Physiological Adaptation of the Mother to Pregnancy

 

I.                    Physiological Adaptation of the Mother to Pregnancy

A. Systemic Changes

                1. Cardiovascular System – increase blood volume of mom (plasma blood) 30 – 50% = 1500 cc of blood

- easy fatigability,  increase heart workload, slight hypertrophy of ventricles, epistaxis – due to   hyperemia of nasal membrane palpitation,

Physiologic Anemia – pseudo anemia of pregnant women

Normal Values

Hct         32 – 42%

Hgb        10.5 – 14g/dL

Criteria

1^st and 3^rd trimester.- pathologic anemia if lower

HCT should not be 33%, Hgb should not be < 11g/dL

2^nd trimester – Hct should not <32%

                                Hgb Shdn't < 10.5%  pathologic anemia if lower

Pathogenic Anemia

Iron deficiency anemia is the most common hematological disorder. It affects toughly 20% of pregnant women.

Assessment reveals:

·         Pallor, constipation

·         Slowed capillary refill

·         Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia

Nursing Care:

• Nutritional instruction – kangkong, liver due to ferridin content, green leafy vegetable-alugbati,saluyot, malunggay, horseradish, ampalaya
• Parenteral Iron ( Imferon) – severe anemia, give IM, Z tract- if improperly administered, hematoma.
• Oral Iron  supplements (ferrous sulfate 0.3 g. 3 times a day) empty stomach 1 hr before meals or 2 hrs after, black stool, constipation
• Monitor for hemorrhage

Alert:

• Iron from red meats is better absorbed iron form other sources
• Iron is better absorbed when taken with  foods high in Vit C such as orange juice
• Higher iron intake is recommended since circulating blood volume is increased and heme is required from production of RBCs

Edema – lower extremities due venous return is constricted due to large belly, elevate legs above hip level.

Varicosities – pressure of uterus

-          use support stockings, avoid wearing knee high socks

-          use elastic bandage – lower to upper

-           

Vulbar varicosities- painful, pressure on gravid uterus, to relieve- position – side lying with pillow under hips or modified knee chest position

Thrombophlebitis – presence of thrombus at inflamed blood vessel

-          pregnant mom hyperfibrinogenemia

-          increase fibrinogen

-          increase clotting factor

-          thrombus formation candidate

Outstanding sign – (+) Homan's sign – pain on cuff during dorsiflexion

Milk leg – skinny white legs due to stretching of skin caused by inflammation or phlagmasia albadolens

Mgt:

1.)     Bed rest

2.)     Never massage

3.)     Assess + Homan sign once only might dislodge thrombus

4.)     Give anticoagulant to prevent additional clotting (thrombolytics will dilute)

5.)     Monitor APTT antidote for Heparin toxicity, protamine sulfate

6.)     Avoid aspirin! Might aggravate bleeding.

1. Respiratory system – common problem SOB due to enlarged uterus & increase O2 demand

       Position- lateral expansion of lungs or side lying position.

2. Gastrointestinal – 1^st trimester change

• Morning Sickness – nausea & vomiting due to increase HCG. Eat dry crackers or dry CHO diet 30 minutes before arising bed. Nausea afternoon - small freq feeding. Vomiting in preg – emesisgravida.

Metabolic alkalosis, F&E imbalance – primary med mgt – replace fluids.

Monitor I&O

constipation – progesterone resp for constipation. Increase fluid intake, increase fiber diet

- fruits – papaya, pineapple, mango, watermelon, cantaloupe, apple with skin, suha.

Except guava – has pectin that’s constipating – veg – petchy, malungay.

- exercise

-mineral oil – excretion of fat soluble vitamins

* Flatulence – avoid gas forming food – cabbage

* Heartburn – or pyrosis – reflux of stomach content to esophagus

- small frequent feeding, avoid 3 full meals, avoid fatty & spicy food, sips of milk, proper body mechanical

increase salivation – ptyalsim – mgt mouthwash

*Hemorrhoids – pressure of gravid uterus. Mgt; hot sitz bath for comfort

3. Urinary System – frequency during 1^st & 3^rd trimester lateral expansion of lungs or side lying pos – mgt for nocturia

Acetyace test – albumin in urine

Benedicts test – sugar in urine

4. Musculoskeletal

Lordosis – pride of pregnancy

Waddling Gait – awkward walking due to relaxation – causes softening of joints & bones

Prone to accidental falls – wear low heeled shoes

Leg Cramps – causes: prolonged standing, over fatigue, Ca & phosphorous imbalance(#1 cause while pregnant), chills, oversex, pressure of gravid uterus (labor cramps) at lumbo sacral nerve plexus

Mgt:

Increase Ca diet-milk(Inc Ca & Inc phosphorus)-1pint/day or 3-4 servings/day. Cheese, yogurt, head of fish, Dilis, sardines with bones, brocolli, seafood-tahong (mussels), lobster, crab.

                                Vit D for increased Ca absorption

dorsiflexion

B. Local Changes

Local change:  Vagina:

V – Chadwick’s sign – blue violet discoloration of vagina

C – Goodel's sign – change of consistency of cervix

I – Hegar's – change of consistency of isthmus (lower uterine segment)

LEUKORRHEA – whitish gray, mousy odor discharge

ESTROGEN – hormone, resp for leucorrhea

OPERCULUM – mucus plug to seal out bacteria.

PROGESTERONE – hormone responsible for operculum

PREGNANT – acidic to alkaline change to protect bacterial growth (vaginitis)

Problems Related to the Change of Vaginal Environment:

1. Vaginitits – trichomonas vaginalis due to alkaline environment of vagina of pregnant mom

Flagellated protozoa – wants alkaline

                            S&Sx:

                            Greenish cream colored frothy irritatingly itchy with foul smelling odor with vaginal edema

Mgt:

FLAGYL – (metronidazole – antiprotozoa). Carcinogenic drug so don’t give at 1^st trimester

1.       treat dad also to prevent reinfection

2.       no  alcohol – has antibuse effect

VAGINAL DOUCHE – IQ H2O : 1 tbsp white vinegar

2. Moniliasis or candidiasis due to candida albecans, fungal infection.

Color – white cheese like patches adheres to walls of vagina.

Signs & Symptoms:

Management – antifungal – Nistatin, genshan violet, cotrimaxole, canesten

Gonorrhea -Thick purulent discharge

Vaginal warts- condifoma acuminata due to papilloma virus

Mgt: cauterization

2. Abdominal Changes – striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue – avoid scratching, use coconut oil, umbilicus is protruding

3. Skin Changes – brown pigmentation nose chin, cheeks – chloasma melasma due to increased melanocytes.

 Brown pinkish line- linea nigra- symphisis pubis to umbilicus

4. Breast Changes – increase hormones, color of areola & nipple

pre colostrums present by 6 weeks, colostrums at 3^rd trimester

Breast self exam- 7 days after mens –– supine with pillow at back

quadrant B – upper outer – common site of cancer

Test to determine breast cancer:

1. mammography – 35 to 49 yrs once every 1 to 2 yrs

   50 yrs and above – 1 x a yr

5. Ovaries – rested during pregnancy

6. Signs & symptoms of Pregnancy

1. Presumptive – s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy . Subjective
2. Probable – signs observed by the members of health team. Objective
3. Positive Signs – undeniable signs confirmed by the use of instrument.

Ballotment sign of myoma

* + HCG – sign of H mole

- trans vaginal ultrasound. Empty bladder

- ultrasound – full bladder

placental grading – rating/grade

o – immature

1 – slightly mature

2 – moderately mature

3 – placental maturity

What is deposited in placenta which signify maturity - there is calcium

Presumptive	Probable	Positive
Breast changes Urinary freq Fatigue Amenorrhea Morning sickness Enlarged uterus Cloasma Linea negra Increased skin pigmentation Striae gravidarium Quickening	Goodel's- change of consistency of cervix Chadwick’s- blue violet discoloration of vagina Hegar's- change of consistency of isthmus Elevated BBT – due to increased progesterone Positive HCG or (+)preg test Ballottement – bouncing of fetus when lower uterine is tapped sharply Enlarged abdomen Braxton Hicks contractions – painless irregular contractions	Ultrasound evidence (sonogram) full bladder Fetal heart tone Fetal movement Fetal outline Fetal parts palpable

II.                              Psychological Adaptation to Pregnancy (Emotional response of mom –Reva Rubin theory)

First Trimester: No tanginal signs & sx, surprise, ambivalence, denial – sign of maladaptation to pregnancy. Developmental task is to accept biological facts of pregnancy

Focus: bodily changes of preg, nutrition

Second Trimester – tangible S&Sx. mom identifies fetus as a separate entity – due to presence of quickening, fantasy. Developmental task – accept growing fetus as baby to be nurtured.

Health teaching: growth & development of fetus.

Third Trimester: - mom has personal identification on appearance of baby

Development task: prepare of birth & parenting of child. HT: responsible parenthood ‘baby’s Layette” – best time to do shopping.

Most common fear – let mom listen to FHT to allay fear

Lamaze classes