physiological and psychological changes of pregnancy

Physiological and Physiological and Psychological Changes of Psychological Changes of

PregnancyPregnancy

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

isthmus of uterus softens - uterine souffle

Patient teaching Braxton-Hicks contractions

Hegars Sign

Cervix softens - Goodells sign fills with a mucus plug increase in discharge, leukorrhea

Vagina increase in vascularity - Chadwicks sign increase in discharge, leukorrhea pH rises and become more susceptible to

yeast infections

Mrs. Andrews complains of a whitish discharge. What is the teaching regarding vaginal discharges?

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 ?

Breasts Growth of alveolar tissue Nipples become more pigmented

Mrs. Andrews states that her breasts are more full and have become very heavy.

What teaching should the nurse include?

Respiratory Changes

– The body adjusts to meet the oxygenation needs by:

» Thoracic rib cage is pushed upward and the diaphragm is elevated as uterus enlarges

» Lower thoracic cage widens to increase tidal volume

»Oxygen consumption is increased to support fetus

–Vasodilation of vessels in nose causing epistaxis and nasal stuffiness

Respiratory Changes

Nursing Care

– Instruct that because of shortness of breath and dyspnea may need to:

» sleep in an upright position

» avoid overloading the stomach

» stop smoking!

–Nasal stuffiness is normal because of increase in hormones

Cardiovascular 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. There is

an increase of about 1500 cc . Over 1000 cc of that is plasma.

– RBC -- ~5.7million which is about a 17% increase.

Cardiovascular Changes

Nursing Care

–Avoid supine hypotension by side lying

–Arise slowly from a lying position

–Wear support hose and avoid constipation to decrease formation of varicose veins

– Instruct that palpitations may be felt and are normal

Gastrointestinal Changes

Nausea and Vomiting –Related to:» increased levels of HCG» changes in CHO metabolism» fatigue

– Nursing CareNursing 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


– Nursing CareNursing Care

» avoid large meals

» use good posture

» Take low Sodium antacids --

Heartburn and Indigestion–Related to:

»slowing of motility and digestion because

of progesterone

»relaxation of cardiac sphincter, regurgitation occurs

»stomach displaced upward and compressed by

enlarged uterus


Constipation

–Related to:

» slowing of motility

» intestinal compression

» oral iron supplement


» Increase water and fiber in diet

»moderate exercise

» **Don’t take laxatives or enema without a doctor’s permission


Hemorrhoids

–Related to :

» pelvic congestion

» straining with stool


» avoid constipation

»Apply topical agents to area

Review

Mrs. Andrews says that she just mixes up some baking soda and that takes care of her indigestion.

Is there any teaching that needs to be done in this situation?

Urinary Changes

Renal Changes

–Related to:

»Kidneys increase in size and weight to enable greater filtration

»Enlarged uterus presses on kidneys and ureters reducing effective flow.

» ureters dilate

»Urinary stasis

Urinary Changes

Urinary frequency and urgency

–Related to:

» pressure of uterus on bladder

Nursing care

Kegels exercises

Limit fluid intake before bedtime

Report dysuria or burning

Skin and Hair Changes Skin

– Increase pigmentation RT increase in production of melanotropin

» face = chloasma

» breasts = areola darkens

» abdomen = linea nigra

– Spider nevi on face and upper trunk

– Striae gravidarum

Hair

– Increase in hair growth

Musculoskeletal Changes Joints, bones, and teeth

– Softening of pelvic cartilage and exaggerated elasticity of connective tissue can lead to unstable gait

– Posture changes

– Leg cramps

– Carpal tunnel syndrome

– Teeth--there is no demineralization

– Nursing CareWear low heel shoes for supportExercisesWalk leading with the heel of the footWrist supports until after delivery assist with pain related to

carpal tunnel syndrome. Goes away after delivery.

Weight Gain

Normal weight gain is about 25 lbs.

Be sure to teach about good nutrition

Hormones

Endocrine– The placenta produces new hormones:

» Human chorionic gonadotropin – maintain pregnancy

» Human placental lactogen – antagonist of insulin

» Estrogen – stimulates development of uterine lining

» Progesterone – maintains pregnancy

» Relaxin – aids in softening the cervix

The End

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physiological and psychological changes of pregnancy

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