1. Nursing 471 A & P, Care for Pregnancy Dr. Jeannie Harper, PhD, RN

2. 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

3. 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

4. Uterus and Cervix Ballottement ~ 16-18 wks Quickening Multigravida 14-16 weeks Primagravida 20 weeks Leukorrhea

5. Breasts Tender, tingling, fuller, heavier Nipples pigmented Montgomery’s tubercles Colostrum present at 16 weeks

6. 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

7. Respiratory System Rate- no change or slight rise Total lung capacity-no change or slight decrease Oxygen consumption increases by 15-20%

8. Basal Metabolic Rate Varies Increases 15-20% at term

9. 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

10. Renal System GFR and RPF increase Mild glucosuria in 20% of pregnant women Mild proteinura may be present Increased tubular reabsorption

11. Integumentary System Hyperpigmentation Chloasma Striae gravidarum Linea nigra Angiomas

12. Integumentary System Palmar erythema Pruritis Epulis Acne, oily skin

13. Musculoskeltal System Lordosis Waddling Pelvic joint relaxation Diastasis recti abdominus

14. Neurologic System Carpal tunnel syndrome Numbness/tingling of hands Lightheadness and syncope in early pregnancy

15. Gastrointestinal System Appetite fluctuates Morning sickness 1 st trimester Peristaltic activity decreases Taste changes Craving Hemorrhoids Hypertrophy of gums Ptyalism Pyrosis

16. 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

18. Diagnosis of Pregnancy Subjective Symptoms Presumptive Objective Signs Presumptive Diagnostic Positive

19. 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

20. 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

21. 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

22. Education Discomforts of pregnancy Signs of potential complications Recognizing preterm labor Physical activity/exercise Body mechanics

23. Education Employment Rest and relaxation Dental care Medications Substance abuse

24. Education Safety Travel Sexual counseling Nutrition

25. Quality versus Quantity Do not diet Fluid requirements 6-8 glasses per day Protein and iron critical Pica

26. Nutrition Additional caloric requirements Pregnancy 300 in 2 nd and 3 rd trimesters Lactation 500 calories

27. 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

28. Adaptation to Pregnancy Maternal Accepting pregnancy Identifying with role of mother Reordering relationships Establishing relationship with unborn child Preparing for childbirth

29. Adaptation to Pregnancy Paternal Announcement phase Moratorium phase Focusing phase  Couvade Sibling

30. Special Pregnancy Care Cultural considerations Childbirth education Teen pregnancy