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Nursing 471 A & P, Care for Pregnancy Dr. Jeannie Harper, PhD, RN
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Uterus and Cervix Prepregnancy weight 60-70 grams Term weight 1100-1200 grams Out of true pelvis at 12 weeks At level of umbilicus at ~22 wks Rotates to right side Uterus, isthmus and cervix soften Uterine souffle arterial flow to placenta
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Uterus and Cervix Funic souffle blood flowing through umbilical cord Chadwick’s sign bluish discoloration of cervix Goodell’s sign softening of cervical tip Hegar’s sign softening of lower uterine segment
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Uterus and Cervix Ballottement ~ 16-18 wks Quickening Multigravida 14-16 weeks Primagravida 20 weeks Leukorrhea
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Breasts Tender, tingling, fuller, heavier Nipples pigmented Montgomery’s tubercles Colostrum present at 16 weeks
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Cardiovascular System Heart rate increases Cardiac output increases Blood volume increases by 40-50% RBC mass increases by 17% H and H decreases WBC count increases 2 nd and 3 rd trimester Clotting factors increase
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Respiratory System Rate- no change or slight rise Total lung capacity-no change or slight decrease Oxygen consumption increases by 15-20%
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Basal Metabolic Rate Varies Increases 15-20% at term
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Renal System Renal pelvis and ureters dilate R side more affected Bladder capacity increases to 1500 mls r/t decreased bladder tone Urinary frequency and urgency 1 st and 3 rd trimesters
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Renal System GFR and RPF increase Mild glucosuria in 20% of pregnant women Mild proteinura may be present Increased tubular reabsorption
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Integumentary System Hyperpigmentation Chloasma Striae gravidarum Linea nigra Angiomas
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Integumentary System Palmar erythema Pruritis Epulis Acne, oily skin
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Musculoskeltal System Lordosis Waddling Pelvic joint relaxation Diastasis recti abdominus
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Neurologic System Carpal tunnel syndrome Numbness/tingling of hands Lightheadness and syncope in early pregnancy
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Gastrointestinal System Appetite fluctuates Morning sickness 1 st trimester Peristaltic activity decreases Taste changes Craving Hemorrhoids Hypertrophy of gums Ptyalism Pyrosis
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Endocrine System HCG maintains corpus luteum Hormone levels increase Estrogen Progesterone Prolactin Relaxin Hormones decrease maternal ability to use insulin Estrogen Progesterone HCS/HPL Cortisol
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Diagnosis of Pregnancy Subjective Symptoms Presumptive Objective Signs Presumptive Diagnostic Positive
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Care of Pregnant Woman Initial Visit Interview Obstetric & current pregnancy history Medical and nutritional history Family and social history Height, Weight, FHR Physical Exam Laboratory Tests CBC, Bl type, Rh, VDRL/RPR, TB, HPV GBS, HIV, GC, Chlamydia, Hep B, Toxo Sickle cell, Pap Smear
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Initial Visit (cont’d) Gestational age EDC, EDD, EDB Noninvasive methods LMP date (Nagele’s Rule) Quickening date Fundal height measurement Invasive methods FHR by Doppler Ultrasongraphy
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Care of Pregnant Woman Subsequent Visits Monthly 1 st and 2 nd trimesters Every two weeks from week 28 Every week from week 36 Weight, BP, urinalysis FHR, fetal movement, fundal hgt 1-hr GTT 1 st visit if @ risk, 28 wks H&H @ 28wks, GBS @ 37 wks
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Education Discomforts of pregnancy Signs of potential complications Recognizing preterm labor Physical activity/exercise Body mechanics
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Education Employment Rest and relaxation Dental care Medications Substance abuse
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Education Safety Travel Sexual counseling Nutrition
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Quality versus Quantity Do not diet Fluid requirements 6-8 glasses per day Protein and iron critical Pica
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Nutrition Additional caloric requirements Pregnancy 300 in 2 nd and 3 rd trimesters Lactation 500 calories
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Weight Gain Based on Body Mass Index (BMI) Normal BMI11.5 – 16 kgs Underweight BMI12.5 – 18 kgs Overweight BMI7 – 11.5 kgs Obese BMIAt least 7 kgs Teens11.5 – 16 kgs
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Adaptation to Pregnancy Maternal Accepting pregnancy Identifying with role of mother Reordering relationships Establishing relationship with unborn child Preparing for childbirth
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Adaptation to Pregnancy Paternal Announcement phase Moratorium phase Focusing phase Couvade Sibling
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Special Pregnancy Care Cultural considerations Childbirth education Teen pregnancy
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