PSYCHOLOGIC/EMOTIONAL ADAPTATIONS OF PREGNANCY

Question 1

1. Circulatory/Cardiovascular
   1.1 Beginning the end of the first trimester there is a gradual increase of about

Answer 1

30% - 50%

Question 2

gradual increase of about 30% - 50% in the total cardiac volume, reaching its peak during the 6th month. This causes a drop in

Answer 2

hemoglobin and hematocrit values

Question 3

1.1.3 Systolic murmurs are common due to

Answer 3

lowered blood viscosity

Question 4

1.1.1 Easily fatigability and shortness of breath because of

Answer 4

increased workload of the heart

Question 5

1.1.2 Slight hypertrophy of the heart, causing it to be displaced to the left, resulting in torsion on the great vessels

Answer 5

(the aorta and pulmonary artery).

Question 6

1.1.4 Nosebleeds may occur because of marked

Answer 6

congestion of the nasopharynx as pregnancy progresses.

Question 7

1.2.2 Increased pressure of uterus against the diaphragm during

Answer 7

second half of pregnancy

Question 8

1.3.1. Edema of the lower extremities occurs. Management:

Answer 8

legs above hip level.

Question 9

1.3.2. Varicosities of the lower extremities can also occur Management:

Answer 9

 Use/wear support hose or elastic stockings to promote venous flow, thus preventing stasis in lower extremities
 Apply elastic bandage
 Avoid use of constricting garters

Question 10

1.4 Because of poor circulation in the blood vessels of the genitalia due to the pressure of the gravid uterus, varicosities of the vulva and rectum can occur Management

Answer 10

side-lying position with hips elevated on pillow and modified knee-chest position.

Question 11

2. Gastrointestinal changes
   2.1 Morning sickness – nausea and vomiting during the first trimester is due to increased human chorionic gonadotropin (HCG). It may also be due to increased acidity or even to emotional factors. Management:

Answer 11

Eat dry toast or crackers 30 minutes before arising in the morning (or dry, high carbohydrate, low fat, and low spices in the diet).

Question 12

2.2 Hyperemesis gravidarum = excessive nausea and vomiting which persists beyond 3 months; results in dehydration, starvation, and acidosis.

Answer 12

Management: D10NSS 300 ml in 24 hours is the priority treatment; complete bed rest is also important

Question 13

2.3 Constipation and flatulence are due to displacement of the stomach and intestines, thus slowing peristalsis and gastric emptying time. May also be due to increased progesterone during pregnancy. Management:

Answer 13

2.3.1 Increase fluids and roughage in the diet
2.3.2 Establish regular elimination time
2.3.3 Increase exercise
2.3.4 Avoid enemas
2.3.5 Avoid harsh laxatives like Dulcolax; stool softeners, e.g. Colace, are better
2.3.6 Mineral oil should not be taken because it interferes with absorption of fat-soluble vitamins

Question 14

2.4 Hemorrhoids are due to pressure of enlarged uterus Management:

Answer 14

cold compress with witch hazel or Epsom salts.

Question 15

2.5 Heartburn management

Answer 15

2.5.1 Pats or butter before meals
2.5.2 Avoid fried, fatty foods
2.5.3 Sips of milk at frequent intervals
2.5.4 Small, frequent meals taken slowly
2.5.5 Bend at the knees, not at the waist
2.5.6 Take antacids (e.g. milk of Magnesia) but never sodium bicarbonate (e.g. Alka Seltzer or baking soda) because it promotes fluid retention.

Question 16

3.1.1 Increased oxygen consumption and production of carbon dioxide during the

Answer 16

first trimester

Question 17

3.1.1 Increased oxygen consumption and production of carbon dioxide during the first trimester.
3.1.2 Increased uterine size causes diaphragm to be pushed or displaced, thus crowding the chest cavity.
Management:

Answer 17

Lateral expansion of the chest to compensate for shortness of breath increases oxygen supply and vital lung capacity.

Question 18

slight increase in basal temperature due to

Answer 18

increased progesterone, but the body adapts after the 4th month

Question 19

8.1 During the first trimester, weight gain of

Answer 19

1.5-3 lbs. is normal

Question 20

8.2 On 2nd and 3rd trimesters, weight gain of

Answer 20

10-11 lbs.

Question 21

8.3 Total allowable weight gain during entire period of pregnancy, therefore, is

Answer 21

20-25 pounds (10-12 kgs).

Question 22

weight:
Fetus Placenta
Amniotic fluid
Increased weight of uterus Increased weight of the breasts Weight of additional fluid
Fat and fluid accumulation

Answer 22

7lbs. 1 lb.
1 ½ lbs.
2 lbs.
1/1 – 3 lbs. 2 lbs.
4-6 lbs.