Maternal Adaptation to Pregnancy

Question 1

Fatigue, Breast tenderness, N/V, Amenorrhea, Urinary frequency, Hyperpigmentation of skin, Fetal movements (quickening), Uterine enlargement, Breast enlargement are signs of which signs of pregnancy?

(subjective)

Answer 1

Presumptive signs

Question 2

Braxton hicks contractions, positive pregnancy test, adominal enlargement, ballotment, goodell sign, chadwick sign, and Hegar sign sign are what kind of s/s of pregnancy?

(objective)

Answer 2

Probable signs

Question 3

Ultrasound verification of embryo or fetus, Fetal movement felt by experienced clinician,
Auscultation of fetal heart tones via Doppler are what kind of signs of pregnancy?

Answer 3

Positive signs

Question 4

This organ increases in size, indicative to (+) Hegar sign, the fundal height by 20 weeks of gestation is 20cm, and the mother may experience Braxton Hicks contractions. What organ is this?

Reproductive System Adaptation

Answer 4

Uterus

Question 5

This organ shows a Goodell and Chadwick sign by 6-8 weeks of pregnancy, the production of mucus increases at the, and ripening occurs 4 weeks before birth. What organ is adapting?

Reproductive System Adaptation

Answer 5

Cervix

Question 6

This organ increases in vascularity with thickening, the vault lengthens, and has leukorrhea. What is organ is adapting?

Reproductive System Adaptation

Answer 6

Vagina

Question 7

This organ stops at ovulation and enlarged until 12 to 14th week of gestation. What organ is adapting?

Reproductive System Adaptation

Answer 7

Ovaries

Question 8

Increase in size and nodularity to prepare for location and colostrum is produced. What is organ is adapting?

Reproductive System Adaptation

Answer 8

Breasts

Question 9

Which part of GI system becomes hyperemic, swollen, friable, and bleed easily during pregnancy?

Gastrointestinal Adaptation

Answer 9

Gums

Question 10

What is the teeth at risk for during the pregancy?

Answer 10

Gingivitis

Question 11

What happens to saliva during pregnancy?

Gastrointestinal Adaptation

Answer 11

• Saliva becomes more acid and increases in production
• This causes a decrease in unconsciously swallowing

PTYALISM

Is self-resolving but some women find chewing gum and sucking hard candies help

Question 12

The woman feels constipated, complains of heart burn(pyrosis) after she eats, and says she nausea and vomitng. Which part of the organ is system affected?

Gastrointestinal Adaptation

Answer 12

Stomach

Question 13

The patient’s blood volume, cardiac output, heart rate and CBC levels are increased. Her blood pressure is decreased throughout pregnancy and the nurse told her to increase her iron intake. Which part of the organ system is adapting?

Answer 13

Cardiovascular

Question 14

During physical assessment, the nurse notices that the patient’s mostly breathing more with her diaphragm than with her abdomen, she hears congestion in the lungs during auscultation, her RR and depth of he breathing has increased. Which part of organ system is adapting during pregnancy?

Answer 14

Respiratory

Question 15

While the nurse was doing physical assessment, she notices that the her pelvis dilated, the ultrasound shows that her ureters got wider, longer, and curvier from the last time; and urinalysis indicates an increase in GFR, urine volume, and kidney activity, especially while lying down. What organ is adapting in response to her pregnancy?

Answer 15

Renal/Urinary Adaptations

Question 16

The patient is 30 weeks in gestation. The nurse notices that her posture is swayed back more and her upper spine is extended (lordosis), as she is moving toward to the center of gravity, and waddles when patient is ambulating. Which organ system is the nurse assessing?

Answer 16

Muskuloskeletal System

Question 17

A client is 21 weeks pregnant and went to the the doctor’s office for physical examination. She says, “I look at myself in the mirror and I see that parts of skin is darker from others, there’s a darker line right in the middle of my belly with stretch marks on the side, I’m losing hair and my palms are pink now. You see? Is there something wrong with me?” And the nurse notices that her heart rate has gone up 10-15 bts/min from her last visit a year ago. What would be the appropriate response to the patient?

Answer 17

That’s the body’s normal sign of your pregnancy. It’s going to take time until after you give birth to your baby for that to go away.

The heart rate has gone up in response to variscosities to help compensate for maternal blood loss in response to the circulation to the baby.

Question 18

Thyroid, Pituitary, and Adrenal Glands

Endocrine Pregnancy Adapation

Answer 18

Thyroid glands
* Slight enlargement
* Increased activity
* Increased in BMR

Pituitary Glands
* Enlargement
* Decrease in TSH (thyroid stimulating hormone), GH (growth hormone)
* Inhibition of FSH (Follicle-stimulating hormone) and LH (Luteinizing hormone
* Increase in prolactin, MSH (Melanocyte-stimulating hormone)
* Gradual increase in oxytocin with fetal maturation

Adrenal glands
* Increase in cortisol (that rate of cortisol secretion is not really increasing but the rate of clearance for cortisol is decreasing)
* Increase in Aldosterone secretion

Question 19

Pancreas

Endocrine Pregnancy Adapation

Answer 19

• Insulin resistance due to hPL (Human placental lactogen)
• Early in pregnancy, material glucose level drops because of the heavy fetal demand for glucose, the fetus is also drawing amino acids and lipids from mother which decreases the mothers ability to synthesize glucose
• After the first trimester hPL from the placenta and steroids (cortisol) from the adrenal cortex act against insulin. The hPL acts as an antagonist against maternal insulin causing the mother to secrete more insulin to counteract the hPL
• Prolactin, estrogen, and progesterone are also thought to oppose insulin

Question 20

Placental Secretions

hCG & hPL

Endocrine Pregnancy Adapation

Answer 20

hCG
* Responsible for maintaining the maternal corpus luteum, which secretes progesterone and estrogen
* What indicates on pregnancy tests that you are pregnant

hPL
* Preparation of mammary glands for lactation and the processes of making glucose
* Antagonist of insulin
* Increases the amount of circulating free fatty acids for fetal growth

Question 21

Placental Secretions

Which hormone acts synergistically with progesterone, increase flexibility of the pubic symphysis, allows the pelvis to expand, and
helps dilate of the cervix?

Endocrine Pregnancy Adapation

Answer 21

Relaxin

RELAXIN: Secretion by the placenta as well as the corpus luteum.

Question 22

Placental Secretions

[_______________] is called the pregnancy hormone, which helps with the endometrium of the uterus. Initially causes thickening of the uterine lining in anticipation of implantation of fertilized oocytes.

Endocrine Pregnancy Adapation

Answer 22

Progesterone

Question 23

Which hormone promotes the enlargement of the genitals, uterus and breasts; increases vascularity and causes vasodilation; relaxation of pelvic ligaments and joints; associated with hyperpigmentation, vascular changes in skin, increase activity of salivary glands and hyperemia of gums; and aids in developing the ductal system of the breasts?

Answer 23

Estrogen

Question 24

What are the nutritional recommendations for pregnant women?

Iron, Protein, Folic Acid, Calories, and Water

Answer 24

• Increase protein, iron, folate and calories
• Protein increased by 60 - 80 g per day
• Folic acid: 400 -800 mcg per day; this is vital in order to help prevent neural tube defects
• Iron : 27 mg of ferrous sulfate per day
• Calories : an additional 300 calories per day
• Water per day at least 8 glasses

Question 25

What are the recommended vitamin and mineral intake for pregnant women?

Vitamin A,D,C; Folate, Calcium

Answer 25

• Vitamin intake while pregnant
• Vitamin A: 770 mg
• Vitamin C: 85 mg
• Vitamin D: 5 mcg
• Folate: 600 mcg
• Calcium 1000 mg

Question 26

What are some foods to avoid while pregnant?

Answer 26

• Avoid some fish due to mercury
• Avoid eating shark, swordfish, king mackerel, orange roughly, ahi tuna, and tilefish

Fish okay in moderation: shrimp, canned light tuna, salmon, lobster, sole, tilapia, cod, haddock, pollock and catfish

Question 27

Listeriosis

Answer 27

Listeriosis
* Found in soil, groundwater, animals and plants
* Often found in unpasteurized milk
* Has a high morbidity and mortality rate
* Causes a fever in the mother but is fatal to the baby (passed through the placenta)
* Leads to preterm births, miscarriages, stillbirths and high neonatal mortality rates
* No soft cheese (brie, feta, camembert)
* No hot dogs or luncheon meats or deli meats
* No smoked seafood (nova-styles, lox, kippered, smoked or jerky)
* No premade salads

Question 28

Maternal Weight Gain Guidelines

Answer 28

Maternal weight gain
Healthy weight BMI 25 to 35 lbs
* First trimester: 3.5 to 5 lbs
* Second and third: 1 lb/wk

BMI less than 19.8: 28 to 40 lbs
* First trimester: 5 lbs
* Second and third: +1 lb/ wk

BMI 25 to 29.9: 15 to 25 lbs
* First: 2 lbs
* Second and third: 2-3 lbs/wk
* BMI over 30: 11 to 20 lbs

Question 29

Maternal Emotional Responses

Ambivalence, Introversion, Acceptance, Mood Swings, Body Image

Answer 29

Ambivalence
* Having conflicting feelings at the same time
Feeling excited while also feeling anxious
Often happens during the first trimester and leads to acceptance in the second trimester when fetal movement is felt

Introversion
* Focusing on oneself, women may become withdrawn and become preoccupied with self and fetus

Acceptance
* Brings a sense of reality and validity to the pregnancy
* Women start to verbalize positive feelings about pregnancy

Mood swings
* Emotional lability throughout pregnancy
* Can be happy one moment and upset the next

Changes in body image
* As the women’s body begins to grow it is common for them to feel overweight and uncomfortable

Question 30

Sibling’s View on Pregnancy

Answer 30

• Reaction is based on age
• Toddler might regress (toilet training or ask to use bottle again)
• School age may ignore the new baby and go out and hang with friends more often
• Sibling rivalry with new infant in family
• Sibling preparation imperative

Question 31

Partner’s View on Pregnancy

Answer 31

• Family centered emphasis
• Partners reaction to pregnancy and change
• Couvade syndrome, ambivalence
• Acceptance (second trimester)
• Preparation for reality of new role (third trimester)

Question 32

A new mother sends a log of all the foods and beverages she consumes throughout her first 5 weeks of pregnancy. Which of the following items should the nurse be concerned about?

Breakfast: 12 oz of coffee with oatmeal and apple.
Lunch: 1 bowel of chicken salad with lettuce and feta cheese prepackaged from the local grocery store.
Snack: Crackers
Dinner: 1 full fried Swordfish with white rice.
Amount of water by the end of the day: 10 glasses

Answer 32

• Prepackaged chicken salad.
• Feta cheese
• Sword fish

Question 33

Fill in the blank.

• During early pregnancy, maternal glucose levels [1] because of the heavy fetal demand for [2]. The fetus is also drawing [3] and [4] from the mother, decreasing the mother’s ability to synthesize glucose. Maternal glucose is diverted across the [5] to assist the growing [6] during early pregnancy, and thus levels decline in the mother. As a result, maternal glucose concentrations decline to a level that would be considered “hypoglycemic” in a nonpregnant woman.
• During early pregnancy there is also a decrease in maternal insulin production and insulin levels. The [7] is responsible for the production of insulin, which facilitates entry of glucose into cells. Although glucose and other nutrients easily cross the placenta to the fetus, [8] does not. Therefore, the fetus must produce its own insulin to facilitate the entry of glucose into its own cells.
• After the first trimester, [9] from the placenta and [10] from the adrenal cortex act against insulin. hPL acts as an [11] against maternal insulin, and thus more insulin must be secreted to counteract the [12. increasing/decreasing] levels of hPL and cortisol during the [13 first/last] half of pregnancy.
• [14], estrogen, and progesterone are also thought to [15. accept/oppose] insulin. As a result, glucose is [16. more/less] likely to enter the mother’s cells and is [17. less/more] likely to cross over the placenta to the [18].

BOX 11.2: Pregnancy, Insulin, and Glucose

Answer 33

1. Decrease
2. Glucose
3. amino acids
4. lipids
5. placenta
6. embryo/fetus
7. pancreas
8. insulin
9. hPL
10. steroid (cortisol)
11. antagonist
12. increasing
13. last
14. prolactin
15. oppose
16. less
17. more
18. fetus