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

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

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

4. Reproductive System

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

13. Cardiovascular System

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

15. 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

16. 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

17. 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

18. Supine Hypotension

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

20. 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

21. Gastrointestinal System

22. 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

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

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

25. Endocrine System

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

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

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

29. 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

30. 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

31. 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

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

33. 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

34. 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

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

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

37. 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

38. Anticipatory Guidance
Refer to Table 8-5