Maternal physiologic changes during pregnancy Flashcards by Joel DiGulio

LMP

280 days
40 wks
10 lunar months (perfect 28 days mos)
9 calendar months

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Trimesters (length of each one)

FIRST: 1st day of LMP - 13 wks
Second: 14 - 26 weeks
Third: 27 - 40 wks

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8 weeks gestation - Fetal development

Fetal development:
Rapid
Heart begins pumping
Limp buds well developed
Facial features discernible
Major divisions of brain discernible
Ears develop from skin folds
Tiny muscles formed beneath skin embryo
Wt = 2g

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What is the approx wt of an 8 wk old embryo?

2 g

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Maternal changes at 8 weeks gestation?

Nausea for up to 12 wk
Uterus changes from pear to globular shape
Hegar sign occurs
Goodell sign occurs
Cervical flexes
leucorrhea increases
Ambivalence about pregnancy may occur.
There is no noticeable Wt gain
Chadwick sign appears as early as 4 weeks

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What is Hegar sign?

When does it occur?

Softening of isthmus of cervix

8 wks gestation

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What is Goodell sign?

When does it occur?

Softening of cervix

8 wks gestation

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What is Chadwick sign?

When does it occur?

Bluing of vagina

As early as 4 weeks

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8 weeks gestation nursing interventions

Teach prevention of nausea
Teach safety
Prepare client for pregnancy

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What should you teach to prevent nausea in the woman at 8 wks gestation?

Eat dry crackers before getting out of bed in the a.m
Eat small, freq meals
Avoid fatty foods
Avoid skipping meals

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Safety education for women at 8 wks gestation includes?

Avoid hot tubs, saunas, and steam rooms throughout pregnancy

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Why are woman advised to avoid hot tubs, saunas, and steam rooms throughout pregnancy?

Increases risk for NTDs in first trimester;

Hypotension may cause fainting.

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At 8 wks gestation how will you prepare the client for pregnancy?

Discuss attitudes toward pregnancy
Discuss value of early pregnancy classes
Provide info about child birth prep classes
Include father and family in prep for childbirth

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Fetal development at 12 weeks gestation?

Embryo becomes fetus
Heart is discernible by U/S
Lower body develops
Sex is discernible
Kidneys produce urine
Fetus weighs 19-28 g (<1 oz)

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How much does a fetus way at 12 wks gestation?

19-28 g (<1 oz)

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Maternal changes at 12 wks gestation?

Uterus rises above pelvic brim
Braxton Hicks contractions are possible (continue throughout pregnancy)
Potential for UTI increases (exists threw preg)
Wt. gain is 2-4 Lb during first trimester
Placenta is fully functioning & producing hormones

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12 weeks gestation - Nursing interventions?

Teach UTI prevention
Discuss nutrition and exercise
Discuss possible effects of pregnancy on sexual relationship.
Recognize father’s role as he labors to incorporate the parental role into his self identity.

How much should a woman increase caloric intake when at 12 wks gestation?

300 cals/day

Fetal development at 16 wks gestation?

Head still dominant
Face looks like human
Arm/leg ratio proportionate
Scalp hair
Meconium in bowel, anus open
Most bones and joint cavities seen on U/S
Muscular mvmts detected
Heart well developed
Blood formation active in spleen
Elastic fibers appear in lungs and terminal; bronichioles appear
Kidneys in position
Cerebral lobes delineated, and cerebellum assumes prominence
General sense organs differentiated
Testes in pos for descent into scrotum/vagina open

Maternal changes at 16 wks gestation?

Quickening may be noted from 16-20 wks gest
Colostrum from nipples possible
Cholesterol increases from 16-32 wks
Placenta clearly defined by 14-16 wks
Insulin resistance begins 14-16 wks of gest and continues to rise until last few wks of pregnancy
Approx Wt gain of 1 lb./wk beginning in second trimester and continuing until delivery.

Nursing interventions for the client at 16 wks gestation?

Explain screeining test and obtain blood sample for MSAFP b/w 15-22 wks of gestation
Expalin the multiple marker, or triple screen, blood test, and obtain a specimen for screeinnig b/w 16-18 wks of gestation to measure the MSAFP, hCG, aand unconjugated estriol

Elevated MSAFP levels are assoc with?

NTDs

Multiple gestations

Low MSAFP levels are assoc with?

Down syndrome

Fetal development at 20 weeks?

Vernix protects body
lanugo covers body and protects body
eyebrows, eyelashes, and head hair develop
fetus sleeps, sucks, kicks
Weight 200-400 g (11-14 oz)

Fetal Wt at 8 weeks gestation?

2 grams

Fetal Wt at 12 weeks gestation?

19-28 g (< 1 oz)

Fetal Wt at 32 weeks gestation?

1800-2200 g (4-5 lb)

Fetal Wt at 36-40 wks gestation?

3200 g (7+ Lb.)

Maternal changes - 20 wks gestation?

``` Fundus reaches umbilicus Breasts begin secreting colostrum; areolae darken Amniotic sac holds approx 400 mL fluid Postural hypotension Quickening becomes "real" Possible S/S: Nasal stuffiness Leg cramps Varicose veins Constipation ```

Nursing interventions - 20 wks gestation?

Comfort measures Remain active Sit w/feet elevated Avoid pressure on lower thighs Use support stockings Dorsiflex foot to relieve leg cramps Cool-air vaporizer/NS nasal spray for stuffiness Avoid Constipation Eat raw fruits, veg's, bran cereal Drink 3 L fluids/day Exercise frequently

Fetal development - 24 weeks gestation

Body well proportions; skin red and wrinkled Sweat glands forming Blood formation ^ in BM & decreases in liver Alveolar ducts/sacs present Lecithin in amniotic fluid (wks 26-27) Neuronal proliferation in cerebral cortex ends. Can hear Testes at inguinal ring in descent to scrotum

Maternal changes - 24 weeks gestation

Uterus rises to umbilicus DBP gradually ^ at 24-32 wks SBP remains same as prepregnancy level

Nursing interventions - 24 wks gestation?

Explain and obtain a blood sample for a glucose challenge that is usually done b/w 24-28 wks gestation. At 24-32 wks gestation, 2-3 U/S measurements may be taken 2 wks apart to compare against standard fetal growth curves.

Fetal development at 28 weeks gestation

``` Can breathe, swallow, and regulate temperature Surfactant forms in lungs Can hear Eyelids open Period of greatest fetal wt gain begins Fetus weights 1100 g (2.5 lb) ```

Maternal changes at 28 weeks gestation

``` Fundus hallway b/w umbilicus and xiphoid Thoracic breathing replaces abd breathing Fetal outline palpable Woman become more introspective Heartburn may begin Hemorrhoids may develop ```

28 weeks gestation - Nursing interventions

Teach TX of hemorrhoids - sitz, topical anesthetics, stool softeners Teach comfort measures - elevate legs when sitting, assume side lying position when resting. Teach measures to avoid heartburn Prepare woman for delivery/parenthood

Fetal development at 32 weeks gestation

Brown fat deposits dev beneath skin 15-17 inches in length Begins storing iron, Ca, & phosphorus Weighs 1800-2200 g (4-5 lb)

Maternal changes at 32 weeks gestation

``` Fundus reaches xiphoids Breast full, tender Urinary freq returns Swollen ankles may occur Sleeping problems may develop Dyspnea may develop ```

32 weeks gestation - Nursing interventions

Teach measures to decrease edema Teach comfort measures: wear well-fitting supportive bra. use semi-fowler position at night for dyspnea. Prepare woman for childbirth.

Fetal development at 36-40 wks gestation

Fetus occupies entire uterus; activity restricted Maternal antibodies transferred to fetus L/S ratio is 2:1 and phosphatidylglycerol is present Fetus weighs 3200 g (7 lb+)

Maternal changes at 36-40 wks gestation

Lightening occurs Placenta weighs approx 20 oz. Mother is eager for birth, may have energy burst Backaches increase Urinary freq increases Braxton Hicks contractions intensify (cervix and lower uterine segment prepare for pregnancy)

36-40 wks gestation - Nursing interventions

Teach safety measures -wear low heeled shoes/flats -NO heavy lifting -sleep on side to relieve bladder pressure Encourage preparation for delivery -KEGAL exercises -encourage packing suitcase -Encourage couple to tour L&D -Discuss PP circumstances: circumcision, rooming-in, possibility of PP blues, birth control, need for adequate rest, father's role