ATI Ch 3 Expected physiological changes during pregnancy (+QUESTIONS)

Nagele's rule

take the first day of the woman's last menstrual cycle, subtract 3 months and then add 7 days and 1 year, adjusting for the year as necessary

Probable signs

- Changes that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus) - Signs can be caused by physiological factors other than pregnancy (pelvic congestion, tumors)

Urine pregnancy test

- Detection of hCG (human chronic gonadotrophin) released by the placenta early in pregnancy - OTC (over-the-counter) pregnancy tests are 95-99% accurate if done according to instructions - Much more sensitive today. May detect pregnancy 1-2 days after first missed period (some newer versions even sooner) - Some test results within 1 minute - If taking it at home: use the first void in the AM - A higher than normal level of hCG may indicate an ectopic pregnancy or down syndrome

Serum pregnancy test

- More accurate than urine - May be as sensitive as early as 1-2 days after implantation - More expensive - Looks at the amount and levels in the blood -> can determine how many weeks you are

Signs of pregnancy

- Presumptive - Probable - Positive

Verifying pregnancy

- Urine or Serum pregnancy test

Probable signs s/s

- abdominal enlargement: related to changes in uterine size, shape and position - Hegar's sign: softening and compressibility of lower uterus - Chadwick's sign: deepened violet/bluish color of cervix and vaginal mucosa - Goodell's sign: softening of cervical tip - Ballottement: rebound of unengaged fetus - Braxton Hicks contractions: false contractions that are painless, irregular and usually relieved by walking - Positive pregnancy test - Fetal outline: felt by examiner

Presumptive signs s/s

- amenorhea - fatigue - n/v - urinary frequency - breast changes: darkened areolae, enlarged Montgomery's glands - quickening: slight fluttering movements of the fetus felt by a woman, usually btw 16-20 weeks of gestation - uterine enlargement

Presumptive signs

- changes that the woman experiences that make her think that she might be pregnant - Can subjective symptoms or objective signs - Signs also might be a result of physiological factors other than pregnancy (peristalsis, infections, stress)

Positive signs

- definitive changes that can be explained only by pregnancy

Positive signs s/s

- fetal heart sounds - visualization of fetus by ultrasound - fetal movement palpated b y an experienced examiner

Human chronic gonadotropin (hCG)

- hCG production can start as early as the day of implantation and can be able detected as early as 7-8 days after conception ●Production of hCG begins with implantation, peaks at about 60 to 70 days of gestation, declines until around 100 to 130 days of pregnancy, and then gradually increases until term. ● Higher levels of hCG can indicate multifetal pregnancy, ectopic pregnancy, hydatidiform mole (gestational trophoblastic disease), or a genetic abnormality such as Down syndrome. ● Lower blood levels of hCG might suggest a miscarriage or ectopic pregnancy. ● Some medications (anticonvulsants, diuretics, tranquilizers) can cause false-positive or false-negative pregnancy results. ● Home pregnancy test: Urine samples should be first-voided morning specimens and follow the directions for accuracy

Measurement of fundal height

- in centimeters from the pubic symphysis to the top of the uterine funds (between 18-32 weeks of gestation) - approximates the gestational age

Body image changes during pregnancy

1st trimester: - physiological changes are not obvious - many women look forward to the changes so that the pregnancy will be more noticeable 2nd trimester: - there are rapid physical changes due to the enlargement of the abdomen and breasts - skin changes also occur such as stretch marks and hyper pigmentation - these changes can affect a woman's mobility (losing her balance and feeling back or leg discomfort and fatigue which can lead to a negative body image

Gravidity

Number of pregnancies - Nulligravida: a woman who has never been pregnant - Primigravida: a woman in her first pregnancy - Multigravida: a woman who has had two or more pregnancies

A nurse is caring for a client who is pregnant and states that her last menstrual period was April 1st. Which of the following is the client's estimated date of delivery? A. January 8 B. January 15 C. February 8 D. February 15

A

A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client's health record includes this data: G3 T1 P0 A1 L1. How should the nurse interpret this information? (Select all that apply.) A. Client has delivered one newborn at term. B. Client has experienced no preterm labor. C. Client has been through active labor. D. Client has had two prior pregnancies. E. Client has one living child.

A, D, E

A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the nurse expect? (Select all that apply.) A. Montgomery's glands B. Goodell's sign C. Ballottement D. Chadwick's sign E. Quickening

B, C, D

Expected VS during pregnancy

BP: - BP not different from pre-pregnancy range during the 1st trimester - SBP: slight or no increase - DBP: slight decrease around 24-32 weeks; will gradually return to pre-pregnancy level by the end of the pregnancy - Supine position: BP might appear to be lower due to the weight and pressure of the gravid uterus on the vena cave which decreases venous blood flow to the heart - Maternal hypotension and fetal hypoxia might occur, which is referred to as supine hypotensive syndrome or supine vena cava syndrom (s/s: dizziness, lightheadedness, pale and clammy skin) - Encourage moms to be on left lateral, SF or supine with a wedge placed under one hip to alleviate pressure to the vena cava Heart rate: - Increases 10-15 bp around 32 weeks of gestation and remains elevated throughout the remainder of the pregnancy RR: - Unchanged or slightly increased - Elevation of the diaphragm and changes to the chest wall to facilitat increased maternal oxygen demands - SOB

A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. Which of the following responses should the nurse make? A. "This is due to an increase in blood volume." B. "This is due to pressure from the uterus on the diaphragm." C."This is due to the weight of the uterus on the vena cava." D."This is due to increased cardiac output."

C

Parity

Number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy, not the number of fetuses whether or not they're stillborn or alive - Nullipara: no pregnancy beyond the stage of viability - Primipara: has completed one pregnancy to stage of viability - Multipara: has completed two or more pregnancies to stage of viability

A nurse in a clinic receives a phone call from a client who believes she is pregnant and would like to be tested in the clinic to confirm her pregnancy. Which of the following information should the nurse provide to the client? A. "You should wait until 4 weeks after conception to be tested." B. "You should be off any medications for 24 hours prior to the test." C."You should be NPO for at least 8 hours prior to the test." D."You should collect urine from the first morning void.

D

GTPAL

G: Gravidity T: Term births (38wks or more) P: Preterm births (from viability up to 37 wks) A: Abortion/ miscarriages (prior to viability) L: Living children

Physiological changes of pregnant pts

Reproductive: - uterus increases in size and changes shape and position - ovulation and menses cease during pregnancy CV: - Increased CO and BV to meet the greater metabolic needs - Increased HR during pregnancy beginning around week 5 and reaches a peak around 32 weeks of pregnancy (10-15/min above pre-pregnancy rate) RR: - maternal oxygen needs increase - 3rd trimester: the size of the chest might enlarge, allowing for lung expansion as the uterus pushes upward. - Increased RR - Decreased total lung capacity Musculoskeletal: - body alterations and weight increase necessitate an adjustment in posture - pelvic joints relax GI: - N/V due to hormonal changes and/or an increase of pressure within the abdominal cavity as the pregnant patient's stomach and intestines are displaced within the abdomen. - Constipation: might occur due to increase transit time of food through the GI tract and thus increased water absorption Renal: - Increased filtration rate (s/t the influence of pregnancy hormones and an increase in blood volume and metabolic demands - Urinary frequency is common Endocrine: - The placenta becomes an endocrine orphan that produces large amounts of hCG, progesterone, estrogen, human placental lactogen and prostaglandins - Hormones are very active during pregnancy and function to maintain pregnancy and prepare the body for delivery

Viability

The point in time when an infant has the capacity to survive outside the uterus. No specific GA but infant born between 22-25 weeks are considered on the threshold of viability

Pregnancy changes in women

● Heart changes in size and shape with resulting cardiac hypertrophy to accommodate increased blood volume and increased cardiac output. Heart sounds also change to accommodate the increase in blood volume with a more distinguishable splitting of S1 and S2, with S3 more easily heard following 20 weeks of gestation. Murmurs also might be auscultated. Heart size and shape should return to normal shortly after delivery. Uterine size changes from a uterine weight of 50 to 1,000 g (0.1 to 2.2 lb). By 36 weeks of gestation, the top of the uterus and the fundus will reach the xiphoid process. This might cause the pregnant woman to experience shortness of breath as the uterus pushes against the diaphragm. ● Cervical changes are obvious as a purplish-blue color extends into the vagina and labia, and the cervix becomes markedly soft. ● Breast changes occur due to hormones of pregnancy, with the breasts increasing in size and the areolas darkening. SKIN CHANGES ● Chloasma: an increase of pigmentation on the face ● Linea nigra: dark line of pigmentation from the umbilicus extending to the pubic area ● Striae gravidarum: stretch marks most notably found on the abdomen and thighs