1. Physiological Adaptations to Pregnancy Effects of Pregnancy on PERSON

2. Reproductive Organ Changes Uterus 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 --Hegar’s sign uterine souffle Patient teaching Braxton-Hicks contractions

3. Cervix 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?

4.  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 ?

5.  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?

6. The Elimination Need Gastrointestinal Changes n n Nausea and Vomiting – –Related to: » »increased levels of HCG » »changes in CHO metabolism » »fatigue –Nursing 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

7. –Nursing Care » »avoid large meals » »use good posture » »Take low Sodium antacids -- n 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

8. n Mrs. Andrews says that she just mixes up some baking soda and that takes care of her indigestion. n Is there any teaching that needs to be done in this situation?

9. n Constipation – –Related to: » »slowing of motility » »intestinal compression » »oral iron supplement –Nursing Care » »Increase water and fiber in diet » »moderate exercise » »**Don’t take laxatives or enema without a doctor’s permission n Hemorrhoids – –Related to : » »pelvic congestion » »straining with stool –Nursing Care » »avoid constipation » »Apply topical agents to area

10. Elimination Need Urinary System n 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 n Urinary frequency and urgency – –Related to: » »pressure of uterus on bladder Nursing care Nursing care Kegels exercises Limit fluid intake before bedtime Report dysuria or burning

11. Regulatory Need n Joints, bones, and teeth – –Softening of pelvic cartilage and exaggerated elasticity of connective tissue – –Posture changes – –Leg cramps – –Carpal tunnel syndrome – –Teeth--there is no demineralization n Endocrine – –The placenta produces new hormones n Exercise, Leisure – –May attend regular prenatal exercise classes – –Don’t take up a new sport – –Travel--wear seat belt

12. Safety with Seat Belts Wear shoulder belt over top of abdomen over top of abdomen Wear lap belt low over the hips

13. Regulatory Need n Mrs. Andrews says that she is employed as a bank teller on a full time basis. n She asks whether she can continue to work throughout her pregnancy

14. Regulatory Need n Employment – –Criteria for work: » »is work environment safe for the fetus » »can woman carry out work commitments without undue stress\ n n What other teaching is necessary regarding work and breaks.

15. Safety / Sensory Need n Skin changes – –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 n Safety – –Clothing – –Bathing – –Immunizations - avoid live vaccines

16. Oxygenation Need n Circulatory System – –Related to: » »cardiac enlargement » »vasodilation » »increase blood volume, hemodilution » »increase cardiac output – 30-50% n n 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.

17. 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

18. n Respiratory changes – –Related to: » »Thoracic cage is pushed upward and the diaphragm is elevated as uterus enlarges » »Oxygen consumption is increased to support fetus » »Lower thoracic cage widens to increase tidal volume n 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

19. Nutrition Need n I n Increase in calories n n Increase in protein n n May have food cravings or Pica Nursing care: – –Teach to take prenatal vitamins and iron – –Teach about normal weight gain ~ 25 lbs.

20. n The End return