NURS 247 CH 11 MATERNAL ADAPTATION DURNG PREGNANCY

PrepU A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucous discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse?

"A one time discharge of bloody mucus in the toilet might have been your mucous plug."

maternal physiologic changes that occur during pregnancy: endocrine system: progesterone

-"hormone of progesterone" -supports endometrium for fetal survival -produced by corpus luteum in first few weeks of preg until placenta can -initially causes, thickening of the uterine lining in anticipation of implantation of fertilized ovum -then maintains endometrium, inhibits uterine contractility + assists in the development of breasts for lactation

maternal physiologic changes that occur during pregnancy: breasts

-Breast changes begin soon after conception; they increase in size and areolar pigmentation -The tubercles of Montgomery enlarge and become more prominent, and the nipples become more erect -The blood vessels become more prominent, and blood flow to the breast doubles -creamy yellowish breast fluid called colostrum expressed by third semester

maternal physiologic changes that occur during pregnancy: ovaries

-Increased blood supply to the ovaries causes them to enlarge until approximately the 12th to 14th week of gestation. -you can't palpate ovaries after 12-14th week because they enlarge bc go blood supply and after you can't feel them bc uterus feels pelvic cavity -They actively produce hormones to support the pregnancy until weeks 6 to 7 when the placenta takes over the production of progesterone. -ovulation ceases during pregnancy bc of elevated estrogen + progesterone, which block FSH (follicle-stimulating hormone) and LH (luteinizing hormone) from anterior pituitary

maternal physiologic changes that occur during pregnancy: vagina

-Increased vascularity because of estrogen influences, resulting in pelvic congestion and hypertrophy -Increased thickness of mucosa, along with an increase in vaginal secretions to prevent bacterial infections -vaginal vault begins to lengthen

maternal physiologic changes that occur during pregnancy: cervix

-Increases in mass, water content, and vascularization -btw wks 6-8 cervix begins to soften (goodell's sign); more cervical mucus -Changes from a relatively rigid to a soft, distensible structure that allows the fetus to be expelled -Under the influence of progesterone, a thick mucus plug is formed, which blocks the cervical os and protects the developing fetus from bacterial invasion -increased vascularization causes Chadwicks sign, a cyanosis

maternal physiologic changes that occur during pregnancy: uterus

-Size increases to 20 times that of nonpregnant size -Capacity increases by 2,000 times to accommodate the developing fetus -Weight increases from 2 oz to approximately 2 lb at term -Uterine growth occurs as a result of both hyperplasia and hypertrophy of the myometrial cells -Increased strength and elasticity allow uterus to contract and expel fetus during birth -uterine contractility enhanced, you get Braxton Hicks contractions -changes in isthmus occur first 6-8 wks gestation, you get Hegar's sign; causes urinary frequency -isthmus (lower portion of uterus) gets increasingly thin -by 20 wks gestation, the fundus or top of the uterus is at the level of the umbilicus and measures 20 cm -fundus reaches highest level at xiphoid process, at 36 wks -by 40 wks fetal head begins to descend and engage in the pelvis, which is termed lightening

emotions assc c pregnancy

-ambivalence: conflicting feelings at the same time, commonly experienced during first trimester, it evolves to acceptance by 2nd trimester, when fetal movement is felt -introversion- focusing on oneself, heightens during 1st and third trimesters -acceptance- during 2nd trimester, enlarging abdomen, fetal movement, bring reality/validity to the pregnancy. Women will verbalize positive feelings about pregnancy and conceptualize fetus. -mood swings aka emotional lability- are common -change in body image- can be very stressful for some women, initiating discussion can help

food concerns during pregnancy: fish/shellfish/mercury ???

-avoid fish with mod/high levels of mercury 6-12 mo prior to conception and throughout pregnancy -avoid shark, swordfish, king mackerel, orange roughy, ahi tuna, and tile fish -eat up to 12 oz (2 avg meals) of low mercury fish such as shrimp, canned light tuna, salmon, pollock, and catfish -listeria infections (found when u eat processed foods/raw or unpasteurized milk) presents as febrile illness in the mother, but can be fatal for fetus, can be passed through the placenta, can lead to preterm births, miscarriges, stillbirths, high mortality.

diagnostic (positive) signs of pregnancy

-confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy a certainty. -If the pregnancy test is positive, the clinical visit should include an estimation of gestational age so that appropriate counseling can be provided. Ultrasound verification of embryo or fetus (4-6 wks) Fetal movement felt by experienced clinician (20 wks) Auscultation of fetal heart tones via Doppler (10-12 wks)

maternal physiologic changes that occur during pregnancy: endocrine system

-controls integrity + duration of gestation by maintaning the corpus luteum via hCG secretion; production of estrogen progesterone, hPl, and other hormones and growth factors via the placenta; release of oxytocin ( by posterior pituitary gland) prolactin (by anterior pituitary) and relaxin (by the ovary, uterus and placenta)

how to avid listeria as a pregnant woman

-don't eat: hot dogs luncheon meats soft cheeses (feta, brie, camembert, blue-veined cheeses) refrigerated pate or meat spreads refrigerated smoked seafood raw/unpasteurized milk salads made in store (ham, chicken, egg, tuna, seafood use all refrigerated/perishable items that are precooked ASAP make sure fridge stays at 40 F or about 5 C below clean fridge regularly can eat: hard cheeses, semi-soft cheeses (mozzarella, pasteurized cheese slices, spreads, cream cheese, cottage cheese)

USDA + my plate diet recommentations

-eat a variety of food groups using portion control -incr intake of vitamins, minerals and fiber -lower intake of saturated fats , trans fats and cholesterol -consume adequate synthetic folic acid from supplements or from fortified foods -increase intake of fruits/veggies + whole grains -balance calorie intake with exercise to maintain healthy weight

maternal physiologic changes that occur during pregnancy: immune system

-enhancement of innate immunity (inflammatory process + phagocytosis) + SUPPRESSION of adaptive immunity (protective response to antigens) -prevents mothers immune system from rejecting fetus but also increases her risk to develop certain infections and influence the course of chronic disorders such as autoimmune diseases

maternal physiologic changes that occur during pregnancy: respiratory system

-enlargement of the uterus shifts the diaphragm up to 4 cm above normal position -leads to 50% increase in air vol/min -tidal vol (aka vol inhaled) increases gradually by 30-40% (from 500-700 ml) as pregnancy progresses; results in maternal hyperventilation and hypocapnia; in turn conversion from abdominal breathing to thoracic breathing -incr estrogen levels; lead to incr vascularity; lead to congestion

maternal physiologic changes that occur during pregnancy: musculoskeletal system

-growing fetus tilts pelvis forward, shifting center of gravity; woman compensates by developing an increased curvature (lordosis) of spine -relaxation and incr mobility of joints occur because of the hormones progesterone and relaxin, which lead to "waddle gait"

maternal physiologic changes that occur during pregnancy: integumentary system

-hyperpigmentation of the skin most common alteration during pregnancy (areola, genital skin, axilla, inner thighs, linea nigra) -you get striae gravidarum (stretch marks) -linea nigra extends from umbilicus to pubic area -melasma ("mask of pregnancy") occurs in 70% of women. Blotchy areas on face (cheeks, chin, nose)

Nutritional needs of woman and fetus

-incr suits/veggies -replace saturated fats with unsaturated ones -make half the plate fruits and veggies -whole grains instead of refined ones -choose foods high in fiber to prevent constipation -avoid hydrogenated or partially hydrogenated fats -no alcohol -use reduced fat spreads and dairy products instead of full fat ones -eat at least two servings of fish a week , c one of them being an oily fish -consume at least 2 quarts of water daily

maternal physiologic changes that occur during pregnancy: endocrine system: hCG

-maintains corpus luteum, which secretes progesterone and estrogen -production by fetal trophoblast cells, until placenta can -basis for early preg tests; appears in maternal bloodstream soon after implantation -prod peaks at 8 weeks then declines

food concerns during pregnancy: artificial sweetners

-not recommended by some providers -ongoing debate of whether they are safe -only six approved for use in foods (stevia, acesulfame-K, aspartame, neotame, saccharin, sucralose)

maternal physiologic changes that occur during pregnancy: endocrine system: hPL (human chorionic somatomammotropin)

-preparation of mammary glands for lactation and making glucose available for fetal growth -alters ability to use insulin/ antagonist of insulin -incr free fatty acids for maternal metabolic needs and decrease maternal metabolism of glucose to facilitate fetal growth

maternal physiologic changes that occur during pregnancy: endocrine system: estrogen

-promotes enlargement of genitals, uterus + breasts -increases vascularity causing vasodilation -relaxation of pelvic ligaments + joints -assc c hyperpigmentation, vascular changes in the skin, increased activity of the salivary glands + hyperemia of the gums and nasal mucous membranes -aids in developing the ductal system of the breasts in prep for lactation ???? -thyroid gland enlarges and becomes more active -moms thyroid hormones transfered to fetus after conception and critical for fetal brain development neurogenesis -pituitary -FSH -LH -TSH- -GH- prolactin oxytocin -pancreas- maternal insulin doesn't cross placenta -hPL-

maternal physiologic changes that occur during pregnancy: renal/urinary system

-renal pelvis becomes dilated -ureters (especially R) elongate, widen + become more curved above the pelvic rim -bladder tone decreases and bladder capacity doubles by term -GFR increases 40-60% during pregnancy -blood flow to the kidney increases by 50-80% as a result of the increase in cardiac output

teaching to promote optimal nutrition during pregnancy

-take prenatals/vitamins -avoid diets -dont skip meals -limit sodas, caffeine-rich drinks -avoid diuretics -don't restrict salt -engage in physical activity

maternal weight gain gain between 15-40 lb in a gradual way depending on PREPREGNANCY WEIGHT AS follows: -obese (BMI = 30 or higher) total weight gain range =

11-20 lb

PrepU The nurse is teaching a pregnant woman with a prepregnancy body mass index (BMI) of 26 about recommended weight gain. The nurse determines that the teaching was successful when the woman states that she should gain approximately how much during her pregnancy?

15 to 25 pounds (7 to 11 kilograms)

maternal weight gain gain between 15-40 lb in a gradual way depending on PREPREGNANCY WEIGHT AS follows: -overweight (BMI 25-29) total weight gain range =

15-25

PrepU The nursing instructor is pointing out to a group of nursing students the various findings which are expected during a normal assessment of a pregnant client. The instructor determines the session is successful when the students correctly provide which gestational week that they should be able to feel fetal movement?

22

PrepU A woman comes to the clinic for her first prenatal checkup. The woman has a body mass index (BMI) of 22. The nurse would anticipate that this client should gain approximately how much weight during her pregnancy?

25 to 35 lbs (11 to 16 kg)

maternal weight gain gain between 15-40 lb in a gradual way depending on PREPREGNANCY WEIGHT AS follows: -normal (BMI = 18.5-24 ) total weight gain range =

25-35 lb

PREPU A client in her first trimester is concerned about how weight gain will affect her appearance and questions the nurse concerning dietary restrictions. How much weight gain should the nurse point out will be safe for this cleint with a low BMI?

28 to 40 pounds (13 to 18 kilograms)

maternal weight gain gain between 15-40 lb in a gradual way depending on PREPREGNANCY WEIGHT AS follows: -underweight (BMI > 18.5) total weight gain range =

28-40 lb

PrepU At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy?

A decrease in the second trimester may occur because of placental growth.

PrepU A pregnant client is concerned she may develop preeclampsia, so she has stopped adding any salt to her food and is now questioning the nurse about avoiding prepared foods. The nurse should point out some salt is very beneficial and can help prevent which negative outcome for her baby?

Congenital hypothyroidism

PrepU A pregnant woman is concerned about the recent onset of a midline swelling that is soft and nontender. The nurse should point out this is most likely related to which condition?

Diastasis recti

PrepU A client at 16 weeks' gestation comes to the office for a routine exam. At what location within the abdomen would the nurse anticipate the uterus to be found?

FHalfway between the symphysis pubis and the umbilicusF

PrepU A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy?

FSH and LH

PrepU 21s A client arrives to the clinic very excited and reporting a postive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy?

Fetal movement felt by examiner

PrepU The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes?

Goodell sign

prepU A student nurse is preparing for a presentation which will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out?

Increased pulse rate and decreased blood pressure

PrepU What effect does progesterone have on normal gallbladder function?

Progesterone interferes with gallbladder contraction, leading to stasis of bile.

PrepU A client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that:

Some of the home pregnancy tests can detect the presence of hCG within one day of the woman's missed period.

PREPU Hormone levels of a woman indicate that the corpus luteum stopped functioning and releasing progesterone after 5 weeks. The nurse would recognize that which scenario is the expected outcome?

Spontaneous abortion would occur

PrepU A nurse is leading a discussion in a prenatal class for a group of primigravida clients. Which factor would the nurse include when explaining the changes that are expected to occur in the uterus during the pregnancy?

The uterus changes from a pear-shaped organ to an oval one.

PrepU Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy?

Visualization of the gestational sac or fetus

PrepU A woman in her 16th week of pregnancy comes to the health center for a follow up visit. Which physiologic change would the nurse expect to assess? Select all that apply.

a uterus that is palpable colostrum that can be expelled from the nipples

PrepU The nurse is assessing a pregnant woman and noticing behavior changes that indicate she is beginning to accomplish the maternal tasks of becoming mother. The client is in her third trimester. Which behavior would the nurse most likely assess?

acknowledging fetus as a separate entity

PrepU During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss?

aldosterone

PrepU Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used.

amennorhea uterine enlargement quickening Braxton Hicks contractions labor

maternal physiologic changes that occur during pregnancy: cardiovascular system

blood volume: incr in plasma (50%) and RBC's (50%) compared to non pregnant values; causes hemodilution (physiologic anemia of pregnancy); reflected in lower hematocrit and hemoglobin -iron requirements increase; with accelerated prod of RBC's, iron necessary for hemoglobin formation, the oxygen carrying components of RBC's. -goes to 1500 ml cardiac output + heart rate: CO increases (30-50%) over non pregnant rate by 32nd wk of pregnancy. Incr CO assc c incr in venous returning greater right ventricular output, especially in L lateral position. HR increases by 10-15 bpm between 14 and 20 wks of gestation, and this increase will persist to term BP: diastolic pressure decreases typically 10-15 mmHg to reach its lowest point by mid-pregnancy; it then gradually returns to non pregnant baseline values by term Blood components: RBC's increase + blood clotting factors. Make pregnancy a hypercoaguble state.

lacto vegetarians

consume milk and dairy products along with plant based foods omit: eggs meat fish poultry

good sources of folic acid

dark green veggies; broccoli, romain lettuce, spinach, baked beans, black-eyed peas, citrus fruits, peanuts, liver

lacto-ovo vegetarians

dont eat: red meat fish poultry do eat: eggs milk dairy products

PREPU A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

fundal height has dropped since the last recording

PrepU After teaching a class of newly pregnant women about the many changes the female body undergoes during pregnancy, the nurse determines that the teaching was successful when the class identifies which hormones as being secreted by the placenta? Select all that apply.

hCG relaxin estrogen

PrepU A woman comes to the prenatal clinic and undergoes a pelvic exam. The doctor notes a softening of the uterine isthmus. The nurse recognized that this finding is known as what sign?

hegar's sign

PrepU A nurse conducting a presentation for a group of nurses explains the changes in various body systems related to pregnancy. The nurse determines that additional teaching is needed when the group chooses which component as contributing to the pregnant woman's hypercoagulable state?

increased number of red blood cells

PrepU A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences?

increased secretion of insulin occurs in the first trimester

PrepU During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy?

influence of estrogen and blood vessel proliferation

______ and ____ need to be supplemented because of their increased requirements for pregnancy

iron and folic acid -both are needed to form new blood cells for the expanded maternal blood volume and to prevent anemia -iron is essential for fetal growth and brain development + prevention of maternal anemia -incr in folic acid is essential before pregnancy and in the early weeks of pregnancy to prevent neural tube defects -27 mg of ferrous iron and 400-800 mcg of folic acid per day are recommended

maternal physiologic changes that occur during pregnancy: GI

mouth and pharynx: gums hyperemic, swollen, friable and tend to bleed easily. Saliva production increases Esophagus: decreased lower esophageal sphincter pressure and tone, which increases the risk of developing heartburn stomach: decreased tone and mobility with delayed gastric emptying time, which increases gastroesophageal reflux and vomitting; decreased gastric acidity and histamine output, which improves symptoms of peptic ulcer disease intestines: decreased tone and mobility; constipation, flatulence gallbladder: decreased tone and mobility; gallstone formation

PrepU The nursing student is preparing a pamphlet which will illustrate the various hormones involved with a pregnancy. Which hormone should the nurse indicate is responsible for the let-down of breast milk in this pamphlet?

oxytocin

substitutes for lactose intolerance

peanuts almonds sunflower seeds broccoli salmon kale molasses encourage lactose free dairy products or calcium enriched orange juice or soy milk

PrepU Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing?

presumptive

PrepU A 27-year-old female was just confirmed to be pregnant. She tells the nurse she just switched to a vegan diet. The nurse explains that she must pay special attention to her intake of which elements to ensure she is getting adequate nutrition for her and the baby? Select all that apply.

protein iron vitamin B12 calcium

pregnant vegetarians must pay close attention to their intake of

protein, iron, calcium, vitamin B12 suggestions include: for protein: substitute soy foods, beans, lentils, nuts, grains, seeds for iron: meat alternatives, vit c-rich foods for calcium: substitute soy, calcium fortified orange juice, tofu for vit B12: eat fortified soy foods and a B12 supplement

maternal physiologic changes that occur during pregnancy: endocrine system: relaxin

secretion by placenta + corpus luteum during pregnancy -works with progesterone to maintain preg -incr flexibility of pubic symphysis, permitting expansion for delivery -dilation of cervix; suppresses oxytocin by hypothalamus, delaying onset of labor contractions

subjective (presumptive) signs of pregnancy

signs that the mother can perceive -least reliable -most obvious sign; absence of menstruation -Skipping a period is not a reliable sign of pregnancy by itself, but if it is accompanied by consistent nausea, fatigue, breast tenderness, and urinary frequency, pregnancy would seem very likely. EX: Fatigue (12 wks) Breast tenderness (3-4 wks) Nausea and vomiting (4-14 wks) Amenorrhea (4 wks) Urinary frequency (6-12 wks) Hyperpigmentation of the skin (16 wks) Fetal movements (quickening; 16-20 wks) Uterine enlargement (7-12 wks) Breast enlargement (6 wks)

couvade syndrome

sympathetic response to their partners pregnancy -may gain weight around mid section

objective (probable) signs of pregnancy

those that can be detected on physical examination by a health care provider. EX: -Braxton Hicks contractions (16-28 wks) - -Positive pregnancy test (4-12 wks) -Abdominal enlargement (14 wks) -Ballottement (16-28 wks) -Goodell's sign (5 wks) - softening of the cervix -Chadwick's sign (6-8 wks) - bluish/purple coloration of vaginal mucosa + cervix -Hegar's sign (6-12 wks)- softening of the lower uterine segment or isthmus

PrepU A client in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. Which suggestion for sleeping should the nurse prioritize for this client?

with a pillow under her right hip

gluten free diet in pregnancy

women may be missing out on important nutrients by adopting this diet