Physiological and Psychosocial Changes During Pregnancy Chapter 8 Physiological and Psychosocial Changes During Pregnancy

Hormonal Influences Pituitary hormones Corpus luteum Influence ovarian follicular development Prompt ovulation Stimulate uterine lining Corpus luteum Estrogen: growth Progesterone: maintenance

Ovarian Hormones Maintain endometrium Provide nutrition Aid in implantation Decrease uterine contractility Initiate breast ductal system development

Reproductive System

Uterus Patterns of uterine growth Estrogen, progesterone: hyperplasia, hypertrophy allow uterus to enlarge, stretch Weight increases from 70 g to 1100 g at term Increased blood flow

Braxton-Hicks Contractions Irregular, painless Prepare uterine muscles If irregular and last <60 seconds, reassure woman Regular pattern or associated with other symptoms, seek medical attention

Cervix Chadwick’s sign Goodell sign Softens Forms mucus plug Call if discharge bloody or yellow/green, foul odor, itching, or pain Refer to figure 8-3 for Chadwick’s sign

Vagina and Vulva Thickening of vaginal mucosa Rugae Becomes edematous More susceptible to yeast infections pH: decreases from 6.0 to 3.5 Discuss vulvar hygiene

Other Reproductive Changes Ovaries Breasts Montgomery tubercles Increased pigmentation (areolae) Discuss bra size changes, options for infant feeding, and strategies for successful breastfeeding Refer to figure 8-4 for Stria gravidarum

Integumentary System Hyperpigmentation Cutaneous vascular changes Chloasma Linea nigra Cutaneous vascular changes Striae gravidarum Angiomas Palmar erythema Refer to figure 8-5 for chloasma

Neurological System Decreased attention span Poor concentration Memory lapses Carpal tunnel syndrome Syncope Anticipatory guidance regarding changes

Cardiovascular System

Heart Position: pushed upward, laterally to left Cardiac hypertrophy due to increased blood volume, cardiac output Heart sounds: exaggerated first and third; systolic murmurs

Blood Volume Plasma and erythrocyte volume increase Increased need for iron Physiologic anemia Teach regarding adequate hydration and diet high in protein, iron Increased fibrinogen volume

Cardiac Output Blood pressure Stasis of blood in lower extremities: risk for varicose veins and venous thrombosis Encourage daily walks to enhance circulation, improve intestinal peristalsis

Supine Hypotension Syndrome Pressure from enlarged uterus decreases venous return from lower extremities Hypotension, dizziness, diaphoresis, pallor Orthostatic hypotension Stagnation of blood in lower extremities Encourage to rise slowly; keep feet moving while standing

Supine Hypotension

Respiratory System Increased tidal volume Increased oxygen consumption Diaphragm elevates Increased chest circumference—dyspnea Educate regarding normal changes and symptoms

Eyes, Ears, Nose, Throat Blurred vision—decreased intraocular pressure and corneal thickening Temporary condition Nasal stuffiness, congestion—increased mucus production Epistaxis Encourage increased fluid intake

Gastrointestinal System

Upper GI Tract Mouth Esophagus—pyrosis, reflux Gingivitis, ptyalism, hypertrophy of gums, epulis Esophagus—pyrosis, reflux Stomach and small intestine Morning sickness, absorption of nutrients

Lower GI Tract Large Intestine—constipation Liver and gallbladder Cholestasia, cholecystitis, cholelithiasis

Urinary System Bladder Kidneys and ureters Structural changes Urinary frequency and urgency Kidneys and ureters Structural changes Functional changes Glomerular filtration rate increases

Endocrine System

Endocrine Glands Thyroid gland Pituitary gland Increased T4 Progressive increase in basal metabolic rate Pituitary gland Prolactin Oxytocin Vasopressin

Endocrine Glands Adrenal glands Pancreas Increased cortisol Increased aldosterone Pancreas Increased number, size of beta cells

Musculoskeletal System Postural changes Lumbar lordosis “Waddle” gait Calcium storage Decreased maternal serum calcium Lower extremity cramps

Assessment and Health Education Comprehensive history and physical exam Ongoing education focusing on current trimester and physical changes Refer to Box 8-1 for nursing diagnoses Refer to Table 8-3 for trimester-by-trimester approach

Maternal Role Transition Rubin—“tasks of pregnancy” Incorporate pregnancy into identity Acceptance of the child Reorder relationships See Table 8-5 for Maternal tasks of pregnancy

Pregnant Adolescent Normal adolescent developmental tasks conflict with tasks of pregnancy May not seek prenatal care Not future oriented—may not accept reality of unborn child Acceptance of pregnancy hindered

Paternal Adaptation Styles of involvement: observer, expressive, and instrumental Couvade “Announcement” phase “Moratorium” phase “Focusing” phase

Developmental Processes Grappling with the reality of pregnancy and the child Struggling for recognition as a parent Creating the role of involved father Seeking parenting information Couvade

Adaptation of Siblings Reactions influenced by age and level of involvement with pregnancy Toddlers Regression Older children May not grasp reality of a baby in the family Adolescents

Adaptation of Grandparents Age affects reactions Number and spacing of other grandchildren Perceptions of the role of grandparents

Other Considerations Single mother Cultural influences High-tech management Societal influences

Nursing Assessment of Psychosocial Changes Thorough history: family background, past obstetrical events, status of current pregnancy Each visit—ask about pregnancy experience, address concerns, offer anticipatory guidance Refer to Box 8-2 for appropriate nursing diagnoses Refer to Table 8-5 for suggested health teaching topics during each trimester

Anticipatory Guidance Refer to Table 8-5