><p>Both subjective (symptoms) and objective</p><p>(signs) findings are used to diagnose andmark the progress of the pregnancy.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 17/48</p><p>Physiologic Changes of Pregnancy</p><p>Reproductive System Changes:</p><p>Uterine changes: Increase in size, length, depth, width, weight,</p><p>wall thickness and volume.Length-from 6.5 to 32 cm.</p><p>Depth-increases from 2.5 to 22 cm.Width-expands from 4 to 24 cm.</p><p>Weight-increases from 50 to 1,000 g.</p><p>Uterine wall thickens from 1 cm to 2 cm by the</p><p>end of pregnancy, the wall thins so it is supple and0.5 cm thick.</p><p>Volume of uterus increases from 2 mL to 1,000mL. It can hold a 7 lb. fetus plus 1,000 mL ofamniotic fluid. Total 4,000 g.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 18/48</p><p>Physiologic Changes of Pregnancy</p><p>Uterine growth is due to formation of a few</p><p>new muscle fibers and stretching of existingmuscle fibers (2 to 7 times longer).</p><p>Week 12 the fetus is palpated just above the</p><p>symphysis pubis.Week 20 or 22 the fetus is at the umbilicus.</p><p>Week 36 should touch the xiphoid process</p><p>which causes some SOB.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 19/48 </p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 20/48</p><p>Terms</p><p>Primigravida - woman in her 1st pregnancy.</p><p>Multipara - a woman who has had 1 or more</p><p>children.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 21/48</p><p>Physiologic Changes of Pregnancy</p><p>Lightening - 2 weeks before term (week 38)</p><p>the fetal head settles into the pelvis toprepare for birth and the uterus returns to</p><p>the height it was at on the 36 week.</p><p> This permits better lung expansion andeasier breathing.</p><p> This is predictable in 1st birth but not</p><p>others. Uterine growth is a presumptive sign of</p><p>pregnancy.</p><p>i i C f</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 22/48</p><p>Physiologic Changes of Pregnancy</p><p>As the uterus increases in size it:</p><p> pushes the intestines to the side elevates the diaphragm and liver</p><p> puts pressure on the bladder</p><p>Uterine blood flow increases:</p><p> before pregnancy - 15 to 20 mL/ min.</p><p> by the end of pregnancy - 500 to 750</p><p>mL/min. with 75% going to the placenta.</p><p> Uterine bleeding can be a major blood loss.</p><p> Uterus is anteflexed, larger and softer.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 23/48</p><p>Physiologic Changes of Pregnancy</p><p>Hegars sign - extreme softening of the lower</p><p>uterine segment. The wall can not be felt orit feels as thin as tissue paper with bimanual</p><p>exam.</p><p>Ballottement - on bimanual exam, tapping oflower segment the fetus is felt to bounced or</p><p>rise in the amniotic fluid up against the to</p><p>top examining hand (week 16 to 20).Braxton Hicks contractions - practice</p><p>contractions. Week 12 until term. Waves of</p><p>hardness or tightening across the abdomen. </p><p>Ph i l i Ch f P</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 24/48</p><p>Physiologic Changes of Pregnancy</p><p> They serve as warm-up exercise and</p><p>increase placental perfusion.</p><p> False labor, the do not cause cervical</p><p>dilation.</p><p>Amenorrhea - absence of menstruation dueto suppression of FSH.</p><p> Presumptive sign.</p><p>Cervical changes:</p><p> Cervix more vascular and edematous.</p><p> Increased fluid between the cells causes</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 25/48</p><p>Physiologic Changes of Pregnancy</p><p>the cervix to soften and increased</p><p>vascularity causes it to darken from pale</p><p>pink to a violet hue.</p><p> A tenacious coating of mucus fills the</p><p>cervical canal.</p><p> Operculum - mucous plug - seals out</p><p>bacteria during pregnancy.</p><p> Goodells sign - softening of the cervix.</p><p>Nonpregnant cervix is like the nose.</p><p>Pregnant is like earlobe.</p><p>Ph i l i Ch f P</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 26/48</p><p>Physiologic Changes of Pregnancy</p><p> Just before labor the cervix becomes soft</p><p>like butter and is ripe for birth.Vaginal changes:</p><p> vaginal epithelium become hypertrophic</p><p>and enriched with glycogen which results inwhite vaginal discharge throughout</p><p>pregnancy.</p><p> Chadwicks sign - vaginal walls are deepviolet color due to increased circulation.</p><p> pH 4 to 5 (from pH over 7) favors growth of</p><p>Candida albicans (yeast like fungi). </p><p>Ph i l i Ch f P</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 27/48</p><p>Physiologic Changes of Pregnancy</p><p> due to Lactobacillus acidophilus a bacteria</p><p>that grows freely in glycogen environment,</p><p>so this increases the lactic acid content.</p><p>Ovarian changes:</p><p> ovulation stops.</p><p> Corpus luteum increases in size until week</p><p>16 and then the placenta has taken over as</p><p>provider of progesterone and estrogen.</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 28/48</p><p>Physiologic Changes of Pregnancy</p><p>Changes in the breasts:</p><p> result of estrogen and progesterone</p><p>production. (1st change)</p><p> feeling of fullness, tingling or tenderness.</p><p> Size increases due to hyperplasia of</p><p>mammary alveoli and fat deposits.</p><p> aerola darkens and diameter increases to 3.5</p><p>cm to 5 or 7.5 cm (1 1/2 to 3 inches)</p><p> blue veins become prominent.</p><p> Montgomerys tubercles-sebaceous glands</p><p>Ph i l i Ch f P</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 29/48</p><p>Physiologic Changes of Pregnancy</p><p>of the areola enlarge and become protuberant.</p><p> secretions keep the nipple supple and help</p><p>prevent cracking and drying during lactation</p><p> week 16 colostrum-a thin, watery, high</p><p>protein fluid can be expelled from the breast</p><p>Systemic Changes:</p><p>Integumentary System</p><p> Abdominal wall must stretch</p><p> Striae gravidarum - pink or reddish</p><p>streaks on sides of abdomen and thighs.</p><p>S t i Ch</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 30/48</p><p>Systemic Changes</p><p> Caused by rupture and atrophy of the</p><p>connective layer of the skin. After birth this lightens to silvery-white</p><p>color. (permanent)</p><p> Diastasis-rectus muscles separate, willappear after pregnancy as a bluish groove.</p><p> Umbilicus stretches until it is smooth.</p><p> Extra pigmentation on abdominal wall. Linea nigra - brown line from umbilicus to</p><p>symphysis pubis.</p><p>S t i Ch</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 31/48</p><p>Systemic Changes</p><p> Melasma - darkened areas on face due to</p><p>melanocyte-stimulating hormone secretedby the pituitary.</p><p> Vascular spiders - small fiery-red branching</p><p>spots on thighs, increases estrogen. Palmar erythema - redness and itching.</p><p> Increased sweat gland activity.</p><p> Scalp hair growth increases.</p><p>S t i Ch</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 32/48</p><p>Systemic Changes</p><p>Respiratory System</p><p> SOB Chronic respiratory alkalosis compensated</p><p>by chronic metabolic acidosis.</p><p> Diaphragm is displaced by 4 cm upward. Vital capacity does not decrease.</p><p> Total O2 consumption is increased by 20%.</p><p> Mild hyperventilation.</p><p> Polyuria - increased urination due to</p><p>plasma bicarbonate excreted by the kidneys.</p><p>S t i Ch</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 33/48</p><p>Systemic Changes</p><p> respirations &gt; 20/min.</p><p> congestion of nasopharynx - increasedestrogen levels</p><p>Temperature:</p><p> increased for 16 weeks due to secretion ofprogesterone from the corpus luteum,</p><p>returns to normal once the placenta takes</p><p>over.</p><p>S t i Ch</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 34/48</p><p>Systemic Changes</p><p>Cardiovascular System:</p><p>Changes are extreme and significant to thehealth of the fetus.</p><p>Blood volume</p><p> increases by 30 to 50 %</p><p> blood loss at birth-300 to 400 mL</p><p> cesarean birth-800 to 1,000 mL</p><p> increase blood volume peaks at week 28 to</p><p>32</p><p>Systemic Changes</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 35/48</p><p>Systemic Changes</p><p> Pseudoanemia - concentration of</p><p>hemoglobin and erythrocytes decline.</p><p>Iron needs</p><p> fetus requires 350 to 400 mg to grow.</p><p> Mother has an increase in RBC needing anadditional 400 mg of iron.</p><p> Prenatal vitamins and foods supply needs.</p><p>Heart cardiac output increases by 25 to 50 %</p><p> heart rate increases by 10 beats/ min.</p><p> heart is shifted more transverse </p><p>Systemic Changes</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 36/48</p><p>Systemic Changes</p><p> Innocent heart murmurs due to positioning.</p><p> Palpitations SNS</p><p>Regional blood flow:</p><p> 3rd trimester blood flow to lower</p><p>extremities is impaired due to pressure onveins and arteries.</p><p> leads to edema and varicoaities.</p><p>Blood pressure:</p><p> does not normally rise</p><p> may decrease in 2nd trimester</p><p>S stemic Changes</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 37/48</p><p>Systemic Changes</p><p>Supine hypotension syndrome:</p><p> when woman lies supine the weight of theuterus presses on the vena cava obstructing</p><p>blood return to the heart.</p><p> risk fetal hypoxia lightheadedness, faintness and palpitations.</p><p> rest on left side.</p><p>Blood constitution: level of circ. fibrinogen increases 50%.</p><p> Factors VII, VIII, IX, X and platelets</p><p>increase. </p><p>Systemic Changes</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 38/48</p><p>Systemic Changes</p><p> Blood lipids increase by 1/3</p><p> cholesterol level increase 90 to 100 %</p><p>Gastrointestinal system</p><p>Uterus displaces the stomach and intestines</p><p>toward the back and sides of the abdomen. Pressure slows peristalsis and the emptying</p><p>time of the stomach.</p><p> Leads to heartburn, constipation andflatulence.</p><p> Nausea and vomiting in early morningwhen hCG and progesterone begin to rise.</p><p>Systemic Changes</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 39/48</p><p>Systemic Changes</p><p> May be a systemic reaction to increases</p><p>estrogen or decreased glucose levels.</p><p> Subsides after 3 months</p><p> Generalized itching due to reabsorption of</p><p>bilirubin into the mothers blood stream due</p><p>to decreased emptying of bile from the GB.</p><p> Hypertrophy of the gumlines and bleeding.</p><p> Peptic ulcers improve.</p><p>Systemic Changes</p></li><li><p>7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy</p><p> 40/48</p><p>Systemic Changes</p><p>Urinary System</p><p> Effects of estrogen and progesteroneactivity.</p><p> Compression of the bladder and ureters.</p><p>...</p></li></ul>

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