MCN 1F Flashcards by Labios Ruzell Ray C.

Confined to reproductive organs

Local Changes

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Length or the height of the uterus increases 6.5-32cm

Landmark symphysis pubis to the top of uterine fundus to measure height of uterus

Depth: 2.5-22cm

Width: 4-24cm

Weight: 50-1000grams

End of Pregnancy: muscle fibers come 2-7 times longer

Volume: 2 to more than 1000mL (can hold a 7lbs fetus plus the amniotic fluid

End of 12 Weeks: Uterus is large enough to be palpated above the symphysis pubis

End of 20/22 Weeks: Palpated at the level of Umbilicus

End of 36 Weeks: Touches xiphoid proces (depresses diaphragm)

2 Weeks before Term:Uterus returns to 36 Week height

Amenorrhea

Uterine Wall Thickness:

Early Pregnancy: 1-2cm

End Pregnancy: 0.5cm thick

Uterine Changes

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Becomes more vascular and edematous (Goodell’s Sign)

Presence and formation of mucus plug (Operculum - helps prevent infection of the fetus and its membrane)

Cervix

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Increased size of vagina

Increased vascularity (Chadwick’s Sign)

Change in Vaginal Secretion

pH now 4/5 = acidic

Acidity make vagina resistant to bacterial invasion

Acidity happens because of action of Lactobacillus acidophilus that grows freely in increased glycogen environment which increases lactic acid content of secretions

pH changes favors the growth of Candida albicans a yeast like fungi

Vagina

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Ovulation stops because of the active feedback of estrogen and progesterone produced by corpus luteum

Later part of Pregnancy: Stopping of ovulation is caused by the placenta. Causes pituitary gland to halt production of FSH and LH

Ovaries

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Feeling of fullness, timgling,or tenderness

Increased size (+73 to growth of mammary alveoli

Areola darkens and increases the diameter to 5-7.5cm

Blue veins become prominent

Nipples are more erectile

Some women for secondary areola, additional darkening of the skin

Breast

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T/F: In the 20th Century Pregnancy was considered a 9 month long illness

TRUE

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Best shared with supportive partner and family

Choose level of pain management they want for labor and delivery

Modern Social Influence on Pregnant Woman

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Cultural background influence active role in pregnancy

Myths & Taboos may affect behavior and activities

Cultural Influence on Pregnancy

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People love as they have loved

How pregnant woman was raised will affect her pregnancy

Pregnant woman won’t believe if all she hears is excruciating pain.

Family Influence on Pregnancy

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How pregnant woman copes with their situation along the stresses they are facing

Woman should feel secure in relationship with others esp the father of her child.

Individual Differences

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Second Trimester: Accepting the Fetus

As soon as fetal movements are felt, psychological responses change

Narcissism & Introversion

Role playing and Increased dreaming

Start to imagine themselves as parents

Refers to child as he or she

Measure the level of acceptance of the coming baby by how well she follows her prenatal schedule and instructions

Since the focus is on the baby; Partner feels left alone to compensate for this feeling

Partner becomes overly absorbed in work to produce something concrete to show that not only woman is capable of creating something

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Emotional Responses that Cause Concerns in Pregnancy: NICEBEDSG

Narcissism

Introversion

Couvade Syndrome

Extroversion

Body Image & Boundary

Emotional Lability

Depression

Stress

Grief

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Partner experiences physical symptoms at same degree or even more intensely than pregnant mother

Couvade Syndrome

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Changes in Sexual Desire

1st Trimester: decrease in libido due to nausea, fatigue, and breast tenderness that accompany early pregnancy

2nd Trimester: as blood flows to pelvic area increases to supply the placenta, libido, and sexual enjoyment will rise

3rd Trimester: Sexual desire remains high or it may decrease due to difficulty in finding a comfortable position

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Experienced by woman and cannot be documented by the examiner; Subjective Symptoms

Presumptive Symptoms

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First Trimester: Accepting the Pregnancy

Ambivalence

Partner and Mother still recovering from the surprise of learning that they are pregnant

Mixed emotions

49% of pregnancy is unintended, unwanted, or mistimed; Accept reality of pregnancy

Ambivalence toward pregnancy refers to interwoven feelings of wanting and not wanting

Partner feels proud and happy about the pregnancy, ambivalent more than the woman

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Third Trimester: Preparing for the Baby and End of Pregnancy or Preparing for Parenthood

Begin nesting activities

Preparing clothing and sleeping arrangements

Name of baby

Ensure safe passage by attending prenatal classes

Grow impatient as they ready themselves for the delivery of the baby

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Presumptive Symptoms

a. Breast Changes - tenderness, fullness, tingling, and enlargement felt by the mother, darkening of areola

b. Nausea & Vomiting

c. Amenorrhea (cessation of menstruation)

d. Increase urination

e. Fatigue

f. Uterine Enlargement

g. Quickening - fetal movement felt by the woman

h. Linea Nigra - dark pigmentations on abdomen

i. Melasma - dark pigmentations on face

j. Striae Gravidarum - red streaks formed in the abdomen

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Confirm Pregnancy

Positive Signs

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Objective Symptoms

Probable Signs

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Older children should be well prepared and informed of the baby and assure that it will not replace them or change their parents’ affection toward them

Changes in Expectant Family

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Partner plays a great part in her situation

The closer the partner is to the pregnant woman, the closer it is to the child

Partner’s Adaptation

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Positive Signs

a. Sonographic Evidence of Fetal Outline

b. Audible Fetal Heart Tone

c. Fetal Movement Felt by Examiner

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Probable Signs

a. Positive Maternal Serum Test - presence of hCG b. Chadwick’s Sign - Pink to Bluish or Violet c. Goodell’s Sign - Softening of the Cervix d. Hegar’s Sign - Softening of the lower segment of the uterus e. Sonography Evidence of Gestational Sac - characteristic ring is evident f. Ballottement - fetus can be felt to rise against abdominal walls g. Braxton Hick’s Contraction - Uterine Tightening h. Fetal outline that is already felt by examiner - examiner can palpitate through abdomen

Mood changes occur frequently in a pregnant woman as a manifestation of narcissism

Emotional Lability

Additional gland of Pregnancy Produces Estrogen causes breast and uterine enlargement Produces progesterone maintains endometrium lining inhibits contractility and aids breast lactation Presence of hCG & hPL hCG - stimulates progesterone and estrogen hPL - serves as antagonists to insulin Relaxin and Prostaglandins relaxin - inhibits uterine activity to soften cervix prostaglandins - initiate labor

Endocrine: Placenta

FSH and LH production stops due to high level of estrogen and progesterone produced by placenta Increased production of Growth Hormone and Melanocytes stimulating hormone - causes skin pigmentation Prolactin and Labor Induction - occurs in late pregnancy; helps breast prepare lactation and aid in labor progress

Endocrine: Pituitary Gland

Increase size which increases hormone production Metabolic Rate increases to 20% or increase Basal Metabolic Rate

Endocrine: Thyroid and Parathyroid Gland

Double production of corticosteroids and aldosterone - help reduce probability of woman to reject foreign protein of the fetus

Endocrine: Adrenal Glands

Increased production of Insulin

Endocrine: Pancreas

Decreased production of Immunoglobin G - to reduce immunologic competency; prevents rejection of fetus

Immune System

Presence of Striae Gravidarum Presence of Linea Nigra Presence of Melasma Presence of Vascular spiders seen on the body Presence of protrusion of umbilicus

Integumentary System

Shortness of Breath

Respiratory System

Increased circulatory blood volume and plasma - results to pseudoanemia Increased RBC production - reason why additional iron is needed Increased cardiac output - 25-50% Decreased peripheral blood floor during 3rd Trimester Increased level of fibrinogen and leukocyte Blood Pressure: 2ND TRIMESTER: slightly decrease due to expanding placenta which causes peripheral resistance to circulation to lower 3RD TRIMESTER: BP rises to 1st Trimester Level

Cardiovascular System

Decrease stomach acidity Slowed intestinal peristalsis Slowed emptying time

Digestive System

Increased aldosterone production and sodium reabsorption Increased GFR and renal plasma flow by 30-50% - leads to filtration of glucose Increased urinary frequency- due to pressure from growing uterus to bladder Increased ureter diameter and bladder capacity

Urinary System

Gradual softening of a woman’s pelvic ligament and joints - to create pliability and facilitate passage; influenced by relaxin and progesterone Wide separation of symphysis pubis Pride of Pregnancy - to change center of gravity

Musculoskeletal System

Bathing

Daily tub baths or showers should be strictly followed Not bathe in hot water for too long

Breast Care

Wear a firm supportive brassiere or brazier with wide straps avoid soap - causes nipple cracking Washing should be done daily esp when colostrum secretions begin drying with soft towel in patting manner if colostrum is profuse, use gauze squares/breast pads change frequently

Dental Care

Avoid sweets encourage regular dental visits brush teeth arising, after meals, bedtime

Discomforts: Breast Tenderness

wear bra/brassier dress warmly avoid soap on nipples and areola to prevent skin drying

Discomforts: Palmar Erythema

apply calamine lotion on her hands palmar erythema is normal

Discomforts: Nausea & Vomiting

Morning sickness First Trimester and subsides by the third month Eat dry crackers Avoid brushing teeth immediately after arising Eat small frequent, low fat meals during the day Drink liquids between meals rather than at meals Avoid fried and spicy foods

Discomforts: Constipation

Drink no less than 2000mL per day Regular exercise Eat fiber foods such as whole grains, fruits, and vegetables

Discomforts: Pyrosis

Eat small frequent meals Sit upright for 30 minutes after a meal Drinking milk between meals Avoid fatty and spicy foods Perform tailor sitting exercises

Fatigue

Frequent rest periods Correct postures Regular Exercise Muscle relaxation and strengthening exercises

Muscle Cramps

Increase calcium intake Regular exercise lie on back momentarily and extend the involved leg while keeping knees straight and dorsiflexing foot

Hypotension

Always rest and sleep on their side not on their back insert a small firm pillow under right hip

Varicosities

Sim’s position/ elevated foot stool for 15-20 minutes twice a day Avoid cross legs or constrictive knee-high hose or garters Avoid long standing Move while standing

Hemorrhoids

Daily bowel evacuation Adequate fluid intake Eating high fiber food Sitting on soft pillow Soaking in a warm sitz bath Exercising regularly

Heart Palpitations

move slowly and gradually

Frequent Urination

Void as necessary Avoid restricting fluid intake and reduce caffeine and cola Limit fluid intake only in the evening before sleeping Sleep side lying at night Performing Kegel exercises

Leukorrhea

Daily baths Wearing cotton under pads Sleeping at night without underwear Avoid douching

Backache

Move slowly Wear low heeled comfy and supportive shoes Apply local heat on the area Squatting when picking up objects than bending over Pelvic Rocking and Tilting Lift objects by holding them close to the body

Headache

Avoid eye strains or tension Rest with ice pack on forehead Change position

Dyspnea

Advise to sleep with her head and chest elevated Use two or more pillows

Ankle Edema

Left side lying position and Elevate legs Avoid constricting clothes Avoid sitting or standing in one position for a long time

Why is Positive Maternal Serum Test considered Probable?

Because there is also a disease that causes the release of this hormone

Discoloration of the Vagina from Pink to Bluish/Violet

Chadwick’s Sign

Softening of the Cervix

Goodell’s Sign

Softening of the lower segment of the Uterus

Hegar’s Sign

Characteristic ring is evident

Sonographic Evidence of Gestational Sac

Tapping of the lower uterine segment on a bimanual examination

Ballottement

Periodic uterine tightening

Braxton Hick’s Contraction

Red Streaks that is formed on the abdomen

Striae Gravidarum

Dark pigmentations on face

Melasma

Dark line pigmentations on abdomen

Linea Nigra

Fetal movement felt again by the woman

Quickening

Mother can palpated the uterus over the symphysis pubis

Uterine Enlargement

Fetal outline can be seen and measure by a sonogram

Sonographic Evidence of Fetal Outline

when estrogen and progesterone increases, what hormones decrease in production?

FSH & LH

Because of the increasing level of estrogen occurring during pregnancy

Palmar Erythema

Results from increased in progesterone production, decreased intestinal motility, displacement of intestines, pressure of uterus

Constipation

MCN 1F Flashcards

(74 cards)