Physiological and Psychological Changes of Pregnancy

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Physiological and Psychological Changes of
Pregnancy
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Reproductive Organ Changes

• Uterus
• enlargement -- 2 ounces to 2 pounds
• rises out of pelvic area and displaces the
  intestines
• changes in tissue
• increase in vascularity
• hypertrophy
• isthmus of uterus softens -
• uterine souffle
• Patient teaching
• Braxton-Hicks contractions

Hegars Sign
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• Cervix
• softens - Goodells sign
• fills with a mucus plug
• increase in discharge, leukorrhea
• Vagina
• increase in vascularity - Chadwicks sign
• increase in discharge, leukorrhea
• pH rises and become more susceptible to yeast
  infections
• Mrs. Andrews complains of a whitish
• discharge. What is the teaching
• regarding vaginal discharges?

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• Perineum
• increased vascularity and pressure causes vulvar
  varicosities
• What should the nurse teach regarding decreasing
  the pressure in the perineal area?
• Ovaries
• corpus luteum remains functioning and there is NO
  ovulation or menstruation.
• Mrs. Andrews asks why she stops having menstrual
  periods while pregnant. What is the nurses
  response ?

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• Breasts
• Growth of alveolar tissue
• Nipples become more pigmented
• Mrs. Andrews states that her breasts are more
  full and have become very heavy.
• What teaching should the nurse include?

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Respiratory Changes

• The body adjusts to meet the oxygenation needs
  by
• Thoracic rib cage is pushed upward and the
  diaphragm is elevated as uterus enlarges
• Lower thoracic cage widens to increase tidal
  volume
• Oxygen consumption is increased to support fetus
• Vasodilation of vessels in nose causing epistaxis
  and nasal stuffiness

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Respiratory Changes

• Nursing Care
• Instruct that because of shortness of breath and
  dyspnea may need to
• sleep in an upright position
• avoid overloading the stomach
• stop smoking!
• Nasal stuffiness is normal because of increase in
  hormones

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Cardiovascular Changes

• Circulatory System
• Related to
• cardiac enlargement
• vasodilation
• increase blood volume, hemodilution
• increase cardiac output 30-50
• Variations in common laboratory tests
• Hgb 12 16 g/dl stays about the same
• Hct -- 37 decreases RT hemodilution. There is
  an increase of about 1500 cc . Over 1000 cc of
  that is plasma.
• RBC -- 5.7million which is about a 17 increase.

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Cardiovascular Changes

• Nursing Care
• Avoid supine hypotension by side lying
• Arise slowly from a lying position
• Wear support hose and avoid constipation to
  decrease formation of varicose veins
• Instruct that palpitations may be felt and are
  normal

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Gastrointestinal Changes

• Nausea and Vomiting
• Related to
• increased levels of HCG
• changes in CHO metabolism
• fatigue
• Nursing Care
• Avoid offending odors
• eat dry CHO (crackers) upon wakening
• Eat 5-6 small meals per day
• Avoid spicy, gas forming foods
• Drink carbonated beverages

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Gastrointestinal Changes

• Heartburn and Indigestion
• Related to
• slowing of motility and digestion because
• of progesterone
• relaxation of cardiac sphincter, regurgitation
  occurs
• stomach displaced upward and compressed by
• enlarged uterus

• Nursing Care
• avoid large meals
• use good posture
• Take low Sodium antacids --

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Gastrointestinal Changes

• Constipation
• Related to
• slowing of motility
• intestinal compression
• oral iron supplement
• Nursing Care
• Increase water and fiber in diet
• moderate exercise
• Dont take laxatives or enema without a
  doctors permission

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Gastrointestinal Changes

• Hemorrhoids
• Related to
• pelvic congestion
• straining with stool
• Nursing Care
• avoid constipation
• Apply topical agents to area

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• Review
• Mrs. Andrews says that she just mixes up some
  baking soda and that takes care of her
  indigestion.
• Is there any teaching that needs to be done in
  this situation?

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Urinary Changes

• Renal Changes
• Related to
• Kidneys increase in size and weight to enable
  greater filtration
• Enlarged uterus presses on kidneys and ureters
  reducing effective flow.
• ureters dilate
• Urinary stasis

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Urinary Changes

• Urinary frequency and urgency
• Related to
• pressure of uterus on bladder
• Nursing care
• Kegels exercises
• Limit fluid intake before bedtime
• Report dysuria or burning

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Skin and Hair Changes

• Skin
• Increase pigmentation RT increase in production
  of melanotropin
• face chloasma
• breasts areola darkens
• abdomen linea nigra
• Spider nevi on face and upper trunk
• Striae gravidarum
• Hair
• Increase in hair growth

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Musculoskeletal Changes

• Joints, bones, and teeth
• Softening of pelvic cartilage and exaggerated
  elasticity of connective tissue can lead to
  unstable gait
• Posture changes
• Leg cramps
• Carpal tunnel syndrome
• Teeth--there is no demineralization
• Nursing Care
• Wear low heel shoes for support
• Exercises
• Walk leading with the heel of the foot
• Wrist supports until after delivery assist with
  pain related to carpal tunnel syndrome. Goes
  away after delivery.

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Weight Gain

• Normal weight gain is about 25 lbs.
• Be sure to teach about good nutrition

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Hormones

• Endocrine
• The placenta produces new hormones
• Human chorionic gonadotropin maintain pregnancy
• Human placental lactogen antagonist of insulin
• Estrogen stimulates development of uterine
  lining
• Progesterone maintains pregnancy
• Relaxin aids in softening the cervix

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• The End
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