nursing care aspects

1. PHYSIOLOGICAL AND
PSYCHOSOCIAL MATERNAL
ADAPTATION TO PREGNANCY
Prepared By:-
Sangeetha Francis

2. MATERNAL PHYSIOLOGICAL ADAPTATIONS TO
PREGNANCY
• Signs of pregnancy
• Amenorrhea
• Fatique
• Nausea
• Vomiting
• Breast changes
• Probable signs (changes observed by the examiner )
• Hegar sign
• Ballotment
• Pregnancy tests
• Positive signs (Those signs attributed to the presence of fetus only)
• Palpating fetal parts

3. Reproductive system and breasts

4. Uterus
• Changes in shape, size, position
• Changes in contractility
• Utero placental blood flow
• Cervical changes
• Changes related to the presence of fetus
• Vagina and vulva changes
• Leukorrhea

5. Breasts
• Fullness
• Tingling
• Heaviness
• Pigmentation
• Secondary areola
• Montgomery's tubercles
• Visible blood vessels
• Striae gravidarum
• Tissues become softer and looser

6. Breast continued..
• Generalized course nodularity
• Mammogenesis
• Precolostrum
• At 16 weeks colostrum

7. Cardiovascular system
• Slight cardiac hypertrophy
• Increased blood volume and cardiac output splitting of s1, s2 ,s3 after 20 weeks
• Displacement of the diaphragm
• Arterial Blood pressure is affected
• Maternal position affects the brachial BP
• Compression to the vena cava
• Compression of the iliac veins
• Blood volume and composition due to expansion
• Increased cardiac out put

9. Respiratory system
• Elevated levels of estrogen cause the ligaments of the rib cage to
relax, permitting increased chest expansion
• The diaphragm is displaced by as much as 4 cm during pregnancy
• The upper respiratory tract becomes more vascular
• capillaries become engorged, edema and hyperemia develop within
the nose, pharynx, larynx, trachea, and bronchi

10. Basal metabolic rate
• This increase varies considerably depending on the prepregnancy
nutritional status of the woman and fetal growth.
• The BMR returns to nonpregnant levels by 5 to 6 days after birth.
• The elevation in BMR during pregnancy reflects increased oxygen
demands of the uterine-placental-fetal unit and greater oxygen
consumption because of increased maternal cardiac work.
• Peripheral vasodilation and acceleration of sweat gland activity help
dissipate the excess heat resulting from the increased BMR during
pregnancy.
• Pregnant women may experience heat intolerance, which is annoying to
some women.
• Lassitude and fatigability after only slight exertion are experienced by
many women in early pregnancy.

11. Acid-base balance
• By about the tenth week of pregnancy, there is a decrease of about 5 mm
Hg in the partial pressure of carbon dioxide (PCOS).
• Progesterone may be responsible for increasing the sensitivity of the
respiratory center receptors, so that tidal volume is increased, PCO2
decreases, the base excess (HC03 or bicarbonate) decreases, and pH
increases slightly.
• These alterations in acid-base balance indicate that pregnancy is a state
of compensatory respiratory alkalosis

12. Renal system
• The kidneys are responsible for maintaining electrolyte and acid-base
balance, regulating extracellular fluid volume, excreting waste
products, and conserving essential nutrients.

13. Integumentary system
• Alterations in hormonal balance and mechanical stretching are
responsible for several changes in the integumentary system during
pregnancy
• Chloasma
• Striae gravidarum 2 types
• Angioma
• Pruritis
• Treatment for acne alert

14. Continues …
• Gum hypertrophy
• Epulis (gingival granuloma gravidarum)
• Nail growth may be accelerated

15. Musculoskeletal system
• Obesity
• Slight relaxation and increased mobility of the pelvic joints

16. Neurologic system
• Compression of pelvic nerves or vascular stasis
• Dorsolumbar lordosis
• Edema
• Acroesthesia (numbness and tingling of the hands)
• Tension headache
• Light-headedness
• Hypocalcaemia

17. Gastrointestinal system

18. APPETITE
• During pregnancy, the woman’s appetite and food intake fluctuate.
• Early in pregnancy, some women have nausea with or without vomiting
(morning sickness).
• Possibly in response to increasing levels of hCG and altered carbohydrate
metabolism.
• Morning sickness or nausea and vomiting of pregnancy (NVP) appears at
about 4 to 6 weeks of gestation and usually subsides by the end of the third
month (first trimester) of pregnancy.
• Severity varies from mild distaste for certain foods to more severe vomiting.
• The condition may be triggered by the sight or odor of various foods.
• By the end of the second trimester, the appetite increases in response to
increasing metabolic needs.

19. continues…
• When ever the vomiting is severe or persists beyond the first
trimester, or when it is accompanied by fever, pain, or weight loss,
further evaluation is necessary
• changes in their sense of taste
• Pica
• Dislikes to food

20. Mouth
• The gums become hyperemic, spongy, and swollen during pregnancy.
• They tend to bleed easily because the increasing levels of estrogen cause
selective increased vascularity and connective tissue proliferation (a
nonspecific gingivitis).
• Epulis (discussed in the section on 'the integumentary system) may
develop at the gumline.
• Ptyalism (excessive salivation), which may be caused by the decrease in
unconscious swallowing by the woman when nauseated or from
stimulation of salivary glands by eating starch.

21. Esophagus, stomach, and intestines
• Herniation of the upper portion of the stomach (hiatal hernia
• occurs after the seventh or eighth month of pregnancy in about 15% to 20%
of pregnant women.
• results from upward displacement of the stomach, which causes the hiatus of
the diaphragm to widen.
• It occurs more often in multiparas and older or obese women.
• Increased estrogen production causes decreased secretion of
hydrochloric acid; therefore peptic ulcer formation or flare-up of
existing peptic ulcers is uncommon during pregnancy and may
improve.

22. Continues..
• oesophageal regurgitation.
• Iron deficient
• Constipation
• hemorrhoids

23. Gallbladder and liver.
• The gallbladder is quite often distended because of its decreased muscle tone during
pregnancy.
• Increased emptying time and thickening of bile caused by prolonged retention are
typical changes.
• These features, together with slight hypercholesterolemia from increased
progesterone levels, may account for the development of gallstones during
pregnancy.
• Hepatic function is difficult to appraise during pregnancy
• only minor changes in liver function develop
• intrahepatic cholestasis (retention and accumulation of bile in the liver, caused by
factors Within the liver) occurs late in pregnancy in response to placental steroids
• result in pruritus gravidarum (severe itching) with or without jaundice.
• These distressing symptoms subside soon after birth.

24. Abdominal discomfort
• Intraabdominal alterations that can cause discomfort include pelvic
heaviness or pressure, round ligament tension, flatulence, distention
and bowel cramping, and uterine contractions.

25. Endocrine system
• Profound endocrine changes are essential for pregnancy
maintenance, normal fetal growth, and postpartum recovery.

26. Pituitary and placental hormones.

27. Thyroid gland.
• During pregnancy, gland activity and hormone production increase.
• The increased activity is reflected in a moderate enlargement of the
thyroid gland caused by hyperplasia of the glandular tissue and increased
vascularity
• Thyroxine binding globulin (TBG) increases as a result of increased
estrogen levels. This increase begins at about 20 weeks of gestation.
• The level of total (free and bound) thyroxine (T4) increases between 6 and
9 weeks of gestation and plateaus at 18 weeks of gestation.
• Free thyroxine (T4) and free triiodothyronine (T 3) return to nonpregnant
levels after the first trimester.
• Despite these changes in hormone production, hyperthyroidism usually
does not develop in the pregnant woman

28. Parathyroid gland
• Parathyroid hormone controls calcium and magnesium metabolism.
• Pregnancy induces a slight hyperparathyroidism, a reflection of
increased fetal requirements for calcium and vitamin D.
• The peak level of parathyroid hormone occurs between 15 and 35
weeks of gestation, when the needs for growth of the fetal skeleton
are greatest.
• Levels return to normal after birth.

29. PSYCO-SOCIAL ADAPTATION TO PREGNANCY

30. Maternal Adaptation
• Accepting the pregnancy
• Identifying with the mother role
• Reordering personal relationships
• Establishing a relationship with the fetus
• Preparing for childbirth

31. Paternal Adaptation
• Accepting the pregnancy
• IDENTIFYING WITH THE FATHER ROLE
• Reordering personal relationships
• Establishing a relationship with the fetus
• Preparing for childbirth

33. Care Paths
• Education for self-care
• Nutrition
• Personal hygiene
• Prevention of urinary tract infections
• Kegel exercises
• Preparation for breastfeeding.
• Dental care
• Physical activity
• Posture and body mechanics
• Rest and relaxation
• Employment
• Clothing
• travel

36. THANK YOU