Scribd- Maternal Adaptation

8/9/2019 Scribd- Maternal Adaptation

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MATERNAL ADAPTATION TO PREGNANCY


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Nursing Process OverviewFor Healthy Adaptation to Pregnancy

AssessmentIdeally, begins before the pregnancy. During a

preconception assessment Evaluate

Woman's health status Nutritional intake Lifestyle Identify any potentialproblems Identify the woman's understanding and expectations of conception, pregnancy, and parenthood.


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Establish a trusting relationship Assess the woman's health and nutritional

status, as well as the well-being of the fetus, throughout pregnancy. Documentthe woman's physiologic adaptations and the family's psychological adaptations

to pregnancy Physical findings are gained through the health history, physicalassessment, and laboratory tests. Assessment in psychological areas

interviewing


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Nursing Diagnosis Examples of nursing diagnosesAnxiety related to unexpected pregnancy Altered breathing pattern related to respiratory system changes of pregnancy Disturbed body image related to weightgain with pregnancy Deficient knowledge related to normal changes of pregnancy Imbalanced nutrition, less than body requirements, related to morning sickness


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Outcome Identification and Planning Plan to review concerns of the woman as well as a plan to ask about the individual responses she is experiencing.


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ImplementationHelp women at prenatal visits to voice their

concerns about either physiologic or psychological changes of pregnancy, May need suggestions on exercise and nutrition to prepare for pregnancy and to followduring pregnancy. Nursing interventions can be instrumental in not only guidinga woman safely through a pregnancy but also connecting her back with ongoing he

alth care.


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Outcome Evaluation Client states she is able to continue her usual lifestyle throughout pregnancy. Family members describe ways they have adjusted their lifestyles to accommodate the mother's fatigue. Couple states they accept the physiologic changes of pregnancy as normal.


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Psychological Changes of PregnancyWoman's attitude toward a pregnancy

depends a great deal on psychological aspectsthe environment the messages about pregnancy her family

communicated to her as a child the society and culture in which she lives as an

adult whether the pregnancy has come at a good time in her life.


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Social Influences cultural background their personal experiences the experiences of friends and relatives current public philosophy of childbirth. People's opinions about adolescent pregnancies, late in life pregnancies, or lesbianpregnancies have changed markedly.


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Cultural Influences may strongly influence how active a role she wants to takein her pregnancy certain beliefs and taboos may place restrictions on her beha

vior and activities To learn about the beliefs of a particular woman and her partner, ask at prenatal visits if there is anything they believe should or shouldnot be done to make the pregnancy successful and keep the baby healthy. Suppor

ting these beliefs shows respect for the individuality of the woman and her knowledge


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Family InfluencesLoving family: more likely to have a

positive attitude toward her pregnancy People love as they have been loved Woman who views mothering as a positive activity is more likely to be pleased when she becomes pregnant than one who devalues mothering


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Individual Influences Woman's ability to cope with or adapt to stress Security in her relationship with the people around her, especially the father of her child, is usually also important to her acceptance of a pregnancy. A woman who thinks of brides as young but mothers as old may believe pregnancy will rob her of her youth.


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The Psychological Tasks of PregnancyFirst Trimester: Accepting the Pregnancy Accept the reality of the pregnancy.A diagnosis of pregnancy is a similar rite of passage. In reality, as many as50% of pregnancies are still unintended, unwanted, or mistimed Often women immediately experience something less than pleasure and closer to disappointment oranxiety at the news that they are pregnant.


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The Partner Partner may go through some of the same psychological changes. Accepting the woman in her changed state. A partner should try to give the womanemotional support while she is learning to accept the reality of pregnancy Often partners are proud and happy about the pregnancy, facilitating acceptance of it. An unwed father may have a great deal of difficulty accepting a pregnancy unless he is actively involved in prenatal care.


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Second Trimester: Accepting the BabyThe Woman Accept that she is having a baby, a separate

step from accepting the pregnancy. Second turning point in pregnancy : quickening, or the first moment a woman feels fetal movement. She begins to imagine herself as a mother Realize that not only is she pregnant but also there is a child inside her.


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Second Trimester: Accepting the BabyThe Partner Feeling of being left out Some men may have difficulty enjoying the pregnancy if they have been misinformed about sexuality, pregnancy, and women's health. Many men comment that the information they receive about childbirthand pregnancy is too concerned with their partner or the child and not enough with how they feel to be relevant to them.


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Third Trimester: Preparing for Parenthoodnest-building activities It is helpful for couples to attend

childbirth education classes or classes on preparing for parenthood.


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Emotional Responses to PregnancyAmbivalencemay want to be pregnant, and yet she may not

be enjoying it. This leads to some degree of ambivalence. refers to the interwoven feelings of wanting and not wanting that can exist at high levels. It is important to emphasize that this ambivalence is normal. Partners also experience

ambivalence, sometimes more so than pregnant women. To help partners resolve some ambivalence, provide an outlet for them to discuss concerns,


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GriefBefore a woman can take on a

mothering role, she has to give up or alter her present roles. She must incorporate her new role as a mother into her other roles as a daughter, wife, or friend. Her partner must incorporate a new role as a father into his other roles ofson, husband, or friend.


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NarcissismSelf-centeredness (narcissism) is generally an

early reaction to pregnancy. Dressing becomes a time-consuming, mirrorstudyingprocedure. She makes a ceremony out of fixing her meals. May lose interest inher job or community events Men may demonstrate the same behavior by reducing risky activities Need to protect her body has implications for nursing care.


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Introversion Versus ExtroversionIntroversion, or turning inward to

concentrate on oneself and one's body, is a common finding during pregnancy. They become more active, appear healthier than ever before, and are more outgoing.


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StressTime of extreme stress for a woma May cause people who were dependent on

the woman before pregnancy to feel neglected To help families keep their perspective, remind them that a decrease in the responsibilities that a pregnant womantakes on is a reaction to the stress of pregnancy, not the pregnancy itself. Awoman with few support people around her almost automatically has more difficul

ty


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Couvade SyndromeMen experience physical symptoms such as

nausea, vomiting, and backache to the same degree or even more intensely than their partners do during a pregnancy. These symptoms apparently result from stress, anxiety, and empathy for the pregnant woman. The more the partner is involved in or attuned to the changes of the pregnancy, the more symptoms he may experi

ence. For the most part, these are healthy


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Changes in Sexual Desire1st Trimester: decrease in libido nausea, fatigue, and breast tenderness thataccompany early pregnancy. 2nd trimester: libido and sexual enjoyment

rise markedly. blood flow to the pelvic area increases to

supply the placenta

3rd trimester: sexual desire may remain high,

or it may decreasebecause of difficulty finding a comfortable

position and increasing abdominal size.


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Reproductive SystemUterus (UterineMeasurements)Uterine Wt. Thickness Length Depth Width Capacity Pregnancy 50 gm. 2 cm 6.5 cm 2.5 cm 4 cm 10 ml Term Pregnancy 1100 gm. 0.5 cm 32 cm 20 cm 24 cm 5000 ml


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Reproductive SystemBlood Flow : Uterine blood flow increases

from 20 ml before pregnancy to 700 to 900 ml at the end of pregnancy. of the blood supply goes to the placenta.

Shape : From pear shape before

pregnancy to spherical and later on to ovoid shape in the last months of pregnancy

Position : After 12 weeks gestation, the

uterus loses its anteflexed position.


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Reproductive SystemLocation of the Fundus :12 weeks - at the level of the symphisis 16 weeks halfway between symphisisand

umbilicus 20 weeks level of the umbilicus 24 weeks 2 fingers above the umbilicus 30 weeks midway between umbilicus and xiphoid process 36 weeks leve

l of the xiphoid process 40 weeks 2 fingers below the umbilicus, drops at 34weeks level because of lightening


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Reproductive SystemContractility :uterus is a highly contractile organ. Beginning on the first trimester,

the uterus undergoes irregular contractions. Late in pregnancy, these contractions, known as BraxtonHicks, becomes more intense and frequent causing some discomfort


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Reproductive SystemCervixColor : Change from pink to purplish due to

increase blood supplyLeukorrhea : Estrogen stimulation results in

increase mucus production that leads to the formation of operculum, the mucus plug of the cervix that protects against bacteria and infection. Consistency: Softening of the cervix, known as Goodels sign, is observable by 6 to 8 weeks gestation.


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Reproductive SystemIsthmusDuring pregnancy, the isthmus

softens and elongates up to 25 mm. It will later form the lower uterine segment,together with the cervix. Hegars sign softening of the lower uterine segment begins as early as 5 week gestation


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Reproductive SystemVaginaIncrease blood supply results in:

Chadwick sign change color from pinkish to purplish or dark-blue Increase sensitivity and heightened sexual responsiveness Vaginal ph 3.5 to 6, acidic


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Reproductive SystemOvariesNo Graafian follicle develop and no

ovulation occurs during pregnancy Corpus luteum is the chief source of hormoneprogesterone during the first 12 weeks gestation, it also produces estrogen, relaxin, inhibins and sometimes oxytocin.


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Reproductive SystemBreastIncrease breast size due to alveolar tissue

growth, fat deposition and increase vascularity. associated with pregnancy includes feeling of fullness and tingling sensation darkening of the skin aroundthe areola. Montgomerys gland becomes prominent and nipples stand out. A c

lear fluid called colustrum, can be expressed from it as early as the 4th month.


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Cardiovascular SystemBlood Volume

Total volume increases by 45 to 50%

for which 75% is plasma and 25% is RBC. Increase volume leads to increase in cardiac output by 25 to 50% Increase in blood volume reaches its peak at about 24

weeks, cardiac workload also reaches its peak during the 2nd trimester.


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Cardiovascular SystemBlood ConstituentsIncrease production of RBC by the bone marrow Hemodilution occurs causing pseudoanemia Increase protein requirement of the fetus and

hemodilution contribute to the reduction of maternal plasma protein level. Reduction of protein level lowers osmotic pressure within intravascular spaces which

causes fluid shift from intravascular to interstitial space. This contributes tothe normal ankle and foot edema of pregnancy. Blood lipid and cholosterol level increases to provide an available supply of energy for the fetus Increase level of clotting factor making woman prone to thrombus formation. Instruct to avoid massage


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Cardiovascular SystemHeart

The heart is displaced to the left

and upward of the diaphragm Slight cardiac enlargement Palpitation during pregnancy.

In the 1st trimester is due to

parasympathetic stimulation In the latter part of pregnancy, it is due to enlarged uterus.


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Cardiovascular SystemBlood Pressure Blood pressure remains the same as

pre-pregnancy level. It may drop slightly on the 2nd trimester but returns to normal levels on the 3rd trimester. Arterial blood pressure is highest in sittingposition, intermediate in supine and lowest in left lateral position.


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Respiratory system

Increase oxygen requirement Effects of estrogen and progesterone Mechanical effect of the enlarge uterus Hyperventilation in an effort to blow off

the extra CO2 from the fetus. Displacement of the diaphragm because of the enlarged uterus Chest crowding compensate by expanding the lung horizontally

Decrease residual volume less air is left in the lung after expiration Shortness of breath


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Respiratory systemTotal body comsumption of O2 increase by 15

20% Nasal congestion occurs due to estrogen stimulation.


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Urinary SystemUrinary frequency during pregnancy is due to:1st trimester uterus exerts pressure on the

bladder as it rises out of the pelvic cavity 2nd trimester pressure of the presenting part on the bladder after lightening Increase blood flow to the kidneywhich increases glomerular filtration rate and consequently, urinary output.


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Lactosuria presence of lactose in the urine is considered

normal. Lactose is secreted by the mammary glands but since it is not yet usedduring pregnancy, it normally spills in the urine.

Nocturia increase urination at night


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Gastrointestinal SystemEffects of ProgesteroneDecrease GIT motility constipation Pyrosis / Heartburn relaxation of

cardiac sphincter Slowed bile movement from gall bladder result in reabsorptionof bilirubin in the maternal blood stream pruritus


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Gastrointestinal SystemEffects of Estrogen Ptyalism increase salivation Epulis hypertrphy or swelling of the gums.


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Intergumentary SystemMelasma facial discoloration Linea Negra dark line from the umbilicus

to the symphisis Darker areola

Increase melanin production

Striae gravidarum Palmar erythema Vascular Spider nevi Activation of sweat and oil glands


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Endocrine SystemThyroid glands slightly enlarge due to

increase metabolic rate Pancreas elevated glucocorticoid level increase insulin production Parathyroid gland increase needs for calcium Adrenal gland increased corticosteroid production and aldosterone promote sodium reabsorption and water retention.Posterior pituitary secretes increase amount of oxytocin and

prolactin as pregnancy nears.


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Skeletal SystemSoftening of joints and ligaments,

especially symphisis and sacroiliac joint is caused by relaxin and estrogenLeg cramps is caused by pressure of

gravid uterus on nerves and imbalance of calcium in the body.


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SIGNS AND SYMPTOMS OF PREGNANCYPressumptiveAmenorrhea Breast change Urinary frequency Quickening Easy fatigability Leukorrhea Nausea and vomiting Chadwick sign Striae Linea negra Melasma

ProbableHegars sign Uterine growth Ballotement Uterine Shuffle Goodels sign Braxton-Hi

cks Contraction Fetal outline Positive Pregnancy test

PositivePositive FHT Funic Shuffle Fetal movement X-ray visualization Positive Ultrasound


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