Physiological Adaptations to Pregnancy

1
Physiological Adaptations to Pregnancy

• Effects of Pregnancy on PERSON

2
Reproductive Organ Changes

• 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 --Hegars sign
• uterine souffle
• Patient teaching
• Braxton-Hicks contractions

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• 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?

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The Elimination NeedGastrointestinal Changes

• 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

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• 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

• Nursing Care
• avoid large meals
• use good posture
• Take low Sodium antacids --

8

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

9

• Constipation
• Related to
• slowing of motility
• intestinal compression
• oral iron supplement
• Nursing Care
• Increase water and fiber in diet
• moderate exercise
• Dont take laxatives or enema without a
  doctors permission
• Hemorrhoids
• Related to
• pelvic congestion
• straining with stool
• Nursing Care
• avoid constipation
• Apply topical agents to area

10
Elimination NeedUrinary System

• 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
• Urinary frequency and urgency
• Related to
• pressure of uterus on bladder
• Nursing care
• Kegels exercises
• Limit fluid intake before bedtime
• Report dysuria or burning

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Regulatory Need

• 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
• Endocrine
• The placenta produces new hormones
• Exercise, Leisure
• May attend regular prenatal exercise classes
• Dont take up a new sport
• Travel--wear seat belt

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Safety with Seat Belts
Wear shoulder belt over top of abdomen
Wear lap belt low over the hips
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Regulatory Need

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

14
Regulatory Need

• Employment
• Criteria for work
• is work environment safe for the fetus
• can woman carry out work commitments without
  undue stress\
• What other teaching is necessary regarding work
  and breaks.

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Safety / Sensory Need

• 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
• Safety
• Clothing
• Bathing
• Immunizations - avoid live vaccines

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Oxygenation Need

• Circulatory System
• Related to
• cardiac enlargement
• vasodilation
• increase blood volume, hemodilution
• increase cardiac output 30-50
• 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.

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• 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

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• 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
• 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

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Nutrition Need

• Increase in calories
• Increase in protein
• May have food cravings or Pica
• Nursing care
• Teach to take prenatal vitamins and iron
• Teach about normal weight gain 25 lbs.

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• The End
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