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NUR 4130 Concepts Of Maternal-Child Nursing And Families Nova Southeastern University

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Nova Southeastern University

NUR 4130 Concepts Of Maternal-Child Nursing And Families Nova Southeastern University

 Small
 Solid
 Pear-Shaped
 Pregnancy = Estrogen and growing fetus cx hypertrophy of Myometrial
cells 1/6 of total blood vL is contained in uterine vasculature by end of
pregnancy.
 Enlargement in :
o Size—Palpable by the end of the 12th week above the
symphysis pubis
o By end of 12 weeksàPear to globular shape
 Increase in weight, strength, elasticity, and vascularity
 Hyperplasia
 Lightening- Descent of the fetal head into the pelvis
 Hegar’s sign- Softening of the lower uterine segment-Isthmus bw the
uterine and cervix
 Braxton Hicks contractions- False labor (beginning about the 4th
month of pregnancy)
o Irregular, generally painless contractions of the uterus, occur
intermittently throughout pregnancy. In later months these
contractions can become uncomfortable and may be confused with
true labor contractions.
 Quickening-Fetal movement felt by mother (real) 18-20 week in a
primiparous, and as early as 16 weeks in multiparous
 McDonald’s sign: Ease of flexing the body of uterus against the
Cervix
~Third trimester- Woman have a hard time breathing, lightening.. ready
to be delivered.
Cervix:
Increase estrogen levels:
 Hyperplasia= Estrogen causes glandular tissue stimulationà increased in
cell number.
 Endocervical gland formation of mucous plug
 Operculum/Mucous plug prevents organisms entering uterus acts as
a barrier—“bloody show.”
 Expelled when dilation begins
 Cervix closed
Increased cervical vascularity causes:
 Goodell’s sign- Softening of the cervix (probable sign of pregnancy)
(6 weeks after pregnancy)
 Chadwick sign- Bluish/purplish discoloration (lots of blood going to
cervix)
Ovaries:
 Ovum production ceases
 Corpus luteum persists and secretes hormones until weeks 6-8
 Secretion of progesterone maintains endometrium till 7th week until
placenta assumes its function
Vagina:
Increased estrogen levels:
 Increased thickness of mucosa
 Increased vaginal secretions to prevent bacterial infections- AKA
(leukorrhea)
o Thick, white and acidic, 3.5-6.0
o Pregnant woman are more susceptible to Candida infection than
usual.
 Connective tissue relaxes during pregnancy to permit passageway of the
infant.
 D/T increased blood flow you see Chadwick’s sign as well àBluish,
purplish color of the vaginal wall (Cervix, vulva-some consider
presumptive-4 weeks)
Breasts:
Increased estrogen and progesterone levels: For preparation of lactation
 Increase in size and number of mammary glands
 More nodular
 Fullness, tingling or tenderness
 Nipples more erectile and areolas darken
 Colostrum produced during third trimester/16th wk
1. Antibody
2. Rich yellow secretion
3. May leak from breast during last trimester
4. Converts to milk a few days post birth
 Prominent superficial/blue veins
 Montgomery tubercle enlarges (sebaceous glands)
 Striae may be present
 Hyperpigmentation of nipples
 Lymph nodes SHOULD NOT be palpable
 Areas of indentation or skin puckering IS NOT normal
Respiratory system : Changes to meet increased O2 demand
Increasing levels of progesterone causes:
 Increased volume of air per minute to 30-40%–take a lot of air in
 Progesterone decreased airway resistance> 20% O2
 Increased antero-posterior diameter
 Chest circumference expands
 Uterus enlarges- Presses upward & elevates diaphragm
 Hyperventilation & SOB d/t change from abdominal to thoracic
breathing as uterus enlarges
 Increased CO2 production
 Nasal stuffiness and epistaxis (Nose bleeds) D/t:
Estrogen—-KNOW WHY IT GIVES NOSE BLEEDS. induced
edema, hypersecretion of mucus, vascular congestion of
nasal mucosa
~Physically anterior posterior diameter is enlarged, which effects respiration.
Progesterone smooth muscle which decreases oxygenation. Some pregnant
woman can pass out bc of hyperventilation, they are breathing in with their
chest, especially during third trimester.
Cardiovascular System:
Increased levels of estrogen and progesterone:
 Cardiac output and blood volume increases- For both mother and
fetus
 Blood volume progressively increases beginning in the first
trimester, increasing rapidly until about 30-34 weeks.
 This increases rbc and plasma
 Increased size of uterus interferes with blood return from lower extremities
 Increased level of red cells to increase oxygen delivery to cells
 Blood flow increases to uterus, placenta, and breasts.
 Blood pressure decreases-Mostly during 2nd trimester- But
increases during last trimester
 Cardiac output begins to increase early in pregnancy and peaks at
25-30 weeks. (Generally elevated in the third trimester)
 This is d/t a decrease in systemic vascular resistance
 Uterus puts pressure on pelvic and femoral blood vessels
 Cx stasis of blood in lower extremity =DVT, edema, varicosity of leg veins,
vulva and rectum (Hemorrhoids), and postural hypotension
~Bc of blood volume increase, the hemoglobin and hematocrit is
lower, hemodillusion. So woman may have physiological anemia, so that
is why woman are given supplemental iron. Causes pressing on femoral
artery, clotting factor is increased, tell woman to stand and walk every 1-2
hours if they are sitting for long periods of time. ~PIH during 20 weeks
 Hyper coagulation state
 Fibrin, plasma fibrinogen increases
 Supine hypotension/venocaval syndrome
 Increase cardiac load – May cause palpitation
 Pulse rate may increase by between 10–15 bpm—KNOW THE ANSWER
WAS 90 THE RATE
 Blood pressure decreases in second trimester due to lowered peripheral
resistance
 Decreased regional blood flow causes edema and varicosities -Late in
pregnancy.
 When the pregnant woman lies supine, the enlarging uterus may press
on the vena cava
 Thus reducing blood flow to the right atrium
 Lowering blood pressure, causing dizziness, pallor and clamminess.
 The enlarging uterus may also press on the aorta
o Called SUPINE HYPOTENSVE SYNDROME aka vena caval
syndrome or aortacaval compression.
 Corrected by having her lay on her side or wedge a pillow
under right hip–KNOW
Physiologic Anemia of Pregnancy (Pseudoanemia)
 Increased blood volume leads to increased plasma over red blood
cells.
 Total RBC (erythrocytes) increases, Plasma increases, hematocrit
DECREASES
 Iron supplements are necessary to meet RBC expansion.
 Increased leukocytes 5600-12,200/mm3, plasma and fibrin levels
 During Labor/postpartum may reach 20,000-30,000/mm3 or higher.
 Fibrin and plasma fibrinogen levels increase
 Clotting factors increased =hypercoagulable state
 WATCH OUT FOR CLOTS
~Very difficult to determine when they have infection, even after birth if you
draw blood work you will be surprised you should wait at least 48 hours.
~Remember normal value is 4,000-11,000
Q:
A pregnant client, at 16 weeks gestation, has a hematocrit of 35%. Her
prepregnancy hematocrit was 40%. Which of the following statements by the
nurse best explains this change?
A. “Because of your pregnancy, you’re not making enough red blood cells.”
B. “Because your blood volume has increased, your hematocrit count is
lower.”
C. “This change may indicate a serious problem that might harm your baby.”
D. “You’re not eating enough iron-rich foods like meat.”
Gastrointestinal System:
 Heartburn aka pyrosis, d/t relaxation of cardiac sphincter
 Constipation, flatulence- Due to displacement of the stomach and decreased
peristalsis/gastric motility
 Nausea/vomiting/morning sicknessà Caused by increased human
chorionic gontropin(HCG) and progesterone levels
 Hyperptyalism- Caused by increased estrogen levels=Excessive salivation
 Risk for gall stone formation due to elevated levels of cholesterol and
smooth muscle relaxation caused by progesterone.
 Mouth: Gingival hypertrophy-Bleed easily (take calcium)
~Most pregnant woman when they eat, their digestion is very slow. Antacids
before you go into labor, they may aspirate.
Abdomen
 Progressive enlargement
 Fetal heart rate heard at approximately 12 weeks gestation
 First Trimester -N&V d/t
1. Elevated human chronic gonadotropin (HCG) Levels
2. Relaxation of smooth muscle of the stomach
3. Changed carbohydrate metabolism
 Elevated progesterone = smooth muscle relaxation = delayed gastric
emptying/decreased peristalsis = bloating and constipation
 Uterus displaces stomach upward
 Intestines are moved laterally and posteriorly
 Hemorrhoids develops in late pregnancy
Renal System:
 Increased blood volume
o Glomerular filtration rate increases as much as 50% by second
trimester until birth, resulting in glycosuria (Greater than a trace
or 1+ is suspicious)
 To compensate, renal tubular reabsorption increases
 Kidneys’ inability to absorb all glucoseà GlycosuriaàMay be normal or
gestational diabetes.
 Urinary frequency-1st & 3rd trimester— Uterus is enlarging and pressing
against bladder.
 This decreases in the 2nd semester BUT reappears in the 3rd.
o Pressure of the uterus on the ureter causes urinary stasis and
pyelonephritis
o Pressure on the urethra results in poor emptying which can
cause infection leading to kidney problems or preterm labor
~Tell woman to drink water and void often bc they may have pylonephritis,
any kidney infection makes pt prone to an abortion –causes preterm labor
Skin & Hair:
 Increased skin pigmentation caused by increased estrogen and
progesterone melanocytic stimulating hormone levels.
 Pigmentation increased inà Areola, nipples, vulva, & perianal area.
 Linea Nigra
o Skin in the middle of the abdomen may develop pigmented line
o Extends from pubic area to the umbilicus or higher
 Facial Chloasma (Melasma Gravidarum) AKA: Mask of pregnancy
o Darkening skin over the forehead and around the eyes
o More prominent in dark-haired women
o Aggravated by exposure to the sun
o Sweat and sebaceous glands are hyperactive
 Striae (Striae Gravidarum)
o AKA Stretch Marks
o Reddish, wavy streaks
o Results from reduced connective tissue strength cx by: Elevated
adrenal steroid levels
o Appear on: Abdomen,thighs,buttocks & breasts
 Vascular spider nevi
o Small, bright red elevation of skin radiating from central body
o Cx = increase SQ blood flow d/t estrogen levels
o May develop on: Chest, neck, face, arms, & legs
Woman may see an increase in hair shedding beginning 1-4 months
PostpartumàAll hair is replaced within 6-12 months
Musculoskeletal System:
Relaxation of joints caused by increased estrogen and progesterone
 Relaxation of pelvic ligaments/joints
 D/t increased relaxing – This aids the birth process=Waddling gait
 Lordosis- Compensate d/t pregnant posture/gait
 Backacheà Pelvic tilt exercises help to ease the discomfort.
 Diastasis Recti=Rectus abdominis muscles separatecaused by pressure of
enlarging uterus on the abdominal muscles
 If muscle tone is not regained other pregnancies wont have the adequate
support.
Central Nervous System:
 Decreased attention, concentration and memory
o May be attributed to depression
 Memory loss disappears after birth
Metabolism:
Increased during pregnancy
 Demands of the growing fetus and its support system
 Increased water retention
Weight Gain
Normal weight gain based on BMI is 25-35 lbs —KNOW WHAT IS NORMAL
 3-5 lbs. 1st trimester
 1 lb./week 2nd and 3rd trimesters
 12-15 lbs. 2nd trimester & 3rd trimester
 Overweight women; 15-25lbs (6.8-11.4 kg).
 Underweight- Reach ideal wt. PLUS gain 25 to 35 lb
 Obese less or equal to 15 lbs (7kg).
 Average gain is 3 to 5 in 1st trimester and 12 to 15 in each of the last two
(normal weight).
 IOM Recommendation
Water Metabolism
 Increased water retentionà Needed for fetus, placenta, amniotic fluid
 Cx byàAffects on Na and fluid retention d/t increase in steroid sex hormones
 Lowered serum protein
 Increased intracapillary pressure and permeability
Nutrient Metabolism
 Fetus has greatest protein and fat demands during 2nd half of
pregnancy àDoubles its weight during last 6-8 wks
 Protein must be stored to maintain a constant level for the breast milk and
mother
 Carbs should be increased during 2nd and 3rd trimesters
 Level of free fatty acids increases d/t human placental lactogen (hPL)àLevel
of lipoproteins and cholesterol increase
 Increased fat or decreased carb production = Ketonuria
~Walk, lower Na. Around 18-20 weeks there is fetal movement.—multigravida
By 4 weeks they can know they gestational age. Mother will feel 16-20 weeks
movement. Examiner 20-24
Endocrine System:
 Thyroid – Enlargement causes increased basal metabolic rate 20-30%
 Pituitary- Enlarges- Returns to normal size post birth.
a. Anterior pituitary producesà FSH (Follicle stimulating hormone)
and LH (Luteinizing Hormone) which stimulates ovum growth,
ovulation and prolongs luteal phase.
i. Also produces prolactin responsible for lactation.
b. Posterior pituitary secretesà Oxytocin (contractions) and
vasopressin.
c. Parathyroid – Slight enlargement allows for better use of calcium
and vitamin D.
Thyroid
 Enlarges d/t increased vascularity and hyperplasia
 Estrogen cx increase in serum-bound iodine
 BMR increases 20-25%
 Neck: Slight hyperplasia of thyroid in the third trimester – Small, nontender
node
Adrenals
 Vasopressin (ADH)
o Cx vasoconstriction = Increased BP
o Regulates water balance
 Oxytocin
o Promotes uterine contractility
o Stimulates ejection of milk from breasts in postpartum -AKA the
“letdown reflex”
 Increased estrogen = Increased cortisol
 Returns to normal 1-6 wks postpartum
 During early 2nd trimester
Adrenals = increased aldosterone
a. Increased aldosterone as a bodily response to increased
sodium excretion associated with progesterone
Pancreas
 Increased insulin needs
 May show signs of gestational diabetes
 In the first trimester decreased insulin production allows for more glucose
availability for fetal growth.
 The rest of the pregnancy the woman has increased insulin needs.
Nutrition :
 A pregnant woman needs an additional 300 cal/day.
 Total calories 2300-2400/day
o Protein = 3 servings/day
o Dairy = 4 8oz servings/day
o Carbohydrate/Grain = 6 servings/day
o Fruit = 2-4 servings/day
o Vegetable = 3-5 servings/day Small
 Solid
 Pear-Shaped
 Pregnancy = Estrogen and growing fetus cx hypertrophy of Myometrial
cells 1/6 of total blood vL is contained in uterine vasculature by end of
pregnancy.
 Enlargement in :
o Size—Palpable by the end of the 12th week above the
symphysis pubis
o By end of 12 weeksàPear to globular shape
 Increase in weight, strength, elasticity, and vascularity
 Hyperplasia
 Lightening- Descent of the fetal head into the pelvis
 Hegar’s sign- Softening of the lower uterine segment-Isthmus bw the
uterine and cervix
 Braxton Hicks contractions- False labor (beginning about the 4th
month of pregnancy)
o Irregular, generally painless contractions of the uterus, occur
intermittently throughout pregnancy. In later months these
contractions can become uncomfortable and may be confused with
true labor contractions.
 Quickening-Fetal movement felt by mother (real) 18-20 week in a
primiparous, and as early as 16 weeks in multiparous
 McDonald’s sign: Ease of flexing the body of uterus against the
Cervix
~Third trimester- Woman have a hard time breathing, lightening.. ready
to be delivered.
Cervix:
Increase estrogen levels:
 Hyperplasia= Estrogen causes glandular tissue stimulationà increased in
cell number.
 Endocervical gland formation of mucous plug
 Operculum/Mucous plug prevents organisms entering uterus acts as
a barrier—“bloody show.”
 Expelled when dilation begins
 Cervix closed
Increased cervical vascularity causes:
 Goodell’s sign- Softening of the cervix (probable sign of pregnancy)
(6 weeks after pregnancy)
 Chadwick sign- Bluish/purplish discoloration (lots of blood going to
cervix)
Ovaries:
 Ovum production ceases
 Corpus luteum persists and secretes hormones until weeks 6-8
 Secretion of progesterone maintains endometrium till 7th week until
placenta assumes its function
Vagina:
Increased estrogen levels:
 Increased thickness of mucosa
 Increased vaginal secretions to prevent bacterial infections- AKA
(leukorrhea)
o Thick, white and acidic, 3.5-6.0
o Pregnant woman are more susceptible to Candida infection than
usual.
 Connective tissue relaxes during pregnancy to permit passageway of the
infant.
 D/T increased blood flow you see Chadwick’s sign as well àBluish,
purplish color of the vaginal wall (Cervix, vulva-some consider
presumptive-4 weeks)
Breasts:
Increased estrogen and progesterone levels: For preparation of lactation
 Increase in size and number of mammary glands
 More nodular
 Fullness, tingling or tenderness
 Nipples more erectile and areolas darken
 Colostrum produced during third trimester/16th wk
1. Antibody
2. Rich yellow secretion
3. May leak from breast during last trimester
4. Converts to milk a few days post birth
 Prominent superficial/blue veins
 Montgomery tubercle enlarges (sebaceous glands)
 Striae may be present
 Hyperpigmentation of nipples
 Lymph nodes SHOULD NOT be palpable
 Areas of indentation or skin puckering IS NOT normal
Respiratory system : Changes to meet increased O2 demand
Increasing levels of progesterone causes:
 Increased volume of air per minute to 30-40%–take a lot of air in
 Progesterone decreased airway resistance> 20% O2
 Increased antero-posterior diameter
 Chest circumference expands
 Uterus enlarges- Presses upward & elevates diaphragm
 Hyperventilation & SOB d/t change from abdominal to thoracic
breathing as uterus enlarges
 Increased CO2 production
 Nasal stuffiness and epistaxis (Nose bleeds) D/t:
Estrogen—-KNOW WHY IT GIVES NOSE BLEEDS. induced
edema, hypersecretion of mucus, vascular congestion of
nasal mucosa
~Physically anterior posterior diameter is enlarged, which effects respiration.
Progesterone smooth muscle which decreases oxygenation. Some pregnant
woman can pass out bc of hyperventilation, they are breathing in with their
chest, especially during third trimester.
Cardiovascular System:
Increased levels of estrogen and progesterone:
 Cardiac output and blood volume increases- For both mother and
fetus
 Blood volume progressively increases beginning in the first
trimester, increasing rapidly until about 30-34 weeks.
 This increases rbc and plasma
 Increased size of uterus interferes with blood return from lower extremities
 Increased level of red cells to increase oxygen delivery to cells
 Blood flow increases to uterus, placenta, and breasts.
 Blood pressure decreases-Mostly during 2nd trimester- But
increases during last trimester
 Cardiac output begins to increase early in pregnancy and peaks at
25-30 weeks. (Generally elevated in the third trimester)
 This is d/t a decrease in systemic vascular resistance
 Uterus puts pressure on pelvic and femoral blood vessels
 Cx stasis of blood in lower extremity =DVT, edema, varicosity of leg veins,
vulva and rectum (Hemorrhoids), and postural hypotension
~Bc of blood volume increase, the hemoglobin and hematocrit is
lower, hemodillusion. So woman may have physiological anemia, so that
is why woman are given supplemental iron. Causes pressing on femoral
artery, clotting factor is increased, tell woman to stand and walk every 1-2
hours if they are sitting for long periods of time. ~PIH during 20 weeks
 Hyper coagulation state
 Fibrin, plasma fibrinogen increases
 Supine hypotension/venocaval syndrome
 Increase cardiac load – May cause palpitation
 Pulse rate may increase by between 10–15 bpm—KNOW THE ANSWER
WAS 90 THE RATE
 Blood pressure decreases in second trimester due to lowered peripheral
resistance
 Decreased regional blood flow causes edema and varicosities -Late in
pregnancy.
 When the pregnant woman lies supine, the enlarging uterus may press
on the vena cava
 Thus reducing blood flow to the right atrium
 Lowering blood pressure, causing dizziness, pallor and clamminess.
 The enlarging uterus may also press on the aorta
o Called SUPINE HYPOTENSVE SYNDROME aka vena caval
syndrome or aortacaval compression.
 Corrected by having her lay on her side or wedge a pillow
under right hip–KNOW
Physiologic Anemia of Pregnancy (Pseudoanemia)
 Increased blood volume leads to increased plasma over red blood
cells.
 Total RBC (erythrocytes) increases, Plasma increases, hematocrit
DECREASES
 Iron supplements are necessary to meet RBC expansion.
 Increased leukocytes 5600-12,200/mm3, plasma and fibrin levels
 During Labor/postpartum may reach 20,000-30,000/mm3 or higher.
 Fibrin and plasma fibrinogen levels increase
 Clotting factors increased =hypercoagulable state
 WATCH OUT FOR CLOTS
~Very difficult to determine when they have infection, even after birth if you
draw blood work you will be surprised you should wait at least 48 hours.
~Remember normal value is 4,000-11,000
Q:
A pregnant client, at 16 weeks gestation, has a hematocrit of 35%. Her
prepregnancy hematocrit was 40%. Which of the following statements by the
nurse best explains this change?
A. “Because of your pregnancy, you’re not making enough red blood cells.”
B. “Because your blood volume has increased, your hematocrit count is
lower.”
C. “This change may indicate a serious problem that might harm your baby.”
D. “You’re not eating enough iron-rich foods like meat.”
Gastrointestinal System:
 Heartburn aka pyrosis, d/t relaxation of cardiac sphincter
 Constipation, flatulence- Due to displacement of the stomach and decreased
peristalsis/gastric motility
 Nausea/vomiting/morning sicknessà Caused by increased human
chorionic gontropin(HCG) and progesterone levels
 Hyperptyalism- Caused by increased estrogen levels=Excessive salivation
 Risk for gall stone formation due to elevated levels of cholesterol and
smooth muscle relaxation caused by progesterone.
 Mouth: Gingival hypertrophy-Bleed easily (take calcium)
~Most pregnant woman when they eat, their digestion is very slow. Antacids
before you go into labor, they may aspirate.
Abdomen
 Progressive enlargement
 Fetal heart rate heard at approximately 12 weeks gestation
 First Trimester -N&V d/t
1. Elevated human chronic gonadotropin (HCG) Levels
2. Relaxation of smooth muscle of the stomach
3. Changed carbohydrate metabolism
 Elevated progesterone = smooth muscle relaxation = delayed gastric
emptying/decreased peristalsis = bloating and constipation
 Uterus displaces stomach upward
 Intestines are moved laterally and posteriorly
 Hemorrhoids develops in late pregnancy
Renal System:
 Increased blood volume
o Glomerular filtration rate increases as much as 50% by second
trimester until birth, resulting in glycosuria (Greater than a trace
or 1+ is suspicious)
 To compensate, renal tubular reabsorption increases
 Kidneys’ inability to absorb all glucoseà GlycosuriaàMay be normal or
gestational diabetes.
 Urinary frequency-1st & 3rd trimester— Uterus is enlarging and pressing
against bladder.
 This decreases in the 2nd semester BUT reappears in the 3rd.
o Pressure of the uterus on the ureter causes urinary stasis and
pyelonephritis
o Pressure on the urethra results in poor emptying which can
cause infection leading to kidney problems or preterm labor
~Tell woman to drink water and void often bc they may have pylonephritis,
any kidney infection makes pt prone to an abortion –causes preterm labor
Skin & Hair:
 Increased skin pigmentation caused by increased estrogen and
progesterone melanocytic stimulating hormone levels.
 Pigmentation increased inà Areola, nipples, vulva, & perianal area.
 Linea Nigra
o Skin in the middle of the abdomen may develop pigmented line
o Extends from pubic area to the umbilicus or higher
 Facial Chloasma (Melasma Gravidarum) AKA: Mask of pregnancy
o Darkening skin over the forehead and around the eyes
o More prominent in dark-haired women
o Aggravated by exposure to the sun
o Sweat and sebaceous glands are hyperactive
 Striae (Striae Gravidarum)
o AKA Stretch Marks
o Reddish, wavy streaks
o Results from reduced connective tissue strength cx by: Elevated
adrenal steroid levels
o Appear on: Abdomen,thighs,buttocks & breasts
 Vascular spider nevi
o Small, bright red elevation of skin radiating from central body
o Cx = increase SQ blood flow d/t estrogen levels
o May develop on: Chest, neck, face, arms, & legs
Woman may see an increase in hair shedding beginning 1-4 months
PostpartumàAll hair is replaced within 6-12 months
Musculoskeletal System:
Relaxation of joints caused by increased estrogen and progesterone
 Relaxation of pelvic ligaments/joints
 D/t increased relaxing – This aids the birth process=Waddling gait
 Lordosis- Compensate d/t pregnant posture/gait
 Backacheà Pelvic tilt exercises help to ease the discomfort.
 Diastasis Recti=Rectus abdominis muscles separatecaused by pressure of
enlarging uterus on the abdominal muscles
 If muscle tone is not regained other pregnancies wont have the adequate
support.
Central Nervous System:
 Decreased attention, concentration and memory
o May be attributed to depression
 Memory loss disappears after birth
Metabolism:
Increased during pregnancy
 Demands of the growing fetus and its support system
 Increased water retention
Weight Gain
Normal weight gain based on BMI is 25-35 lbs —KNOW WHAT IS NORMAL
 3-5 lbs. 1st trimester
 1 lb./week 2nd and 3rd trimesters
 12-15 lbs. 2nd trimester & 3rd trimester
 Overweight women; 15-25lbs (6.8-11.4 kg).
 Underweight- Reach ideal wt. PLUS gain 25 to 35 lb
 Obese less or equal to 15 lbs (7kg).
 Average gain is 3 to 5 in 1st trimester and 12 to 15 in each of the last two
(normal weight).
 IOM Recommendation
Water Metabolism
 Increased water retentionà Needed for fetus, placenta, amniotic fluid
 Cx byàAffects on Na and fluid retention d/t increase in steroid sex hormones
 Lowered serum protein
 Increased intracapillary pressure and permeability
Nutrient Metabolism
 Fetus has greatest protein and fat demands during 2nd half of
pregnancy àDoubles its weight during last 6-8 wks
 Protein must be stored to maintain a constant level for the breast milk and
mother
 Carbs should be increased during 2nd and 3rd trimesters
 Level of free fatty acids increases d/t human placental lactogen (hPL)àLevel
of lipoproteins and cholesterol increase
 Increased fat or decreased carb production = Ketonuria
~Walk, lower Na. Around 18-20 weeks there is fetal movement.—multigravida
By 4 weeks they can know they gestational age. Mother will feel 16-20 weeks
movement. Examiner 20-24
Endocrine System:
 Thyroid – Enlargement causes increased basal metabolic rate 20-30%
 Pituitary- Enlarges- Returns to normal size post birth.
a. Anterior pituitary producesà FSH (Follicle stimulating hormone)
and LH (Luteinizing Hormone) which stimulates ovum growth,
ovulation and prolongs luteal phase.
i. Also produces prolactin responsible for lactation.
b. Posterior pituitary secretesà Oxytocin (contractions) and
vasopressin.
c. Parathyroid – Slight enlargement allows for better use of calcium
and vitamin D.
Thyroid
 Enlarges d/t increased vascularity and hyperplasia
 Estrogen cx increase in serum-bound iodine
 BMR increases 20-25%
 Neck: Slight hyperplasia of thyroid in the third trimester – Small, nontender
node
Adrenals
 Vasopressin (ADH)
o Cx vasoconstriction = Increased BP
o Regulates water balance
 Oxytocin
o Promotes uterine contractility
o Stimulates ejection of milk from breasts in postpartum -AKA the
“letdown reflex”
 Increased estrogen = Increased cortisol
 Returns to normal 1-6 wks postpartum
 During early 2nd trimester
Adrenals = increased aldosterone
a. Increased aldosterone as a bodily response to increased
sodium excretion associated with progesterone
Pancreas
 Increased insulin needs
 May show signs of gestational diabetes
 In the first trimester decreased insulin production allows for more glucose
availability for fetal growth.
 The rest of the pregnancy the woman has increased insulin needs.
Nutrition :
 A pregnant woman needs an additional 300 cal/day.
 Total calories 2300-2400/day
o Protein = 3 servings/day
o Dairy = 4 8oz servings/day
o Carbohydrate/Grain = 6 servings/day
o Fruit = 2-4 servings/day
o Vegetable = 3-5 servings/day

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NUR 4130 Concepts Of Maternal-Child Nursing And Families Nova Southeastern University

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