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Family NRSG > Wk 4: Maternal Adaptations to Pregnancy > Flashcards

Wk 4: Maternal Adaptations to Pregnancy Flashcards

1
Q

Phases of pregnancy: 1 - Antepartum

A

The period of time from conception to the onset of labor

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2
Q

(2) Intrapartum

A

The phase that includes the onset of labor through delivery of the placenta

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3
Q

(3) Postpartum

A

Also known as the puerperium, the 6-week period of time after delivery in which maternal physiological changes of pregnancy

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4
Q

Trimesters of pregnancy of pregnancy during the antepartum phase

A

Further divided into more 12 week timeframes called trimesters

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5
Q

First trimester

A
  • Conception to 12 wks gestation
  • physical discomfort of nausea, vomiting, fatigue, urinary frequency
  • Most important one for fetal and placental dev. cause all frameworks and structures are formed
  • fetus makes facial expressions, hands touch mouth up to 50 times per hour
  • At 10 wks unique fingerprints ,knee joints,
  • Anything ingested by mom can lead to problems with the fetus or with the pregnancy. sucks thumb.
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6
Q

Second trimester

A
  • wk 13 - 26
  • Client feels well and excited
  • Fetal movement is felt around 16 - 20 wks
  • Fetal dev. is one of growth and maturation
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7
Q

Third trimester

A
  • Wks 29 - 40 wks
  • Increased discomfort with breathing, urination, etc.
  • Eager to be done and see the baby
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8
Q

Nursing care

A
  • Counsel
  • Support
  • Provide anticipatory guidance about whats normal, and danger signs
  • Not all clients want the same detail or have the same understanding - “read” the client and individualize info
  • Not all clients are excited about being pregnant
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9
Q

Calculating the due date

A
  • Naegele’s rule
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10
Q

An estimated due date can be calculated by following steps 1 through 3:

A
  • determine 1st day of last period (LMP)
    -Next, count back 3 calendar months
  • Add 1 year and 7 days to get Due date
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11
Q

Routine prenatal blood work

A
  1. Complete cell blood count
  2. Blood type and Rh & antibody screen
  3. Rubella titer
  4. HIV
  5. Hepatitis B surface antigen status
  6. STD/serology screening. (syphilis)
    - Read the results over!
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12
Q

Complete cell blood count - RBC, WBC, Platelets

A
  • Low H&H could indicate anemia and nutrition education is important
  • Low platelets could indicate clotting disorder
  • Unusually elevated WBC could indicate recent or ongoing infection
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13
Q

Blood type, Rh, and antibody screen

A
  • ABO incompatibility: Mother is type O, baby is A,B or AB could heighten risk of newborn jaundice
  • Rh incompatibility: mother is Rh negative, baby is Rh positive therefore Rhogam is indicated
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14
Q

Rubella titer

A
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15
Q

HIV, Hep B, STD/serology

A
  • Early maternal treatment in pregnancy, newborn tx after birth
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16
Q

Additional prenatal lab testing

A
  • Fetal fibronectin - If symptoms of preterm labor
  • Herpes culture - if indicated
  • Blood glucose studies - around 24 weeks
  • Toxicology screening - if indicated
  • TB testing - if indicated
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17
Q

TORCHS titers:

A
  • Toxoplasmosis
  • Other infections like HIV, syphilis, parvovirus B19, Varicella, and zika
  • Rubella
  • Cytomegalovirus
  • Herpes simpllex virus
  • Syphilis
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18
Q

Relevance of OB physiology

A
  • Virtually every organ system affected
  • Understanding maternal physiology is crucial to understanding clinical pregnancy scenarios
  • This knowledge will also improve a patient’s education about her pregnancy
  • The changes are reversed during postpartum as her body systems are put “back into place”
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19
Q

8 adaptations of pregnancy:

A
  1. Hyper-dynamic (continous changes and activityy)
  2. Hypermetabolic - all systems are go, go, go!
  3. Hypervolemic
  4. Hypercoaguable, clot make to the max
  5. Low resistance circulatory system
  6. Compensatory respiratory alkalemia
  7. diabetogenic
  8. Balance issues
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20
Q

All maternal changes in normal pregnancy are designed to support the fetus

A
  • Many of the changes may be misinterpreted as disease
  • The key difference if often measured in the degree of change
  • changes often occur at the expense of the mother in an effort to protect the fetus from environmental stresses
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21
Q

Overall guidelines

A
  • Therapeutic management is aimed at maintaining optimal oxygen delivery and consumption
  • This can be done by assuring that fluid volume, hemoglobin, and oxygen are all maximized
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22
Q

Pregnancy and chronic disease

A
  • Pregnancy as a stress test for life
  • pregnancy likely to unmask occult chronic disease:
  • glucose intolerance
  • renal dysfunction
  • hypercoaguable states
  • Valvular heart disease
  • Cerebral aneurysm
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23
Q

Goals of pregnancy

A
  • effectively carry a fetus to full term
  • Achieve an uncomplicated delivery
  • result in a healthy mother and infant
  • reutrn of these changes to nonpregnany baseline such that conception can occur
  • repeat the cycle
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24
Q

Musculoskeletal changes

A
  • Balance issues
  • Hormone relaxin - Ligaments soften, beginning with ovulation, highest at 12 wks
  • Ligament pain with laxity
  • posture changes as pregnancy progresses
  • Center of gravity changes, brain is still in “pre-bump” muscle memory
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25
Q

Typical wt gain with singleton

A

25 - 35 pounds

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26
Q

Ligament pain

A
  • Will be more on the right side, cause of large intestine
  • Change positions slowly. warm bath. Tylenol. Sleep on other side with pillow support.
  • NRSG care: risk to fall, sit at side of bed before standing, proper spine alignment, uterine support when pt in bed
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27
Q

Reproductive system changes

A
  • Hyper-dynamic
  • Hypervolemic
  • Uterus capacity increases. 1/6 of maternal blood volume is contained within vascular system of uterus.
  • Cervical changes: Goodell’s sign (softening). Noted in writings of socrates.
  • Endocervical glands produce sticky mucus: mucus plug will be expelled as cervix begins dilation.
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28
Q

Uterus

A
  • Pre-pregnancy small semisolid pear shaped
  • Weight increases from 50 gm to 1000 gm
  • Enlargement primarily a result of hypertrophy of myometrial cells
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29
Q

Uterine blood flow

A
  • Normal uteroplacental blood flow during pregnancy
  • Non-pregnany: ~200 mL/min
  • At term = 700-800 mL/min
  • This flow increase is due to an increase in vessel____
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30
Q

The placenta

A
  • Comm. between mom and fetus
  • Placenta is a ____
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31
Q

Functions of placenta

A
  • Feeding
  • Breathing - “fetal lung”
  • Elimination
  • Endocrine system
  • Marked changes in maternal ___
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32
Q

Two sides of the placenta

A
  • Cotyledons on maternal side
  • Anchoring sites
  • Intervillous spaces where oxygen and carbon dioxide are exchanged by diffusion are between the cotyledons
  • Missed spot on maternal side = could still be in mom
  • Ulteroplacental blood flow keeps the spaces more open
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33
Q

Wharton’s jelly

A

white stuff in umbilical cord. Keeps baby from bleeding out the cord.

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34
Q

Vaginal changes

A
  • increased secretions
  • Thickening of vaginal mucosa
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35
Q

Breasts

A
  • Enlarge to prepare for lactation
  • Superficial veins prominent, nipples erectile and areolas darken
  • Colostrum may leak during the third trimester
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36
Q

The fetus

A
  • ___
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37
Q

Intrauterine growth restriction (IUGR): Symmetrical

A
  • Entire body is proportionally small
  • Small for gestational age (SGA)
  • May be normal
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38
Q

Intrauterine growth restriction (IUGR): Asymmetrical

A
  • Implies undernourished fetus, majority of the energy goes to gorw the rbain and heart at the expense of the
    __
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39
Q

Endocrine system glands

A

___

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40
Q

Endocrine glands r/t pregnancy

A
  • Hypothalamus regulates pituitary
  • Recc. reading this part in the book
41
Q

Pancreas - Insulin resistance

A
  • Fetus primarily depends on glucose
  • Facilitated diffusion across placenta, low to high
  • Fetal blood sugar is approx 75% of mom’s
  • If mom is at 200 then baby is 150 = too much!
  • Moms with uncontrolled Blood sugar may cause baby to have type 2 diabtes
42
Q

Endocrine glands - Ovaries

A
  • Estrogen: increases x30 in pregnancy, affects joint laxity
43
Q

Hormone-like agents - Prostaglandins

A
  • Hormone-like pipid products from fatty acids
  • Inflammatory agent
  • ___
44
Q

How does this affect nursing care?

A
  • Normal RR is higher: around 18
  • Anticipate fear and anxiety: risk for hyperventilation
  • Calm approach and support to reduce fear and anxiety and keep adrenals calm, especially with preterm labor.
45
Q

Cardio changes

A
  • Maternal HR and cardiac output increase early in first trimester
  • nonpregnant = 50 - 100 ml/min
  • ___
46
Q

Hypervolemic

A
  • Occurs gradually over the course of pregnancy
  • __
47
Q

Vital sign changes

A
  • Increase in HR –> 10 - 20 bpm. 25% decrease in systemic vascular resistance (SVR)
  • 2nd trimester, systolic BP decreases by 5-10 mmHg.
  • Diastolic BP decreases by 10-15 mmHg
48
Q

Supine hypotension (vena cava compression)

A
  • Supine position after 5th month
  • Uterus compresses the inferior vena cava
  • More important in late 2nd, and 3rd trimester
  • __
49
Q

Cardiovascular changes during labor

A
  • 300 - 500 cc blood volume from uterus forced back into maternal circulation with each contraction
  • B/P increases with contractions, particularly in 2nd stage
50
Q

Postpartum cautions

A
  • ___
51
Q

Hematological changes

A
  • Changes in blood viscosity
  • “Anemia of Pregnancy”
  • Oncotic changes
  • Increased plasma volume by 50%
  • ___
52
Q

Why the extra fluid?

A
  • May keep BP more stable
  • May serve to dissipate fetal heat production and provide increased renal filtration
  • Why the physiologic anemia?
  • ___
53
Q

Hematologic, cont

A
  • Procoagulant factors increase
  • Increased risk of venous clots: __
54
Q

Lab values

A
  • WBC’s increase to 25,000 - 30,000/mm during labor and postpartum
  • ___
55
Q

NRSG care: review BP trends in prenatal record

A
56
Q

NRSG care: keep pregnant patient off her back

A
57
Q

NRSG care: Don’t be falsley re-assured by “normal” vital signs in a perinatal patient who is bleeding:

A
58
Q

Hypercoaguable

A

Compression devices for c-sections, bariatric patients

59
Q

Oxygen consumption changes

A
  • Incredibly increased
60
Q

Gasses seek equalization across placental villi

A

Just reminding of how gas exchange works in the placenta

61
Q

Placental circulation

A
  • Baby’s operative lung function and communication with mom
  • Maternal = higher O2
  • Fetal side = Higher CO2
62
Q

Respiratory system changes

A
  • Progesterone decreases airway resistance
  • O2 consumption increases 15-20% (volume breathed in each minute)
  • ___
63
Q

Respiratory & pulmonary system

A
  • Greater tendency to pulmonary edema
  • Blood is “thinner” (fewer protein sponges)
  • Plasma is pulled from capillaries into the tissues
  • Caution with aggressive IV fluids
  • Oxytocin is an anti-diuretic –> promotes fluid retention
64
Q

Resp. system and NRSG care

A
  • Dilligent intake and output, especially with oxytocin
  • Assess lung sounds at least once per shift, especially with oxytocin
  • If patient hyperventilates, offer methods for re-breathing CO2
65
Q

GI system changes

A
  • N/V = increased hCG levels
  • Gums may bleed easily
  • Excessive salivation
  • Delayed gastric emptying and peristalsis (elevated ___
66
Q

GI system during labor

A
  • Gastric motility and absorption of solid food are reduced
  • ___
67
Q

How does N/V affect the fetus?

A
  • inadequate ___
68
Q

GI system and NRSG care

A
  • Clear liquids in labor, unless ordered otherwise
  • Postpartum, monitor elimination, both urine and stool
69
Q

Urinary system changes

A
  • 1st trimester: frequent urination
  • 2nd: not a big deal
  • 3rd: frequent
70
Q

Kidney changes - Glomerular filtration rate

A
  • Rough measure of the # of functioning nephrons
  • Not measured directly: is creatinine rising, falling, stable?
  • Rising = ___
71
Q

Bladder & NRSG care

A
  • In labor, monitor bladder fullness to prevent distention and allow for fetal descent: if foley, remove prior to pushing
  • Postpartum:
  • ___
72
Q

Dermatologic system changes

A
  • Common changes
  • Linea nigra
  • Facial chloasma “mask of pregnancy”
73
Q

Skin changes cont.

A
  • ___
74
Q

Skin changes and NRSG care

A
  • ___
75
Q

Immune system changes

A
  • Immune response is decreased
  • Decreases rejection of embryo, which contains foreign DNA
  • It is harder to a woman’s immune system to fight infections
  • ___
76
Q

Becoming a mother: 4 tasks of pregnancy

A
  • Seeking safe passage
  • Acceptance of child by self and others
  • Binding in (taking in)
  • Giving of herself (taking hold)
77
Q

Emotional postpartum needs

A
  • Recognition of the effort made during labor: approval of behavior during labor and postpartum, acceptance of learning needs
  • Support and encouragement in her care for the infant
  • Attention from family members, particularly from the partner; ___
78
Q

Summary of maternal changes

A
  • Changes often occur at the expense of the mother in an effort to protect the fetus from environmental stresses
  • An important task of the nurse ___
79
Q

Key components of nutrition care

A
  • Nutrition assessment
  • Diagnosis of nutrional related problems or risk factors
  • ___
80
Q

Why is nutrition so important in pregnancy?

A
  • Increased nutrient demands
    -___
81
Q

Nutrient needs before conception

A
  • First trimester crucial ___
82
Q

The nutrition you need

A
  • ___
83
Q

Nutrient needs during pregnancy

A
  • Weight gain: partly dependent on BMI before pregnancy
  • BMI –> page 210
  • Overall total recommended pregnancy weight gain for women of “normal weight” –>
  • 11.5 to 16 kg
  • 25 - 35 lbs
84
Q

Recommended weight gain per trimester

A
  • 25-35 range recommendation:
  • 1st trimester (fist 12 wks from LMP, 3 months): 1 lb per month. Or 3 lbs
  • 2nd and 3rd trimesters: 1lb/week (28 remaining wks)
  • Total: 3 lbs in first trimester
  • 28 lbs in 2nd and 3rd trimesters = 31 lbs total
85
Q

Other nutrition recommendations: women with obesity

A
86
Q

Other nutrition recommendations: underweight women

A

__

87
Q

Other nutrition recommendations: Cues for concern

A

___

88
Q

Calories per day for pregnancy

A

___

89
Q

Healthy “diet” components

A
  • Protein: Increase protein intake by 25% daily
  • Cues for inadequate protein intake: not enough irion, B vit, calcium, phosphorus
  • B12 if vegetarian
90
Q

Fats and pregnancy

A

___

91
Q

Minerals and vitamins

A

__

92
Q

Other nutrition issues during pregnancy

A
  • No alcohol
  • PICA: eating nonfood. not good.
93
Q

Nutrient needs: adolescent

A
  • Her body is still growing
  • Same caloric recommendations as other women
  • Needs adequate calcium and irion
  • C-section risk if pelvis is not fully grown
  • Increased risk of future metabolic syndrome and cardio diseases
94
Q

Physical activity during pregnancy

A
95
Q

Care management: diet history

A

___

96
Q

Nursing care and nutrition status

A
97
Q

Home birth advantages vs disadvantages

A
  • Less expensive
  • Familiar surroundings
  • Disadvantages:
  • Time delay in emergency
  • No meals delivered
  • Nobody pampers you
  • No immediate assistance with breastfeeding
    -Housework taunts you
98
Q

Hospital advantages vs disadvantages

A
  • Advantage: emergency medical care just down the hall
  • Housekeeping
  • Experts monitor your recovery
  • Meals brought to you
  • Assistance with breastfeeding and child care
  • Visitors limited
  • Disadvantages: More expensive
  • Visitors limited
99
Q

Why are childbirth classes important?

A
  • They reduce anxiety
  • They teach:
  • How to maintain a healthy pregnancy
  • ___

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