PREGNANCY CHANGES AND CARE
UTERINE CHANGESBEFORE: 7.5X5X2.5, 60 GEND: 28X24X21, 1000 GWALLS THIN AS THEY STRETCHINCREASED BLOOD/LYMPH VESSELSBRAXTON-HICKS CONTRACTIONS
CERVICAL CHANGESINCREASED CELL NUMBERMUCOUS PLUGGOODELLS SIGN-SOFTENINGCHADWICKS SIGN-DISCOLORATIONINCREASED VASCULARIZATION
VAGINAL CHANGESHYPERTROPHYINCREASED VASCULARIZATION, HYPERPLASIAINCREASED VAGINAL DISCHARGEACIDIC PH OF DISCHARGELOOSENING OF CONNECTIVE TISSUE
BREAST CHANGESINCREASED SIZE, NODULARITYSUPERFICIAL VEINSNIPPLES ERECTDARKENING OF AREOLASTRIAECOLOSTRUM-12 WK+
RESPIRATORY CHANGESHYPERVENTILATIONINCREASING TIDAL VOLUMECONSUMPTION INCREASESVC INCREASESDIAPHRAGM ELEVATES, SUBCOSTAL ANGLE INCREASES, RIB CAGE FLAIRSTHORACIC BREATHINGNASAL STUFFINESS, EPISTAXIS
CARDIOVASCULAR CHANGESHEART UP, TO LEFT, ROTATED FORWARDINCREASED BLOOD VOLUME-PEAKS AT MID-3RD TRIMESTER (45%)DECREASED VASCULAR RESISTANCEINCREASED C.O. TILL 20-24 WKS, THEN STEADY
VITAL SIGN CHANGESBLOOD PRESSURE DECREASES THROUGH 2ND TRIMESTER, GRADUAL INCREASE 3RDINCREASED PULSE (0-15 BPM)SAME OR INCREASED RESPIRATIONS
CIRCULATION CHANGESINCREASED BLOOD TO UTERUS, KIDNEYSINCREASED STAGNATION IN LOWER EXTREMITIES INCREASED FEMORAL VENOUS PRESSURE
SUPINE HYPOTENSIVE SYNDROMEVENA CAVA SYNDROMEDECREASED BP, DIZZY, PALLOR, CLAMMYTURN PT ON SIDE IMMEDIATELY
RBC CHANGESERYTHROCYTE VOLUME INCREASESINCREASED PLASMA VOLUME GREATER THAN ERYRHROCYTEDECREASED HCT-PHYSIOLOGIC ANEMIA
WBC CHANGESSAME OR INCREASED LEUKOCYTE PRODUCTION OVER BLOOD VOLUMEINCREASE HIGHER AT LABOR, POST-PARTUM
CLOTTING FACTORS CHANGEFIBRIN LEVEL INCREASESFIBRINOGEN LEVEL INCREASESBLOOD FACTORS INCREASECLOTTING TIME NMLALL LEADS TO INCREASED HYPERCOAGULABLE STATE, DVT RISK
GASTROINTESTINAL CHANGES 1ST TRIMESTERNAUSEA/VOMITINGCHANGES IN TASTE, SMELLGUM TISSUE HYPEREMIC, SOFTERINCREASED SALIVA
GI CHANGES LATER IN PREGNANCYHEARTBURNBLOATINGCONSTIPATIONHEMORRHOIDSPROLONGED EMPTYING TIME OF GALLBLADDER
URINARY TRACT CHANGESFREQUENCYIMPAIRED DRAINAGE OF BLOOD/LYMPH FROM BLADDERKIDNEY/URETER DILATIONINCREASED GFR, RPFGLYCOSURIALOWER BUN VALUE, CREATININE CLEARANCE MORE ACCURATE
SKIN AND HAIR CHANGESLINEA NIGRACHLOASMAAREOLA, NIPPLES, VULVA, PERIANAL DARKERINCREASED SWEATINGSTRIAESPIDER NEVIDECREASED HAIR GROWTH, SHEDDING POSTPARTUM
MUSCULOSKELETAL CHANGESNO DENTAL CHANGESJOINTS OF PELVIS RELAXLUMBODORSAL CURVE INCREASEDPARESTHESIAS OF EXTREMITIESDIASTASIS RECTI
METABOLISM CHANGESMOST ARE ACCELERATEDTISSUE REPLACEMENTFETAL NEEDSPREP FOR LABOR/LACTATION
NUTRIENT CHANGESINCREASED LIPIDS, CHOLESTEROLINCREASED DEMAND FOR CHOINCREASED DEMAND FOR IRONIRON TRANSFER TO FETAL LIVERINSULIN REQUIREMENT INCREASESGLYCOSURIA: DIABETES VS. PHYSIOLOGIC CHANGE GFR HIGHER
SIGNS OF PREGNANCYPRESUMPTIVE: SUBJECTIVEPROBABLE: OBJECTIVEDIAGNOSTIC: POSITIVE
PRESUMPTIVE CHANGESAMENORRHEANAUSEA/VOMITINGEXCESSIVE FATIGUEURINARY FREQUENCYBREAST CHANGESQUICKENING
PROBABLE SIGNSGOODELLS SIGN-SOFTENING OF CERVIXHEGARS SIGN-SOFT ISTHMUSCHADWICKS SIGN-BLUE TINTUTERINE ENLARGEMENTUTERINE SOUFFLESKIN CHANGESFETAL OUTLINE PALPABLEPREGNANCY TESTS
DIAGNOSTIC CHANGESFHTFETAL MOVEMENT PALPATEDVISUALIZATION BY U/S
PSYCHOLOGIC RESPONSEAMBIVALENCEACCEPTANCEINTROVERSIONMOOD SWINGSBODY IMAGE CHANGES
FATHERS RESPONSEAMBIVALENCERECOGNITION AS FATHER/PARENTFINANCIAL ISSUESFEAR RE: BABYS HEALTHFEAR RE: MOTHERS HEALTHROLE IN LABORFEAR OF HURTING BABY/MOM W/SEXMAY DEVELOP PREGNANCY SYMPTOMS
SIBLING RESPONSESIBLING RIVALRYCONSISTENCY IMPORTANT, REASSURANCEREGRESSIONPRENATAL: BRING TO VISITS, FAMILY AFFAIRPOST-PARTUM: INVOLVE CHILDREN, VISIT AT HOSPITAL
DEFINITIONSABORTION: BEFORE END OF 20 WKSGESTATION: #WEEKS POST LMPTERM: 38-42 WKSPRETERM: 20-37 WKSPOST-TERM: AFTER 42 WKS
GRAVIDAGRAVIDANULLIGRAVIDAPRIMIGRAVIDAMULTIGRAVIDA
PARITYPARA: BIRTH AFTER 20 WKNULLIPARAPRIMIPARAMULTIPARAALL REFER TO # PREGNANCIES, NOT # OF CHILDREN BORN
TPAL FOR PARITYT: TERM INFANTS BORNP: PRETERM INFANTS BORNA: ABORTIONL: LIVING CHILDREN (CURRENTLY)
INITIAL HISTORYCURRENT PREGNANCYPAST PREGNANCIESGYN/MENSTRUAL HXCURRENT MEDICAL HXPAST MED HXFAMILY MED HXSOCIAL, PERSONAL, OCCUPATION, PERSONALRELIGION, CULTURE, LANGUAGEPARTNER HX
HIGH RISK DESIGNATIONVARY WITH TIME OF PREGNANCYMEDICAL-PREEXISTING, CURRENTPSYCHOSOCIALNUTRITIONOBSTETRICEDUCATIONAL
INITIAL LABSCBCBLOOD TYPE, RH FACTORRUBELLASYPHILIS, CHLAMYDIA, GONORRHEAANTIBODY SCREENHEPATITIS B/CPAP SMEARU/AHIV RECOMMENDED
ADDITIONAL POSSIBLE LABSHGB ELECTROPHORESISAFP/QUADRUPLE SCREENING1 HR PGT or 2 HR 75 OGT TOX SCREENGROUP B STREPADDL HCT/HGB, STI SCREEN, GLUCOSE (individualized to pt)
PSYCHOSOCIAL ASSESSMENTREACTION TO PREGNANCYSUPPORT SYSTEM, FAMILY ISSUESFINANCIAL ISSUESLIVING CONDITIONSHISTORYABUSECUSTOMS, CULTURE
EDUCATIONAL ASSESSMENTEDUCATIONAL LEVELPREFERRED WAYS TO LEARNDESIRE FOR INFOHX, EXPERIENCELANGUAGE
NUTRITIONAL ASSESSMENTPREGRAVIDA WEIGHTHEIGHT, WEIGHT, BMIFAMILY/PERSONAL MEDICAL HXDIET RECALLLAB REVIEWFINANCES, WIC, FOOD STAMPS
STANDARD DAILY FOOD PLANDAIRY: 4 SERVINGSPROTEINS: 3 2-OZ SERVINGS (6 0Z)GRAINS: 6-11 FRUITS: 2-4, MIN 1 VIT C RICHVEGETABLES: AS DESIREDFATS: 3-5FLUIDS: 8-10/DAY, MIN 4-6 H2O
RECOMMENDED WEIGHT GAIN GENERAL GDLNSVARIES WITH STARTING WEIGHTLOW: 28-40 LBSNML: 25-35OVER: 15-25OBESE: 15
WEIGHT GAIN PATTERNNML WEIGHT PATIENTS:3.5-5 LB (1.6-2.3 KG) 1ST TRIMESTER1 LB (O.5 KG)/WEEK TILL TERMTWINS: 1.5 LB/WEEK 2ND/3RD/ TRIMESTERLOW WEIGHT GAIN ASSOC WITH PRETERM BIRTHS, IUGR, LBW INFANTSHIGH WT GAIN ASSOC WITH LGA INFANTS, BIRTH COMPLIC, POSS MALFORMATIONS OF CNS
CALORIE RECOMMENDATIONS1ST TRIMESTER: NO INCREASE2ND/3RD: +300 KCAL/DAY TWINS: +600 KCAL/DAYBREASTFEEDING: +200 KCAL OVER PREGNANCY INTAKE
FACTORS AFFECTING DIETCULTURE, FAMILYFINANCES, PSYCHOSOCIAL FOOD PREFERENCES, INTOLERANCEPREGNANCY DISCOMFORTSEATING DISORDERSEDUCATION, KNOWLEDGE LEVELVEGETARIANISM
FACTORS AFFECTING PREGNANT TEENS DIETPSYCHOSOCIAL DEVELOPMENTSELF IMAGE, BODY IMAGEDENIAL OF PREGNANCYLIFESTYLE, PREPREGNANT DIETANEMIA COMMON, CALCIUM INTAKEAGE PAST MENARCHELESS THAN 4 YRS PAST, TEEN STILL GROWING, NEED HIGHER KCAL TO HAVE NML WT INFANT
FOLLOW-UP VISITSANY PROBLEMS, COMPLAINTSREVIEW DANGER SIGNSWT, BP, URINE PROTEIN, SUGAR, KETONESLABS PRN FHT, MEASUREMENTEDEMA, PHYSICAL CHANGESEDUCATION APPROPRIATE FOR GA
FAMILY INVOLVEMENTINVOLVE FOB, SIGNIFICANT FAMILY, FRIENDS IN VISITSENCOURAGE PARTICIPATION IN VISITS, CLASSESANSWER QUESTIONS OF ALL PRESENT
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