Physiological Changes in Pregnancy

Question 1

time frame- 1st 2nd and 3rd trimesters

Answer 1

– First trimester = Weeks 1 - 13 (Months 0 to 3)
– Second trimester= Weeks 14 to 26 (Months 3 to 7)
– Third trimester = Weeks 27 to 40 (or delivery) (Months 7 through 9)

Question 2

Cardiovascular changes in preg

Answer 2

• increase blood volume, cardiac output, rbc, WBC, heart rate, risk of thrombus
• decrease H&H
• normal = platelets

Question 3

iron deficiency anemia in preggos (%)

Answer 3

Hemoglobin <11%
Hematocrit <33%

increase blood volume = dilutional anemia is common

Question 4

hypotension concerns in preggos?

Answer 4

• orthostatic (hormones causing vasodilation)
• supine (2nd half of preg due to weight of fetus obstructing vena cava)
  ‣ intervention: lay on side, place wedge under one hip to displace weight

Question 5

Cardiovascular danger signs for preggos

Answer 5

• Headache, generalized swelling, high BP

Question 6

respiratory changes in preggos

Answer 6

– Nasal and sinus congestion
– Epistaxis (nose bleeds) frequent
◦ Humidify air as intervention
– Growing fetus causes repositioning of the lungs and work of breathing more uncomfortable (dyspnea)
-RR mostly unchanged
-Increase maternal oxygen consumption (20-40%)

Question 7

how much does heart rate increase in preg? when does it peak?

Answer 7

10-15 beats

32 weeks gestation

Question 8

GI changes in preggos

Answer 8

Nausea and/or vomiting
– Increased salivation (ptyalism)
– Bleeding gums
– Flatulence
– Heartburn – 2nd and 3rd trimesters, stomach displaced and slowing GI motility
– Gallbladder changes – delayed emptying, increase risk gallstones
– Constipation - intervention: dietary changes, increase fluid/fiber
– Hemorrhoids

Question 9

interventions for hemorrhoids

Answer 9

sitz bath, witch hazel

Question 10

heart burn vs epigastric pain

Answer 10

epigastric pain is not normal! look at BP and whole picture client to differentiate

Question 11

integumentary changes in preggo

Answer 11

– Striae gravidarum (stretch marks)
◦ Separation of the underlying connective tissue on breasts, thighs, & abdomen
– Skin hyperpigmentation
– Linea nigra
◦ Line of pigmentation from the symphysis pubis to the top of the fundus
– Melasma (cholasma)
◦ Mask of pregnancy – blotchy, brownish hyperpigmentation of the skin on the forehead, nose, & cheeks
– Dry skin, pruritus (itching)
– Acne
– Hair thickening/growth, hirsutism during preg and hair loss after preg

Question 12

musculoskeletal changes in preggo

Answer 12

– Low back pain, joint discomfort, difficulty walking
◦ Lordosis / sway back (forward curvature of the spine)
◦ Anterior neck flexion ?
◦ Increased mobility of pelvic joints (pelvic joints relax)
– Leg cramps due to nerve compression from uterus
◦ Intervention: Dorsiflex foot
– Ligament spasm, diastasis recti - abd muscles seperate due to expansing uterus and lose some tone

Question 13

urinary/renal changes in preggo

Answer 13

Urinary frequency and urgency (1st and 3rd trimester) (should not be painful!!)
– (GFR) Filtration rate increases
– UTI risk - give client s/s to report to provider, UTI common in preg that can lead to pylonephritis
◦ gush of fluid is sign of preterm!
• Intervention: decrease fluids before bed time but not through out the day, kegels, avoid bubble baths, cotton underwear

Question 14

when is urinary frequency common in pregnancy?

Answer 14

1st and 3rd trimester

Question 15

placenta becomes an endocrine _____

Answer 15

organ

Question 16

endocrine changes in preggo (increase vs decrease)

Answer 16

– Hormones maintain pregnancy and prepare for delivery 
– Produces large amounts of: (increase in) 
•  hCG
•  Progesterone= Maintains pregnancy 
•  Estrogen
•  Human placental lactogen
•  Prostaglandins 
•  Prolactin 
•  Oxytocin 
•  Thyroid 
•  BMR
•  Need for glucose / Production of insulin
•  Cortisol 

Decrease in
• FSH

Question 17

neuro changes in preggos

Answer 17

– Headache can be related to increase blood volume, also warning sign for preeclampsia 
– Carpal tunnel  
• Intervention: Elevate hands at night 
– Syncope
• Intervention: Lay on left-side (left lateral position) if experiencing s/s 
– Fatigue (1st and 3rd trimester)
• Intervention: Rest periods 
– Insomnia

Question 18

reproductive changes in preggos

Answer 18

– Breasts enlarge and tender 
– Uterus 
– Braxton-Hicks contractions 
– Cervix/Vagina 
– Yeast infections due to increase alkalinity of vagina

Question 19

A patient in the third trimester of pregnancy expresses concern to the nurse
about changes to her muscles, joints, and bones. Which conditions does the
nurse reassure the patient are normal changes of pregnancy? Select all that
apply.
– Waddling gait
– Low back pain
– Increased risk of falls
– Fractures
– Severe muscle aches

Answer 19

– Waddling gait
– Low back pain
– Increased risk of falls