Term
| What happens to the uterus physically during pregnancy? |
|
Definition
1. Increased vascularity/dilation of blood vessels
2. hyperplasia-new muscle fibers/tissue
3. hypertrophy-enlargement of pre-existing fibers
4. development of the decidua
5. growth changes R/T stimulation from high levels
of estrogen/progesterone
5. shape changes
6. position changes |
|
|
Term
|
Definition
| the thick layer of modified mucous membrane (ednometrial lining) that lines the uterus during pregnancy and is shed with the afterbirth |
|
|
Term
| What are the positions of the uterus at different time periods? |
|
Definition
-12 weeks-at or above the symphysis pubis
-16 weeks-between SP and umbilicus
-20 weeks-at the umbilicus
-36 weeks-almost to the xiphoid process |
|
|
Term
| At which week should the distance the fondus to the symphysis pubis equal gestational age? |
|
Definition
|
|
Term
| What happens when lightening occurs? |
|
Definition
The baby drops
-nulliparas-2 weeks before term
-multiparas-when labor starts |
|
|
Term
|
Definition
| The fetus is not yet in the pelvis but can be palpated floating structure |
|
|
Term
| Why do pregnant mother's waddle? |
|
Definition
They have an altered center of gravity as enlarging uterus tilts
against the anterior abdominal wall |
|
|
Term
| What are the Bracksten-Hicks contractions? |
|
Definition
| They are irregular, painless contractions that help to facilitate blood flow and start around 4 months. Too many could be preterm labor. |
|
|
Term
| What is important to know about uteroplacental blood flow? |
|
Definition
1. uterine blood flow increases
2. more oxygen is extracted from the blood in the latter part of the pregnancy
3. At the end of pregnancy, 1/6 of total blood volume within the vascular system of uterus
4. Anything that can effect blood supply can cause bad effects to the fetus:
Ex: supine hypotension, rupture of the uterus or placenta, smoking |
|
|
Term
|
Definition
| 6 weeks-softening of lower uterine segment (very uncomfortable) |
|
|
Term
| What are changes in the uterus? |
|
Definition
1. Goodell’s sign-softening of cx-6 weeks
2. Chadwick’s sign-bluish cast-8 weeks
3. friability increases
4. operculum-mucus plug-endocervical glands (snot, may take a while to come out may last all pregnancy) |
|
|
Term
| What could also create Chadwick's sign? |
|
Definition
|
|
Term
| What happens during pregnancy to the vagina? |
|
Definition
1. increased vascularity
2. leukorrhea-thick white vaginal discharge
3. change in pH leads to higher risk for yeast inf. |
|
|
Term
| What happens to the breasts during pregnancy? |
|
Definition
1. start to change by week 6 R/T hormone surge
2. increase in sensitivity, breast and nipple size
3. increase in feeling firm, heaviness, nipple erect
4. nipples and areola become more pigmented
5. vessels beneath the skin dilate-more visible
6. striae gravidarum (stretch marks) may appear
7. may leak colostrum as early as 16 weeks |
|
|
Term
| What can happen to breast stimulation during pregnancy? |
|
Definition
| Breast stimulation can stimulate production of oxytocin causing contractions. This could lead to preterm labor. |
|
|
Term
| What happens to the heart during pregnancy? |
|
Definition
1. slight hypertrophy R/T increase blood flow
2. position change R/T diaphragm position
3. transient murmurs may be auscultated
4. cardiac output
-increased 30-50% by week 32
-only 20% increase by week 40
-R/T increased stroke volume and heart rate
6. pulse rate increases 10-15 bt/min |
|
|
Term
| Why will cardiac issues present in a pregnant mother? |
|
Definition
| The blood volume increases by 50% and puts more stress on the heart. |
|
|
Term
| What happens to the blood during pregnancy? |
|
Definition
1. increase in blood volume 40-50% (1500ml)
-plasma-1000 ml
-RBC’s-450 ml
2. physiological anemia-hemodilution of cells
-anemic if Hgb under 10g/dl, Hct under 35%
3. increase in WBC’s
4. coag times
-circulation time decreases by week 32 near normal at term
-↑ in clotting factors leads to ↑ tendency for blood to coagulate
-↑ risk for thrombosis-esp. with C/S |
|
|
Term
| What happens to blood pressure during pregnancy? |
|
Definition
1. 1st trimester-no change in BP
2. 2nd trimester-BP ↓ 5-10 mm Hg
3. 3rd trimester-BP returns to 1st trimester values
4. supine hypotensive syndrome
-if they lie on their backs
-at 5 minutes, reflex bradycardia (fetus HR)
-CO ↓ by half
-woman feels faint |
|
|
Term
| What drink should you use when taking Fe supplement? |
|
Definition
| Orange juice increases absorption |
|
|
Term
| What can a nurse suggest to promote circulation in a pregnant woman? |
|
Definition
| Walk around, put feet up when sitting, wear compression stockings |
|
|
Term
| What should a nurse tell someone who is taking Fe supplement? |
|
Definition
| Stool will look tarry color, you may be constipated, drink plenty of water |
|
|
Term
| What happens to the rib cage during pregnancy? |
|
Definition
|
|
Term
| How does breathing shift during pregnancy? |
|
Definition
| From Abdominal to thoracic |
|
|
Term
| Why is there elevated maternal oxygen requirements during pregnancy? |
|
Definition
1. acceleration in metabolic rate
2. the need to add to the tissue mass of uterus
3. fetal needs |
|
|
Term
| What happens when ↑ vascularity of the upper resp. tract during pregnancy? |
|
Definition
1. nasal and sinus stuffiness-(estrogen-induced)
2. epistaxis (nosebleeds) & gum bleeds are normal
3. changes in the voice |
|
|
Term
|
Definition
| It softens cartilage throughout the body: used for rib cage expansion, and pelvis but also affects joints (may cause knee pain) |
|
|
Term
| What happens to the pulmonary function during pregnancy? |
|
Definition
1. deep breathing-↓ airway resistance-Progesterone
2. ↑ tidal volume
3. resp rate ↑ 2 breaths/min
4. ↑ awareness to breath (gotta catch my breath)
5. sensitivity in medulla to CO2-↑ depth, rate |
|
|
Term
| What happens to the basal metabolic rate during pregnancy? |
|
Definition
1. ↑ 15-20% by term
2. reflects ↑ in oxygen demand
3. may experience heat intolerance R/T excess
heat from ↑ BMR
(Labor room will be warm) |
|
|
Term
| What happens to the acid base balance during pregnancy? |
|
Definition
1. pregnancy is a state of resp. alkalosis compensated by mild metabolic acidosis
2. facilitates maternal-fetal O2-CO2 transfer |
|
|
Term
| What should you remember when putting in a foley catheter on a pregnant woman? |
|
Definition
| The urethra has lengthened. Once you get flash of urine advance the foley a few more inches before inflating the balloon to avoid damaging the urethra. |
|
|
Term
| What does ↑ estrogen and progesterone do to uterus size & blood volume? |
|
Definition
| ↑ estrogen and progesterone |
|
|
Term
| What causes larger amounts of urine during pregnancy? |
|
Definition
| Dilations of ureters, pelvis, renal calyces |
|
|
Term
| What are reasons for increased bacteria in the bladder? |
|
Definition
1. Urine flow rate slowed→stasis/stagnation
2. Tubular reabsorption is impaired→glucose ↑ in urine→ more alkaline urine |
|
|
Term
| What causes increase in urinary frequency? |
|
Definition
| ↑ in bladder sensitivity and compression from uterus |
|
|
Term
| At what trimester is the bladder pulled up into the abdomen? |
|
Definition
|
|
Term
| What is a functional change in the renal system during pregnancy? |
|
Definition
|
|
Term
| What is the most efficient position a pregnant woman to be to increase kidney perfusion? |
|
Definition
|
|
Term
| What are the two things you are looking for when you dip a patient's urine and how often should you do a urine dip? |
|
Definition
Urine dip every visit and look for:
1. Protein (preeclampsia) +1 is ok
2. Glucose (gestational diabetes) |
|
|
Term
| What could cause excessive edema during pregnancy? |
|
Definition
|
|
Term
| What is needed to maintain normal Na level? |
|
Definition
| Increased tubular reabsoprtion |
|
|
Term
| Less blood flow causes pooling of fluids in the legs, how can this be corrected? |
|
Definition
| Elevate the legs or use diuretics but elevating is a better approach. |
|
|
Term
| What causes hyperpigmentation during pregnancy? |
|
Definition
Caused by stimulation of anterior pituitary
hormone melanotropin. Darkening of nipple, areola, vulva, thighs |
|
|
Term
|
Definition
brownish facial pigmentation-intensified by sun
-usually fades after pregnancy |
|
|
Term
|
Definition
| dark vertical line from symphysis pubis to fundus that starts as linea alba-before pigmentation but is not present in all pregnant women |
|
|
Term
| What is striae gravidarum? |
|
Definition
| Stretch marks on abdomen, breasts, thighs caused by separation of collagen. 50-90% of women will have this. |
|
|
Term
| What are other changes that occur in pregnancy? |
|
Definition
1. angiomas-vascular spiders
2. palmar erythema-blotches on hands
3. pruritus-itching from the inside out
4. gum hypertrophy-bleeding gums
accelerated nail growth
5. hirsutism-excessive hair growth
6. ↑ blood supply = ↑ perspiration |
|
|
Term
| How can you treat pruritus? |
|
Definition
| Change soap, use lotion, Benadryl, different detergents |
|
|
Term
| What do you need to check if a pregnant mother has bleeding gums? |
|
Definition
| If she is brushing her teeth. If not give her a softer tooth brush. Also check the calcium levels. The baby may be taking calcium from the mom. |
|
|
Term
| What happens to the back of a pregnant woman? |
|
Definition
| Lordosis increases for balance |
|
|
Term
| How much can the pelvis open when relaxin is in her system? |
|
Definition
| 1/4 inch cartilage separation |
|
|
Term
| What can happen to the abdominal muscles in pregnancy? |
|
Definition
| (diastasis recti abdominis) Separation of the abdominal muscles. Exercise can help the muscle come back together. |
|
|
Term
| What is sciatica & how can it be treated? |
|
Definition
| Pressure on the pelvic nerve caused by the pregnancy creates pain that radiates down one leg. Abdominal sling & support garments can be used to reduce pressure. |
|
|
Term
| What does dependent edema cause? |
|
Definition
Carpel tunnel;
burning, paresthesia, pain in the hand, radiating to the elbow |
|
|
Term
| What happens to a pregnant woman that has a history of migraines? |
|
Definition
| they get worse due to increase blood flow |
|
|
Term
| What are two neurological adverse effects that can happen from pregnancy? |
|
Definition
| Tension headaches, syncope (early stages) |
|
|
Term
| What GI negative effects does pregnancy cause? |
|
Definition
Constipation, Nausea, vomiting, hiaitial hernias
bleeding of gums/problems of the mouth
-caused by rising level of estrogen
-ptyalism-excessive salivation |
|
|
Term
| When estrogen increases what happens to HCl? |
|
Definition
|
|
Term
| What happens when progesterone goes up? |
|
Definition
| Stomach emptying time decreases & heartburn can occur |
|
|
Term
| What can a pregnant woman do to reduce heartburn? |
|
Definition
| Avoid spicy foods, take Tums (increases calcium as well), sit up after meals, small frequent meals-> keep stomach full to have continuous emptying |
|
|
Term
| What are the effects of gallbladder distention? |
|
Definition
| Prolonged emptying time and thickening of bile→development of gall stones & can lead get into the skin causing pruritus gravidarum (pups) |
|
|
Term
| What are some change in appetite/food consumption? |
|
Definition
1. change in CHO, protein, fat metabolism
2. pica-craving for non-food material
3. morning sickness-usually ends by 2nd trimester |
|
|
Term
| Why does morning sickness end by the 2nd trimester? |
|
Definition
| The placenta has taken over hormonal control |
|
|
Term
Endocrine system in a pregnant woman
? |
|
Definition
|
|
Term
| What are the ↑ secretions of pituitary hormones during pregnancy? |
|
Definition
thyrotropin
FSH/LH
prolactin
vasopressin (antidiurectic hormone)
oxytocin |
|
|
Term
| What are the ↑ secretions of thyroid hormones during pregnancy? |
|
Definition
thyroxine
triiodothyronine |
|
|
Term
| What is released from the parathyroid during pregnancy? |
|
Definition
| ↑ secretion of parathyroid hormones |
|
|
Term
| What is released from the adrenal glands during pregnancy? |
|
Definition
cortisol-r/t ↑ estrogen-regulates CHO/prot meta.
Aldosterone-protective response to Na excretion |
|
|
Term
| What is secreted from the pancreas during pregnancy? |
|
Definition
|
|
