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Psychological Adaptations During Pregnancy | NUR 106D - Maternal Nursing, Quizzes of Nursing

Class: NUR 106D - Maternal Nursing; Subject: Nursing; University: Jefferson State Community College; Term: Fall 2013;

Typology: Quizzes

2013/2014

Uploaded on 05/15/2014

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TERM 1
Ambivalence
DEFINITION 1
having conflicting feelings such as:-Proud & excited/fearful &
anxious-Universal feeling
TERM 2
Introversion
DEFINITION 2
focusing on ones self-1st and 3rd trimesters-May appear
passive to family-Focuses on behaviors to ensure safety
TERM 3
Acceptance
DEFINITION 3
-2nd trimester - Feels movement, hears heart beat, sees
image -Able to see fetus as separate individual -New body
image
TERM 4
Mood
swings
DEFINITION 4
-emotionally liability-Cries w/o apparent reason-emotional
roller-coaster-Can be difficult for spouse and family
TERM 5
Maternal Emotional Responses to Change in
body image
DEFINITION 5
-Varies from person to person-Some feel beautiful-Some feel
overweight & uncomfortable
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Ambivalence

having conflicting feelings such as:-Proud & excited/fearful & anxious-Universal feeling TERM 2

Introversion

DEFINITION 2 focusing on ones self-1st and 3rd trimesters-May appear passive to family-Focuses on behaviors to ensure safety TERM 3

Acceptance

DEFINITION 3 -2nd trimester - Feels movement, hears heart beat, sees image -Able to see fetus as separate individual -New body image TERM 4

Mood

swings

DEFINITION 4 -emotionally liability-Cries w/o apparent reason-emotional roller-coaster-Can be difficult for spouse and family TERM 5

Maternal Emotional Responses to Change in

body image

DEFINITION 5 -Varies from person to person-Some feel beautiful-Some feel overweight & uncomfortable

Maternal Role Tasks is

to...

Ensuring safe passage throughout pregnancy and birth- Primary focus of womans attention-Participating in positive self-care activities Diet, exercise, overall well-being TERM 7

Maternal role in 1st trimester

DEFINITION 7 woman focusing on herself, not fetus-acceptance of pregnancy-identification of what must be given up to assume new role TERM 8

Maternal role in 2nd

trimester

DEFINITION 8 developing attachment to fetus-family needing to relate to fetus-identification with infant, learning how to delay own desires TERM 9

Maternal role in 3rd trimester

DEFINITION 9 having concern for herself and fetus as a unit-unconditional acceptance-questioning her ability to become a good mother TERM 10

Physical and emotional demand of pregnancy

DEFINITION 10 -Changing shape-Emotional status-Fetal activity-Changes in breast size-Pressure on bladder and other discomforts Partner becomes confused and anxious-1st tri: less interested in sex-2nd tri: increased interest in sex-3rd tri: may experience discomfort with sex Womans sexual health linked to self-image Discuss alternative noncoital modes with spouse

Pattern of uterine growth

-Results from hyperplasia and hypertrophy-Predictable pattern-Helps confirm Estimated date of birth (EDB) Estimated date of delivery (EDD) Estimated date of confinement (EDC) TERM 17

12 weeks gestation is Palpated?

DEFINITION 17 above symphysis pubis. TERM 18

16 weeks is Palpated?

DEFINITION 18 Midway between symphysis pubis and umbilicus TERM 19

36 weeks is palpated?

DEFINITION 19 Highest level at xiphoid process TERM 20

40 weeks

DEFINITION 20 Head descends into pelvic cavityLightening Contractility

Braxton Hicks contractions

Infrequent during 1sttwo trimesters Mistaken for false labor Uterine blood flow-Inc. in size and number of blood vessels- Expands blood flow dramatically-Late pregnancy blood flow to uterus and placenta reaches 450-650 ml/hr-Uterine souffle-correlates to mothers pulse TERM 22

Describe the weight and length of the uterus

before pregnancy and after pregnancy.

DEFINITION 22 -before conception uterus is small pear-shaped organ contained in pelvic cavity-weighs approx 50-70g (1.8-2.5oz) before pregnancy-at end of pregnancy uterus extends to level of xiphoid process-at end of pregnancy weighs approx 800.1200g (1.8-2.6 lbs) TERM 23

Identify how much the blood supply increases

to the uterus during pregnancy.

DEFINITION 23 -as uterus increases in size blood flow rises-early pregnancy most of blood flow is to myometrium and endometrium-late pregnancy blood flow reaches 450-650 ml/min-adequate perfusion is necessary for delivery of most substances needed for fetal growth and waste removal TERM 24

Describe the changes in the cervix during

pregnancy.

DEFINITION 24 -color changes and consistency-estrogen causes cervix to become congested w/blood (hyperemic) which causes the bluish purple color-Chadwicks sign: earliest signs of pregnancy, bluish purple color that extends to vagina and labia-cervix softens-Goodells sign (softening ofcervix)-mucus plug forms in cervical canal to block ascent of bacteria TERM 25

Describe the changes in the ovaries during

pregnancy.

DEFINITION 25 -after conception, secretes progesterone for first 6-7 weeks of pregnancy-corpus luteum secretes progesterone until placenta is developed-ovulation ceases b/c of circulating levels of estrogen and progesterone which inhibit release of FSH and LH

physiologic changes in the thyroid gland

during pregnancy.

-early in 1sttrimester, rise in T4 and thyroxine- bindingproteinoccurs-serum level of unbound T4 rises in early pregnancy and then returns to normal-BMR increases up to 25%b/cof fetal metabolic activity TERM 32

physiologic changes in the parathyroid gland

during pregnancy.

DEFINITION 32 -PTH slightly decreased during 1sttrimester and normal rest of pregnancy TERM 33

physiologic changes in the pancreas during

pregnancy.

DEFINITION 33 -glucose levels are 10-20% lower than b4 pregnancy-hypoglycemia may develop b/w meals and at night as fetus draws glucose from mother-during 2ndhalf of pregnancy maternal sensitivity to insulin begins to decline b/c of effects of human placental lactogen, prolactin, progesterone, estrogen, and cortisol-higher blood glucose level makesmore glucose available for fetal energy needs and stimulates pancreas of healthy woman to produce additional insulin-inadequate insulin results in gestational diabetes TERM 34

physiologic changes in the adrenal gland

during pregnancy.

DEFINITION 34 -total and free cortisol are elevated-cortisol regulates carbohydrate and protein metabolism-aldosterone increases during pregnancy to overcome salt-wasting effects of progesterone to maintain the necessary level of sodium in the greatly expanded blood volume and meet needs of fetus TERM 35

what hormones are secreted by the placenta

DEFINITION 35 -hCG-estrogen-progesterone-Human Placental Lactogen hPL alsocalled hCS-Relaxin

hCG

-produced by trophoblastic cells that surround the developing embryo-rapid increase of hCG stimulates estrogen and progesterone production until placenta is sufficiently developed-causes a positive pregnancy test TERM 37

Estrogen

DEFINITION 37 -after placental sufficiency, producedby placentafor remainder of pregnancy-has 3 fxns during pregnancy:-stimulates uterine growth and increases blood supply to uterine vessels-aids in developing the ductal system in breasts for lactation-assoc w/hyperpigmentation, vascular chgs in skin, increased activity ofsalivaryglands andhyperemia of gums and nasal membranes TERM 38

Progesterone

DEFINITION 38 -most important pregnancy hormoneand has these fxns-maintain endometrial layer for implantation of fertilized egg-prevents spontaneous abortion by relaxing smooth muscle of uterus-prevents tissue rejection of fetus-stimulates development of lobes and lobules in breasts for lactation-facilitates deposit of maternal fat stores, which provide reserves for pregnancy and lactation-relaxes all smooth muscle (gastric sphincter, decreased bowel motility, dilation of uterus, increased bladder capacity)- raises respiratory sensitivity to CO2 and stimulates increased ventilation w/increased air entering lungs TERM 39

Human Placental Lactogen hPL -also called

hCS

DEFINITION 39 -increases availability of glucose for fetus-reduces sensitivity of maternal cells to insulin-decreases maternal metabolism of glucose, freeing glucose for transport to fetus-causes free fatty acids to metabolize for energy for pregnant woman TERM 40

Relaxin

DEFINITION 40 -inhibits uterine activity-softens connective tissue of cervix- relaxes pelvic joints

Discuss blood pressure changes during

pregnancy

-remains stable despite increase in blood volume b/c of decreased peripheral vascular resistance-systolic pressure remains unchanged or decreases slightly-diastolic pressure may decrease- pressure is lowest when in lateral recumbent position-pressure is higher when standing than when sitting-systolic and diastolic increase when arm in dependent position-when supine, uterus partially occludes vena cava and aorta and impedes return of blood which results in reduced cardiac return, cardiac output and BP TERM 47

Discuss systemic vascular resistance changes

during pregnancy

DEFINITION 47 -decreases during pregnancy r/t:-smooth muscle relaxation in vessel walls cause by progesterone and prostaglandins- addition of uteroplacental unit, provides greater area for circulation-fetal heat production may cause vasodilation- decreased responsiveness of angiotensin II receptors- increased nitric oxide levels cause vasodilation TERM 48

cause of venous pooling,edema of the legs,

postural hOTN,& supine hOTN as a result of

CV changes.

DEFINITION 48 -wt of expanding uterus on inferior vena cava and iliac veins partially obstructs blood return from veins in legs, causing stasis of blood and venous distention-when supine, uterus partially occludes vena cava and aorta and impedes return of blood which results in reduced cardiac return, cardiac output and BP TERM 49

Identify the advantage of lateral position in

pregnancy.

DEFINITION 49 -BP is thelowest inthis position-alleviates pressure on blood vessels TERM 50

20. Explain changes in the respiratory system

in regards to anatomic change, lung function,

oxygen consumption, hyperventilation and

dyspnea.

DEFINITION 50 -diaphragm is elevated by uterus-movement of diaphragm is slightly increased-volume of lungs is decreased b/c of elevated diaphragm-ribs flare, substernal angle widens, AP diameter expands-caused by pressure of uterus and relaxation of ligaments from relaxin-breathing becomes thoracic rather than abdominal, adding to dyspnea-O2 consumption increases by 20%-Half the O2 is used by fetus and placenta, t he rest is consumed by uterus, breast tissue and increased RR and cardiac demands-woman breathes more deeply to compensate, but RR remains the same-tidal volume increases 30-40%-respiratory minute volume increases by 30-50%

21. Explain changes in the urinary system in

regards to anatomic changes, renal plasma

and glomerular filtration rate.

-bladder capacity doubles (result of progesterone)-frequency and urgency is experienced (hormonal changes, increased blood volume, chgs in GFR)-may experience stress or urge incontinence- nocturia is common-increased risk for infection and trauma during childbirth b/c of edematous tissues-kidneys chg in size and shape b/c of dilation of renal pelves, calyces and ureters-dilation is caused by: effects of progesterone; compression of ureters b/w enlarging uterus and bony pelvic brim-GFR and renal plasma flow increases to excrete additional metabolic waste from mother and fetus TERM 52

Identify what happens to sodium during

pregnancy.

DEFINITION 52 -progesterone has salt-wasting effects, so aldosterone increases to compensateto maintain necessary level of sodium in the greatly expanded blood volume to meet the needs of the fetus TERM 53

Explain glucosuria & proteinuria during

pregnancy.

DEFINITION 53 -as GFR increases, filtered load of glucose exceeds ability of renal tubules to reabsorb it and glucose spills into the urine, therefore glucosuria is common-mild proteinuria is common and does not mean abnormal kidney fxn or preeclampsia TERM 54

Explain why stagnation of urine is common.

DEFINITION 54 -flow of urine thru ureter is obstructed, ureters and renal pelvis dilate resulting in stasis of urine TERM 55

Explain why nausea and vomiting,heartburn

and constipation are common during

pregnancy.

DEFINITION 55 -heartburn is a result of lower esophageal sphincter tone decrease; reduced tone along with upward displacement of stomach allows reflux of acidic stomach contents-decreased motility r/t progesterone, allows time for more water to be absorbed which may lead to constipation-increased levels of progesterone and estrogen contribute to nausea and vomiting

chloasma (mask of pregnancy)

-chloasma: areas of pigmentation include brownish patches over the forehead, cheeks and nose-increases w/exposure to sunlight TERM 62

Identify changes in carbohydrate metabolism

during pregnancy

DEFINITION 62 -estrogen, progesterone, hPL, prolactin, cortisol cause maternal tissue to be resistant to insulin-mothers ability to use insulin is decreased as a protective mechanism to supply glucose for fetus-mothers pancreas produces more insulin to metabolize glucose and prevent hyperglycemia TERM 63

Identify why physiologic edema is present in

the lower extremities during pregnancy.

DEFINITION 63 -because of hemodilution, a slight decrease occurs in colloid osmotic pressure which favors the development of dependent edema-edema increases further toward term when wt of uterus compresses the veins of pelvis-process delays venous return, causing veins of legs to become distended and increase venous pressure resulting in additional fluid shifts from vascular to interstitial TERM 64

what trimester is edema evident in the lower

extremities.

DEFINITION 64 -third trimester TERM 65

List the seven presumptive signs of

pregnancy

DEFINITION 65 -amenorrhea-nausea and vomiting-fatigue-urinary frequency-breast and skin changes-vaginal and cervical color changes-fetal movement (quickening)

why are presumptive signs called subjective

signs.

-they are subjective because they are what the woman experiences and can be caused by other conditions besides pregnancy TERM 67

Identify the presumptive sign that is

commonly evident first.

DEFINITION 67 -amenorrhea TERM 68

Identify how many weeks N & V (nausea and

vomiting) is commonly evident.

DEFINITION 68 -usually begins about 6 weeks after LMP and disappears by about 14-16 weeks TERM 69

Identify when N & V usually

ceases

DEFINITION 69 -usually disappears by about 14-16 weeks TERM 70

Identify the cause of frequent micturition.

DEFINITION 70 -hormonal changes in the first few weeks of pregnancy- continues later when pressure is on bladder by expanding uterus

Identify the time (weeks) element Hegars sign

is evident.

-6-8 weeks after LMP TERM 77

Goodells sign.

DEFINITION 77 -softening of the cervix TERM 78

Identify the time element Goodells sign is

commonly evident.

DEFINITION 78 -6-8 weeks after LMP TERM 79

Braxton Hicks contractions

DEFINITION 79 -irregular, painless contractions that occur throughout pregnancy TERM 80

ballottement

DEFINITION 80 -sudden tap on the cervix during vaginal exam may cause fetus to rise in amniotic fluid and then rebound to original position

Identify when ballottement is evident

(months).

-mid-pregnancy (this is what book and internet says) TERM 82

Explain why feeling the outline of the fetus is

not a positive sign.

DEFINITION 82 -large leiomyoma may feel like the fetal head-small, soft leiomyoma may simulate small parts of the fetus TERM 83

Identify the hormones responsible for a

positive pregnancy test.

DEFINITION 83 -hCG and beta subunit of hCG TERM 84

Identify the advantages of the immunologic

tests.

DEFINITION 84 -radioimmunoassay-most sensitive pregnancy tests available are accurate b4 first missed period-agglutination inhibition test-quick and ideal for early dx of pregnancy, can detect hCG 3-5 days after conception-radioreceptor assay-accurate 6-8 days after conception, very sensitive, used to detect small amts of hCG (ectopic pregnancies) TERM 85

List the three positive signs of pregnancy.

DEFINITION 85 -auscultation of fetal heart sounds-fetal movements felt by examiner-visualization of the fetus

Family health history includes...

-general health of family-chronic dz, DM, heart dz, TB, hepatitis TERM 92

Partner Health History Includes...

DEFINITION 92 -genetic abnormalities-chronic dz-use of drugs, cocaine-use of alcohol-tobacco use-blood type, esp if mom is Rh- due to blood incompatibility TERM 93

Discuss the components of the physical exam

at the initial visit.

DEFINITION 93 -Vital signs: BP, Pulse, RR, Temp-Cardiovascular: venous congestion, edema-Musculoskeletal: posture and gait, ht and wt, pelvic measurements, abdomen-Neurologic system- Integumentary system-Endocrine system-GI: mouth, intestine-Urinary:UA screen for protein, glucose, ketones, bacteria-Reproductive system: breasts, external organs, internalorgans TERM 94

Explain why a dietary history is important.

DEFINITION 94 -Low income women may have deficient diets-adolescent pregnancies are at risk for smaller infants, so weight gain s/b increased-diets of teenagers are often low in vit A and C, folic acid, calcium, iron, zinc and Mg-vegetarians may be lacking in calcium, iron, zinc, and vit D and B12*all of these are determined by the diet history and the nurse can know what the pt may need to adjust TERM 95

Discuss why dietary habits are modified

during pregnancy.

DEFINITION 95 -nutrient needs during pregnancy increase to meet demands of mother and fetus-increases are not large and relatively east to obtain thru the diet

Identify what nutrients need to be increased

during pregnancy

-carbs-vitamins-folic acid-minerals-fats-protein-calories TERM 97

Why does Carbohydrates need to be

increased during pregnancy?

DEFINITION 97 -complex carbs s/b major source b/c supply other nutrients- fiber absorbs water and stimulates peristalsis to help prevent constipation, delays gastric emptying causing sensation of fullness TERM 98

Why does fats need to be increased during

pregnancy?

DEFINITION 98 -fats provide energy as well as fat-soluble vitamins-fat provides fatty acids to help in neurologic and visual development in fetus-fat is transferred to infant after birth during breastfeeding-fatty fish, salmon and herring TERM 99

What is the need of calories during

pregnancy?

DEFINITION 99 -increase by 340 calories during 2ndtrimester,452 calories during 3rdtrimester,no extra needed in 1sttrimester TERM 100

Why does protein need to be increased during

pregnancy

DEFINITION 100 -necessary for metabolism, tissue synthesis, tissue repair- protein intake of 71g/day during 2ndhalf to expand blood volume and support growth of maternal and fetal tissues