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Metro Community College NURS 1400 Family Nursing I Unit 1

Metro Community College NURS 1400 Family Nursing I Unit 1. CONCEPTION. Fertilization Implantation. DEVELOPMENTAL CHARACTERISTICS & FUNCTION. Placenta Umbilical cord Fetus Fetal circulation. Pregnancy. Psychosocial Effects of Pregnancy. Presumptive Signs of Pregnancy. Amenorrhea

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Metro Community College NURS 1400 Family Nursing I Unit 1

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  1. Metro Community College NURS 1400 Family Nursing I Unit 1

  2. CONCEPTION • Fertilization • Implantation

  3. DEVELOPMENTAL CHARACTERISTICS & FUNCTION • Placenta • Umbilical cord • Fetus • Fetal circulation

  4. Pregnancy

  5. Psychosocial Effects of Pregnancy

  6. Presumptive Signs of Pregnancy • Amenorrhea • Nausea and vomiting • Fatigue • Urinary frequency • Breast enlargement and tenderness • Quickening

  7. Probable Signs of Pregnancy • Goodell’s sign (softening of the cervix) • Chadwick’s sign (bluish vaginal tissue) • Hegar’s sign (softening of the cervix) • Ballottement • Positive pregnancy test Ballottement

  8. Figure 14–4 Hegar’s sign, a softening of the isthmus of the uterus, can be determined by the examiner during a vaginal examination.

  9. Figure 14–5 Early uterine changes of pregnancy. A, Ladin’s sign, a soft spot anteriorly in the middle of the uterus near the junction of the body of the uterus and the cervix. B, Braun von Fernwald’s sign, irregular softening and enlargement at the site of implantation. C, Piskacek’s sign, a tumorlike, asymmetric enlargement.

  10. Figure 14–5 (continued) Early uterine changes of pregnancy. A, Ladin’s sign, a soft spot anteriorly in the middle of the uterus near the junction of the body of the uterus and the cervix. B, Braun von Fernwald’s sign, irregular softening and enlargement at the site of implantation. C, Piskacek’s sign, a tumorlike, asymmetric enlargement.

  11. Figure 14–5 (continued) Early uterine changes of pregnancy. A, Ladin’s sign, a soft spot anteriorly in the middle of the uterus near the junction of the body of the uterus and the cervix. B, Braun von Fernwald’s sign, irregular softening and enlargement at the site of implantation. C, Piskacek’s sign, a tumorlike, asymmetric enlargement.

  12. Positive Signs of Pregnancy • Fetal heart tones • Fetal movement • Ultrasound Abdominal ultrasound Transvaginal probe

  13. Estimation of Due Date • Naegele’s rule • Uterine size • Ultrasound

  14. Näegle’s Rule • First day of last menstrual period – 3 months + 7 days = EDB

  15. Expected Date of Delivery • Other indicators of gestational age • FHT with doppler at 10–12 weeks • Fetal movement felt at about 20 weeks • Fundal height correlation with gestational age • Ultrasound

  16. Fundal Height related to Gestational Age

  17. Physiologic Adaptation to Pregnancy

  18. Reproductive System • Uterus • Enlarges to hold a volume of 15–20 liters • At 12 weeks rises out of the pelvis • Walls thin, but strengthened with fibrous tissue

  19. Reproductive System (continued) • Uterus (continued) • 20–25% of cardiac output goes to uterus • Braxton Hicks contractions occur throughout pregnancy • Cervix • Softens and becomes bluish in color • Mucous plug forms to protect the fetus

  20. Reproductive System (continued) • Vagina, perineum, and vulva • Increased vascularity • Increased vaginal discharge • Acidic environment prevents bacterial infection • Yeast infection (candida) common during pregnancy

  21. Reproductive System (continued) • Ovaries • Normal function ceases • Corpus luteum secretes progesterone • Placenta produces progesterone by six to seven weeks and corpus luteum regresses

  22. Reproductive System (continued) • Breasts • Enlarge and become tender • Increased alveoli • Areola darken • Tubercles of Montgomery enlarge and secrete a substance to maintain areolar suppleness • Colostrum may leak from the breast

  23. Hematologic System • Blood volume • Increases by 40–50% • Plasma volume increases by 1,200–1,600 ml • Red blood cells increase by 450 ml • Physiologic anemia results • Hemoglobin drops up to 2 mg/dl • Iron deficiency anemia considered when hemoglobin drops to 10.5 mg/dl or less

  24. Hematologic System (continued) • Blood coagulation • Increase in clotting factors and risk of thrombus

  25. Cardiovascular System • Heart • Displaced up and to the left • Heart enlarges • Systolic murmurs common

  26. Cardiovascular System (continued) • Cardiac output • Increases by 10 weeks, peaks at 24 weeks • Heart rate increases by 20 beats/minute • Blood pressure • Decreases in first trimester • Returns to normal reading by term • Systemic vascular resistance • Decreases during pregnancy

  27. Effect of positioning during pregnancy Supine hypotension Cardiovascular System (continued) Inferior vena cava Descending aorta A. Supine position B. Right lateral position

  28. Respiratory System • Changes in mechanical function • Diaphragm rises 4 cm • Chest circumference increases 5 to 7 cm • Progesterone • Causes increase in tidal volume (30–40%) and decrease in Pco2 (compensated respiratory alkalosis) • Rate does not change • Changes facilitate removal of carbon dioxide from fetus

  29. Gastrointestinal System • Mouth • Gums become soft and edematous • Ptyalism may develop • Benign tumors may appear • Esophagus • Progesterone relaxes cardiac sphincter • Pyrosis or heartburn develops from acid reflux

  30. Gastrointestinal System (continued) • Stomach and intestine • Delayed stomach emptying • Constipation common • Gallbladder • Predisposed to stone formation

  31. Gastrointestinal System (continued) • Liver • Spider angioma • Palmar erythema • Albumin decreased, alkaline phosphatase increased, cholesterol increased Stomach compressed Liver pushed up Bladder largely in pelvis therefore frequent urination

  32. Endocrine System • Thyroid • Enlarges, euthyroid state maintained • Increase in BMR by 25% • Parathyroid • Increased secretion of parathyroid hormone to meet calcium needs of the fetus • Pituitary • FSH, LH suppressed • Prolactin increased • Oxytocin for contractions and lactation

  33. Endocrine System (continued) • Adrenal glands • Cortisol • Activates gluconeogenesis • Increases blood glucose levels • Aldosterone • Increases • Protects the woman from sodium loss • Pancreas • Beta cells increase in number and size

  34. Endocrine System (continued) • Placenta • hCG • Confirms pregnancy • Maintains corpus luteum • Human placental lactogen (HPL) • Produces insulin resistance • Makes adequate glucose available to fetus

  35. Endocrine System (continued) • Placenta (continued) • Estrogen • Vasodilation, softens cervix, breast development • Progesterone • Relaxes smooth muscle of uterus, GI tract, GU tract, and aids breast development

  36. Endocrine System (continued) • Changes in metabolism • Fetus has constant need for glucose • In fasting state ketosis develops rapidly • Maternal insulin resistance develops • Diabetogenic effect of pregnancy • Increased need for iron • Water retention • Dependent edema common in late pregnancy

  37. Weight Gain in Pregnancy • Individualized by pre-pregnancy weight • Average weight gain is 27.5 lbs. • 27.5–39.6 lb for underweight women • 25.3–35.2 lb for normal weight women • 15.4–25 lb for overweight women

  38. Urinary System • Anatomic changes • Kidneys and ureters enlarge • Ureters compressed at pelvic brim • Increased incidence of pyelonephritis • Urinary frequency and incontinence common • Bladder tone relaxed and capacity and pressure increase • UTIs common in pregnancy

  39. Urinary System (continued) • Physiologic changes • Increased blood flow by 35–60% • Increase in GFR • Increased urine flow and volume • Decreased BUN, creatinine, uric acid • Increased filtration of solutes • Glucose • Protein • Altered excretion of drugs (increased)

  40. Spider angiomas and palmar erythema Hyperpigmentation Linea nigra Chloasma Striae gravidarum Integumentary System

  41. Musculoskeletal System • Lordosis develops • Back pain common during pregnancy • Ligaments soften due to relaxin • Pelvic discomfort • Unsteady gait

  42. Eye, Cognitive, and Metabolic Changes • Decreased intraocular pressure • Thickening of cornea • Reports of decreased attention, concentration, and memory • Extra stored water, fat, and protein are stored • Fats more completely absorbed

  43. Nausea and Vomiting • Probably caused by hormones • Client education • Plenty of fluids, avoid caffeine and carbonation • Frequent, small meals, high protein, and carbohydrates • Eat crackers to avoid an empty stomach • Avoid noxious odors • Limit stress

  44. Nausea and Vomiting (continued) • Hyperemesis gravidarum–severe vomiting requiring medical intervention

  45. Heartburn • Caused by reflux • Client education • Monitor for foods that cause symptoms • Spread liquids throughout the day • Stay upright after meals • Don’t eat close to bedtime, extra pillows • Bend at waist • OTC calcium containing antacids

  46. Heartburn (continued) • Epigastric pain can also be associated with hypertension in pregnancy

  47. Constipation • Caused by progesterone’s effect on GI tract • Aggravated by iron supplementation • Client education • Increase fiber • Increase fluids • Regular exercise • Regular time for bowel movements

  48. Fatigue • More common early in pregnancy • Client education • Meditation may be helpful • Rest when tired • Alleviate stress • Reassurance that the fatigue lessens after the first trimester

  49. Frequent Urination • Most common early in pregnancy • Client education • Notify HCP if pain or burning occur • Kegel exercises

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