Post on 12-Feb-2016
description
PHYSIOLOGIC ADAPTATIONS TO PREGNANCY
Developed by D. Ann Currie, R.N., M.S.N.
REPRODUCTIVE SYSTEM• UTERUS• CERVIX• VAGINA• BREASTS
REPRODUCTIVE SYSTEM• UTERUS-ENLAREMENT DUE TO
INCREASE ESTROGEN AND PROGESTERONE
• INCREASE VASCULARITY• HYPERPLASIA• HYPERTROPHY
Nonpregnant Uterus
UTERINE GROWTH• LENGTH:2 1/2 in. to 12 1/2 in(6.5cm-
32cm)• WIDTH:1 1/2in to 9 1/2 in(4cm-24cm)• DEPTH:1in to 8 1/2 in(2.5cm-22cm)• WEIGHT;2 1/2oz. to 2 1/2 lb.(60-70g-
1100-1200g)• VOLUME: 1-2ml to 5000ml(10ml-
5000ml)
Uterine Growth
CERVIX• INCREASE VASCULARITY AND
HYPERTROPHY DUE TO ESTROGEN AND PROGESTERONE
• CHADWICK’S SIGN• GOODELL’S SIGN• MUCORRHEA DEVELOPS- MUCOUS
PLUG FORMS
Bimanual Examination
Hegar's sign
Ladin’s Sign
B Sign
Pisacek’s Sign
VAGINA• INCREASE VASCULARIZATION DUE
TO ESTROGEN AND SOFTEN ING DUE TO PROGESTERONE
• CHADWICK’S SIGN• VAGINAL DISCHARGE TENDS TO BE
THICK AND WHITE=LEUKORRHEA• PH-4-6.5.(NONPREGNANT WOMAN
3.5-4.5)
BREASTS• BREAST CHANGES ARE DUE TO
ESTROGEN AND PROGESTERONE• INCREASE
VASCULARITY,NODULARITY,AND HYPERTROPHY
• PIGMENTATION OF NIPPLES DARKEN• MONTGOMERY’S GLANDS BECOME
PROMINENT
BREASTS• CONT• COLOSTRUM IS PRODUCED AND
MAYBE SECRETED AS EARLY AS 16 WEEKS
• BREAST FEEL FULL,INCREASE SENSITIVITY,TINGLELY,AND HEAVY.
BREAST CHANGES
HEMOLOGICAL CHANGES IN PREGNANCY• BLOOD VOLUME-40-50 %
INCREASE(1500 ML)• PLASMA VOLUME-50%
INCREASE(1200-1300ML) BY 30-34 WEEKS
• RBC’S-17-20% INCREASE(5-6.25MIL/MM
• PLT-150,000-400,000
HEMOLOGICAL CHANGES• CONT• WBC’S-INCRESE IN 2ND -3TH
TRIMESTER(5,000-15,000MM-)• FIBRINOGEN-INCRESAES 50-80%• FACTORS VII,VIII,IX,X- INCREASE• FACTORS XI,XII-DECREASE• SED RATE- INCREASES
CARDIOVASCULAR SYSTEM• HEART RATE- INCREASES 10-15
BEATS PER MIN.• B/P- 1ST TRIMESTER-REMAIN THE
SAME-2ND TRIMESTER DECREASES- AND 3RD TRIMESTER RETURNS TO NORMAL
• CARDIAC OUTPUT-INCREASES 30-50%
CARDIOVASCULAR SYSTEM• CONT• MYOCARDIAL HYPERTOPHY-
INCREASES 12%• THE HEART IS SHIFTED UPWARD,
ANTERIORLY AND LATERALLY TO LEFT
• HEART SOUNDS-S1,S2,S3 AFTER 20WKS.-MURMURS ARE COMMON
Supine Hypotension from pressure on the vena cava
RESPIRATORY SYSTEM• INCREASED CHEST EXPANSION• DIAPHRAGM DISPLACED AS MUCH AS
4CM.• INCREASED VASCULARITY AND
SECRETION OF MUCOUS MEMBRANES
• RESPIRATORY RATE INCREASES 2 BPM
RESPIRATORY SYSTEM • CONT• TIDAL VOLUME INCREASES 30-40%• VITAL CAPACITY UNCHANGED• INSPIRATORY CAPACITY INCREASES• EXPIRATORY VOLUME DECREASES• TOTAL LUNG CAPACITY
UNCHANGED OR SL.DECREASE.
RESPIRATORY SYSTEM• CONT• O2 CONSUMPTION INCREASES 15-
20%• PO2-INCREASES(104-108mmHG)• PCO2-DECREASES(27-32mmHG0• HCO3-DECREASES(18-31mEq/L)• PH-INCREASES(7.4-7.45)
RENAL SYSTEM• RENAL PELVIS AND URETERS DILATE-
RIGHT MORE THAN LEFT• BLADDER CAPACITY-INCREASES TO
1500ML.• GLOMERULAR FILTRATION RATE-
INCREASES 30-50%• RENAL PLASMA FLOW-INCREASES
30%
RENAL SYSTEM • CONT• LABS- GLUCOSE IN URINE UP TO 1+ • PROTEIN-N URINE TRACE TO 1+• BUN-DECREASED 8-20mg/dl• CREATININE-DECREASED (0.6-1.2mg/dl)• URIC ACID -DECREASED 1ST-2ND
TRIMESTER(4.5-5.8mg/dl)-3rd back to normal
INTEGUMENTARY SYSTEM
• HYPERPIGMENTATION OF NIPPLES,AREOLAE, AXILLAE, AND VULVA
• CHLOASMA• LINEA NIGRA• STRIAE GRAVIDARUM• ANGIOMAS
Linea Nigra
STRIAE GRAVIDARUM
INTEGUMENTARY SYSTEM• CONT.PALMAR ERYTHEMA• HYPERACTIVE SWEAT AND
SEBACEOUS GLANDS• SKIN DISORDERS MAY INCREASE-
INCLUDING PRURITUS AND ACNE• HAIR GROWTH INCREASES
GASTROINTESTINAL SYSTEM• GUMS-INCREASE
VASCULARITY,HYPEREMIC, SPONGY AND SWOLLEN
• EPULIS• PTYALISM• N/V-”MORNING SICKNESS”• HIATAL HERNIA MAY OCCUR IN 15-
20%PREGNANT CLIENTS
GASTROINTESTINAL SYSTEM• HEARTBURN-PYROSIS• DECREASE TONE AND MOLITY OF
GI TRACT• CONSTIPATION• GB EMPTYING TIME IS SLOWED-GB
STONE MAY FORM• STOMACH IS DISPLACED UPWARD
GASTROINTESTINAL SYSTEM• COLON IS COMPRESSED AND
DISPLACED.• APPETITE CHANGES
MUSCULOSKELETAL SYSTEM• LORDOSIS OCCURS• CENTER OF GRAVITY CHANGES• GAIT CHANGES-”WADDLING”• SL. RELAXATION OF PELVIC JOINTS• MUSCLE TONE OF ABDOMINAL
MUSCLESDECREASES• DIASTASIS RECTI ABDOMINIS MAY
OCCUR
POSTURAL CHANGES IN PREGNANCY
Diastasis Recti Abdominis
NEUROLOGIC SYSTEM• COMPRESSION OF PELVIC NERVES• EDEMA INVOLVING PERPHERAL
NERVES MAY RESULT IN CARPAL TUNNEL SYNDROME.
• ACROESTHESIA• TENSION H/A• HYPOCALCEMIA-MUSCLE CRAMPS
AND TETANY
ENDROCINE SYSTEM• PITUITARY GLAND-SUPPRESSION OF
FSH AND LH FROM ANT PITUITARY• INCREASES IN SIZE• MSH.,PROLACTIN,TSH,AND
ADRENOCORTICOTROPIC HORMONE ARE INCREASED
• OYTOCIN INCREASES AS FETUS MATURES AND LABOR IS NEAR
ENDOCRINE SYSTEM• THYROID GLAND-INCREASES IN SIZE
SLIGHTLY• BMR INCREASES 25%(15-20%)• T4 INCREASES AND THAN RETURNS
TO NORMAL• PARATHYROID GLAND-PARATHYROID
HORMONE INCREASES-PEAK AT 15-35 WKS
ENDOCRINE SYSTEM• CONT• PANCREAS-INSULIN PRODUCTION
INCREASES-HOWEVER THERE IS PERIPHERAL RESISTANCE TO INSULIN
• BLOOD SUGARS-DECREASE IN 1ST TRIMESTER 2ND-3RD BLOOD SUGAR RISE TO NORMAL OR INCREASED
ENDOCRINE SYSTEM• ADRENAL GLANDS-INCREASED
ALDOSTERONE LEVELS,INCREASED CORTISOL LEVELS
ENDROCRINE SYSTEM• PLACENTA-PRODUCES ESTROGEN
AND PROGESTERONE• RELAXIN• HUMAN PLACENTAL LACTOGEN• INSULINASE
IMMUNOLOGICAL SYSTEM• HELPER T CELLS DECREASE• SUPPRESSOR T CELLSS INCREASE• B CELL FUNCTION IS SUPPRESSED• IgG DECREASES• RISK FOR INFECTION INCREASES• WBC’S -INCREASE(5000-15000)• POLYMORPHONUCLEAR NEUTROPHILS
INCREASE
DANGER SIGNS DURING PREGNANCY• SEVERE VOMITING• FREQUENT AND
SEVERE H/A• EPIGASTRIC PAIN• FLUID DISCHARGE
FROM VAGINA• VISUAL
DISTURBANCES
• ABDOMINAL-UNUSUAL OR SEVERE PAIN
• FM CHANGES OR ABSENCE
• SWELLING OF HANDS AND FACE
• VAGINAL BLEEDING