Maternal physiologic changes during pregnancy Flashcards
LMP
280 days
40 wks
10 lunar months (perfect 28 days mos)
9 calendar months
Trimesters (length of each one)
FIRST: 1st day of LMP - 13 wks
Second: 14 - 26 weeks
Third: 27 - 40 wks
8 weeks gestation - Fetal development
Fetal development: Rapid Heart begins pumping Limp buds well developed Facial features discernible Major divisions of brain discernible Ears develop from skin folds Tiny muscles formed beneath skin embryo Wt = 2g
What is the approx wt of an 8 wk old embryo?
2 g
Maternal changes at 8 weeks gestation?
Nausea for up to 12 wk Uterus changes from pear to globular shape Hegar sign occurs Goodell sign occurs Cervical flexes leucorrhea increases Ambivalence about pregnancy may occur. There is no noticeable Wt gain Chadwick sign appears as early as 4 weeks
What is Hegar sign?
When does it occur?
Softening of isthmus of cervix
8 wks gestation
What is Goodell sign?
When does it occur?
Softening of cervix
8 wks gestation
What is Chadwick sign?
When does it occur?
Bluing of vagina
As early as 4 weeks
8 weeks gestation nursing interventions
Teach prevention of nausea
Teach safety
Prepare client for pregnancy
What should you teach to prevent nausea in the woman at 8 wks gestation?
Eat dry crackers before getting out of bed in the a.m
Eat small, freq meals
Avoid fatty foods
Avoid skipping meals
Safety education for women at 8 wks gestation includes?
Avoid hot tubs, saunas, and steam rooms throughout pregnancy
Why are woman advised to avoid hot tubs, saunas, and steam rooms throughout pregnancy?
Increases risk for NTDs in first trimester;
Hypotension may cause fainting.
At 8 wks gestation how will you prepare the client for pregnancy?
Discuss attitudes toward pregnancy
Discuss value of early pregnancy classes
Provide info about child birth prep classes
Include father and family in prep for childbirth
Fetal development at 12 weeks gestation?
Embryo becomes fetus Heart is discernible by U/S Lower body develops Sex is discernible Kidneys produce urine Fetus weighs 19-28 g (<1 oz)
How much does a fetus way at 12 wks gestation?
19-28 g (<1 oz)
Maternal changes at 12 wks gestation?
Uterus rises above pelvic brim
Braxton Hicks contractions are possible (continue throughout pregnancy)
Potential for UTI increases (exists threw preg)
Wt. gain is 2-4 Lb during first trimester
Placenta is fully functioning & producing hormones
12 weeks gestation - Nursing interventions?
Teach UTI prevention
Discuss nutrition and exercise
Discuss possible effects of pregnancy on sexual relationship.
Recognize father’s role as he labors to incorporate the parental role into his self identity.
How much should a woman increase caloric intake when at 12 wks gestation?
300 cals/day
Fetal development at 16 wks gestation?
Head still dominant
Face looks like human
Arm/leg ratio proportionate
Scalp hair
Meconium in bowel, anus open
Most bones and joint cavities seen on U/S
Muscular mvmts detected
Heart well developed
Blood formation active in spleen
Elastic fibers appear in lungs and terminal; bronichioles appear
Kidneys in position
Cerebral lobes delineated, and cerebellum assumes prominence
General sense organs differentiated
Testes in pos for descent into scrotum/vagina open
Maternal changes at 16 wks gestation?
Quickening may be noted from 16-20 wks gest
Colostrum from nipples possible
Cholesterol increases from 16-32 wks
Placenta clearly defined by 14-16 wks
Insulin resistance begins 14-16 wks of gest and continues to rise until last few wks of pregnancy
Approx Wt gain of 1 lb./wk beginning in second trimester and continuing until delivery.
Nursing interventions for the client at 16 wks gestation?
Explain screeining test and obtain blood sample for MSAFP b/w 15-22 wks of gestation
Expalin the multiple marker, or triple screen, blood test, and obtain a specimen for screeinnig b/w 16-18 wks of gestation to measure the MSAFP, hCG, aand unconjugated estriol
Elevated MSAFP levels are assoc with?
NTDs
Multiple gestations
Low MSAFP levels are assoc with?
Down syndrome
Fetal development at 20 weeks?
Vernix protects body lanugo covers body and protects body eyebrows, eyelashes, and head hair develop fetus sleeps, sucks, kicks Weight 200-400 g (11-14 oz)
Fetal Wt at 8 weeks gestation?
2 grams
Fetal Wt at 12 weeks gestation?
19-28 g (< 1 oz)
Fetal Wt at 32 weeks gestation?
1800-2200 g (4-5 lb)
Fetal Wt at 36-40 wks gestation?
3200 g (7+ Lb.)
Maternal changes - 20 wks gestation?
Fundus reaches umbilicus
Breasts begin secreting colostrum; areolae darken
Amniotic sac holds approx 400 mL fluid
Postural hypotension
Quickening becomes "real"
Possible S/S:
Nasal stuffiness
Leg cramps
Varicose veins
ConstipationNursing interventions - 20 wks gestation?
Comfort measures
Remain active
Sit w/feet elevated
Avoid pressure on lower thighs
Use support stockings
Dorsiflex foot to relieve leg cramps
Cool-air vaporizer/NS nasal spray for stuffiness
Avoid Constipation
Eat raw fruits, veg’s, bran cereal
Drink 3 L fluids/day
Exercise frequently
Fetal development - 24 weeks gestation
Body well proportions; skin red and wrinkled
Sweat glands forming
Blood formation ^ in BM & decreases in liver
Alveolar ducts/sacs present
Lecithin in amniotic fluid (wks 26-27)
Neuronal proliferation in cerebral cortex ends.
Can hear
Testes at inguinal ring in descent to scrotum
Maternal changes - 24 weeks gestation
Uterus rises to umbilicus
DBP gradually ^ at 24-32 wks
SBP remains same as prepregnancy level
Nursing interventions - 24 wks gestation?
Explain and obtain a blood sample for a glucose challenge that is usually done b/w 24-28 wks gestation.
At 24-32 wks gestation, 2-3 U/S measurements may be taken 2 wks apart to compare against standard fetal growth curves.
Fetal development at 28 weeks gestation
Can breathe, swallow, and regulate temperature Surfactant forms in lungs Can hear Eyelids open Period of greatest fetal wt gain begins Fetus weights 1100 g (2.5 lb)
Maternal changes at 28 weeks gestation
Fundus hallway b/w umbilicus and xiphoid Thoracic breathing replaces abd breathing Fetal outline palpable Woman become more introspective Heartburn may begin Hemorrhoids may develop
28 weeks gestation - Nursing interventions
Teach TX of hemorrhoids - sitz, topical anesthetics, stool softeners
Teach comfort measures - elevate legs when sitting, assume side lying position when resting.
Teach measures to avoid heartburn
Prepare woman for delivery/parenthood
Fetal development at 32 weeks gestation
Brown fat deposits dev beneath skin
15-17 inches in length
Begins storing iron, Ca, & phosphorus
Weighs 1800-2200 g (4-5 lb)
Maternal changes at 32 weeks gestation
Fundus reaches xiphoids Breast full, tender Urinary freq returns Swollen ankles may occur Sleeping problems may develop Dyspnea may develop
32 weeks gestation - Nursing interventions
Teach measures to decrease edema
Teach comfort measures: wear well-fitting supportive bra. use semi-fowler position at night for dyspnea.
Prepare woman for childbirth.
Fetal development at 36-40 wks gestation
Fetus occupies entire uterus; activity restricted
Maternal antibodies transferred to fetus
L/S ratio is 2:1 and phosphatidylglycerol is present
Fetus weighs 3200 g (7 lb+)
Maternal changes at 36-40 wks gestation
Lightening occurs
Placenta weighs approx 20 oz.
Mother is eager for birth, may have energy burst
Backaches increase
Urinary freq increases
Braxton Hicks contractions intensify (cervix and lower uterine segment prepare for pregnancy)
36-40 wks gestation - Nursing interventions
Teach safety measures
-wear low heeled shoes/flats
-NO heavy lifting
-sleep on side to relieve bladder pressure
Encourage preparation for delivery
-KEGAL exercises
-encourage packing suitcase
-Encourage couple to tour L&D
-Discuss PP circumstances: circumcision,
rooming-in, possibility of PP blues, birth control,
need for adequate rest, father’s role
