1. Introduction http://www.youtube.com/watch? v=fpUP6DeOH9Uhttp://www.youtube.com/watch? v=fpUP6DeOH9U

2. PHYSIOLOGIC ADAPTATIONS TO PREGNANCY Developed by D. Ann Currie, R.N., M.S.N. 2012

4. REPRODUCTIVE SYSTEM UTERUS CERVIX VAGINA BREASTS

5. REPRODUCTIVE SYSTEM UTERUS-ENLAREMENT DUE TO INCREASE ESTROGEN AND PROGESTERONE INCREASE VASCULARITY HYPERPLASIA HYPERTROPHY

6. Nonpregnant Uterus

7. UTERINE GROWTH LENGTH:2 1/2 in. to 12 1/2 in(6.5cm-32cm) WIDTH:1 1/2in to 9 1/2 in(4cm- 24cm) DEPTH:1in to 8 1/2 in(2.5cm- 22cm) WEIGHT;2 1/2oz. to 2 1/2 lb.(60- 70g-1100-1200g) VOLUME: 1-2ml to 5000ml(10ml- 5000ml)

8. Uterine Growth

9. CERVIX INCREASE VASCULARITY AND HYPERTROPHY DUE TO ESTROGEN AND PROGESTERONE CHADWICK’S SIGN GOODELL’S SIGN MUCORRHEA DEVELOPS- MUCOUS PLUG FORMS

10. Bimanual Examination

11. Hegar's sign

12. Ladin’s Sign

13. B Sign

14. Pisacek’s Sign

15. VAGINA INCREASE VASCULARIZATION DUE TO ESTROGEN AND SOFTEN ING DUE TO PROGESTERONE CHADWICK’S SIGN VAGINAL DISCHARGE TENDS TO BE THICK AND WHITE=LEUKORRHEA PH-4-6.5.(NONPREGNANT WOMAN 3.5-4.5)

16. BREASTS BREAST CHANGES ARE DUE TO ESTROGEN AND PROGESTERONE INCREASE VASCULARITY,NODULARITY,AN D HYPERTROPHY PIGMENTATION OF NIPPLES DARKEN MONTGOMERY’S GLANDS BECOME PROMINENT

17. BREASTS CONT COLOSTRUM IS PRODUCED AND MAYBE SECRETED AS EARLY AS 16 WEEKS BREAST FEEL FULL,INCREASE SENSITIVITY,TINGLELY,AND HEAVY.

18. BREAST CHANGES

19. HEMOLOGICAL CHANGES IN PREGNANCY BLOOD VOLUME-40-50 % INCREASE(1500 ML) PLASMA VOLUME-50% INCREASE(1200-1300ML) BY 30- 34 WEEKS RBC’S-17-20% INCREASE(5- 6.25MIL/MM PLT-150,000-400,000

20. HEMOLOGICAL CHANGES CONT WBC’S-INCRESE IN 2ND -3TH TRIMESTER(5,000-15,000MM-) FIBRINOGEN-INCRESAES 50- 80% FACTORS VII,VIII,IX,X- INCREASE FACTORS XI,XII-DECREASE SED RATE- INCREASES

21. CARDIOVASCULAR SYSTEM HEART RATE- INCREASES 10-15 BEATS PER MIN. B/P- 1ST TRIMESTER-REMAIN THE SAME-2ND TRIMESTER DECREASES- AND 3RD TRIMESTER RETURNS TO NORMAL CARDIAC OUTPUT-INCREASES 30-50%

22. CARDIOVASCULAR SYSTEM CONT MYOCARDIAL HYPERTOPHY- INCREASES 12% THE HEART IS SHIFTED UPWARD, ANTERIORLY AND LATERALLY TO LEFT HEART SOUNDS-S1,S2,S3 AFTER 20WKS.-MURMURS ARE COMMON

24. Supine Hypotension from pressure on the vena cava

25. RESPIRATORY SYSTEM INCREASED CHEST EXPANSION DIAPHRAGM DISPLACED AS MUCH AS 4CM. INCREASED VASCULARITY AND SECRETION OF MUCOUS MEMBRANES RESPIRATORY RATE INCREASES 2 BPM

26. RESPIRATORY SYSTEM CONT TIDAL VOLUME INCREASES 30- 40% VITAL CAPACITY UNCHANGED INSPIRATORY CAPACITY INCREASES EXPIRATORY VOLUME DECREASES TOTAL LUNG CAPACITY UNCHANGED OR SL.DECREASE.

27. RESPIRATORY SYSTEM CONT O2 CONSUMPTION INCREASES 15-20% PO2-INCREASES(104-108mmHG) PCO2-DECREASES(27-32mmHG0 HCO3-DECREASES(18-31mEq/L) PH-INCREASES(7.4-7.45)

28. RENAL SYSTEM RENAL PELVIS AND URETERS DILATE-RIGHT MORE THAN LEFT BLADDER CAPACITY- INCREASES TO 1500ML. GLOMERULAR FILTRATION RATE- INCREASES 30-50% RENAL PLASMA FLOW- INCREASES 30%

29. RENAL SYSTEM CONT LABS- GLUCOSE IN URINE UP TO 1+ PROTEIN-N URINE TRACE TO 1+ BUN-DECREASED 8-20mg/dl CREATININE-DECREASED (0.6- 1.2mg/dl) URIC ACID -DECREASED 1ST- 2ND TRIMESTER(4.5-5.8mg/dl)- 3rd back to normal

30. INTEGUMENTARY SYSTEM HYPERPIGMENTATION OF NIPPLES,AREOLAE, AXILLAE, AND VULVA CHLOASMA LINEA NIGRA STRIAE GRAVIDARUM ANGIOMAS

31. Linea Nigra

32. STRIAE GRAVIDARUM

33. INTEGUMENTARY SYSTEM CONT.PALMAR ERYTHEMA HYPERACTIVE SWEAT AND SEBACEOUS GLANDS SKIN DISORDERS MAY INCREASE-INCLUDING PRURITUS AND ACNE HAIR GROWTH INCREASES

34. GASTROINTESTINAL SYSTEM GUMS-INCREASE VASCULARITY,HYPEREMIC, SPONGY AND SWOLLEN EPULIS PTYALISM N/V-”MORNING SICKNESS” HIATAL HERNIA MAY OCCUR IN 15-20%PREGNANT CLIENTS

35. GASTROINTESTINAL SYSTEM HEARTBURN-PYROSIS DECREASE TONE AND MOLITY OF GI TRACT CONSTIPATION GB EMPTYING TIME IS SLOWED-GB STONE MAY FORM STOMACH IS DISPLACED UPWARD

36. GASTROINTESTINAL SYSTEM COLON IS COMPRESSED AND DISPLACED. APPETITE CHANGES

37. MUSCULOSKELETAL SYSTEM LORDOSIS OCCURS CENTER OF GRAVITY CHANGES GAIT CHANGES-”WADDLING” SL. RELAXATION OF PELVIC JOINTS MUSCLE TONE OF ABDOMINAL MUSCLESDECREASES DIASTASIS RECTI ABDOMINIS MAY OCCUR

38. POSTURAL CHANGES IN PREGNANCY

39. Diastasis Recti Abdominis

40. NEUROLOGIC SYSTEM COMPRESSION OF PELVIC NERVES EDEMA INVOLVING PERPHERAL NERVES MAY RESULT IN CARPAL TUNNEL SYNDROME. ACROESTHESIA TENSION H/A HYPOCALCEMIA-MUSCLE CRAMPS AND TETANY

41. ENDROCINE SYSTEM PITUITARY GLAND- SUPPRESSION OF FSH AND LH FROM ANT PITUITARY INCREASES IN SIZE MSH.,PROLACTIN,TSH,AND ADRENOCORTICOTROPIC HORMONE ARE INCREASED OYTOCIN INCREASES AS FETUS MATURES AND LABOR IS NEAR

42. ENDOCRINE SYSTEM THYROID GLAND-INCREASES IN SIZE SLIGHTLY BMR INCREASES 25%(15-20%) T4 INCREASES AND THAN RETURNS TO NORMAL PARATHYROID GLAND- PARATHYROID HORMONE INCREASES-PEAK AT 15-35 WKS

43. ENDOCRINE SYSTEM CONT PANCREAS-INSULIN PRODUCTION INCREASES- HOWEVER THERE IS PERIPHERAL RESISTANCE TO INSULIN BLOOD SUGARS-DECREASE IN 1ST TRIMESTER 2ND-3RD BLOOD SUGAR RISE TO NORMAL OR INCREASED

44. ENDOCRINE SYSTEM ADRENAL GLANDS-INCREASED ALDOSTERONE LEVELS,INCREASED CORTISOL LEVELS

45. ENDROCRINE SYSTEM PLACENTA-PRODUCES ESTROGEN AND PROGESTERONE RELAXIN HUMAN PLACENTAL LACTOGEN INSULINASE

46. IMMUNOLOGICAL SYSTEM HELPER T CELLS DECREASE SUPPRESSOR T CELLSS INCREASE B CELL FUNCTION IS SUPPRESSED IgG DECREASES RISK FOR INFECTION INCREASES WBC’S -INCREASE(5000-15000) POLYMORPHONUCLEAR NEUTROPHILS INCREASE

48. DANGER SIGNS DURING PREGNANCY SEVERE VOMITING FREQUENT AND SEVERE H/A EPIGASTRIC PAIN FLUID DISCHARGE FROM VAGINA VISUAL DISTURBANCES ABDOMINAL- UNUSUAL OR SEVERE PAIN FM CHANGES OR ABSENCE SWELLING OF HANDS AND FACE VAGINAL BLEEDING

50. QUESTIONS

51. Thank you http://www.youtube.com/watch? v=e7R5xxDy3QU&playnext=1&li st=PL31A451E578811741&featu re=results_mainhttp://www.youtube.com/watch? v=e7R5xxDy3QU&playnext=1&li st=PL31A451E578811741&featu re=results_main