Normal Pregnancy (Maternal and Newborn Nursing) Part 3

Presumptive Signs of Pregnancy

Amenorrhea. Amenorrhea, the absence of menstruation, is often one of the first indications of pregnancy. A missed menstrual period, however, does not always signify conception. Pregnancy is dated from the first day of the woman?s LNMP. To be considered normal, the period should have come on time, lasted as long as is usual for the woman, and have been the normal flow for her. If any of these three items are not true of that period, ask the client to recall the first day of her previous menstrual period (PMP).

Nausea. Nausea may begin soon after the first missed menstrual period and usually disappears after the third month of pregnancy. Approximately half of all pregnant women experience some nausea or vomiting, usually owing to hormonal changes. Although it is sometimes called ?morning sickness,? the nausea or vomiting of pregnancy may happen at any time during the day. If this condition lasts beyond the fourth month, results in a weight loss of 8 pounds or more, or affects the woman?s general health, it is considered a complication of pregnancy, hyperemesis gravidarum.

Frequent Urination. The enlarging uterus presses against the urinary bladder. This action may cause the woman to feel the need to urinate more frequently than usual. As the uterus grows upward into the abdominal cavity, the pressure eases. Late in the pregnancy, the woman again feels the need to empty her bladder frequently. Once again, this is caused by pressure, as the fetal head moves downward before birth.

Fatigue. During the early months of pregnancy, the woman may feel drowsy and may tire easily. She may find that she requires more rest and sleep than usual and that even if she gets the extra rest, she still feels tired. Although the exact causes of this fatigue are unknown, tiredness is probably caused by the body?s increased use of energy because it works harder than normal during this time.

Quickening. The first fetal movements that the pregnant woman feels are called quickening. The woman usually experiences quickening between 18 and 20 weeks of gestation, but it may occur a week or two earlier in a multigravida. Women describe quickening as a light, ?fluttery? sensation. This ?feeling of life? is not considered a positive sign of pregnancy because it cannot be confirmed objectively by anyone other than the woman herself. The movement of gas within the colon can also simulate this feeling.

Breast Changes. The earliest breast changes that occur in pregnancy are similar to those a woman may experience before her menstrual period. However, the sensations during pregnancy are more intense than premenstrual changes. The sensations include enlargement, heaviness, tingling, throbbing, or tenderness. The breasts may be so tender that the discomfort awakens a woman who rolls over onto her stomach during sleep. As the pregnancy progresses, the areolae and the nipples enlarge and darken. By the 14th week, the woman?s breasts begin to produce colostrum. This clear or slightly milky fluid will be produced in very small amounts throughout the rest of her pregnancy, and in a greater quantity during the first day or two after birth. After that, her true milk will come in.

Pigment Changes. Pregnancy causes some skin changes. A suntanned, bronzed masking may appear across the face of dark-haired women. This is known as melasma (or chloasma gravidarum), or the ?mask of pregnancy.? A line of darker pigmentation, known as the linea nigra, often appears on the lower abdomen and extends from the umbilicus to the pubic bone. Hormone level changes cause these pigment changes.

Probable Signs of Pregnancy

Probable signs of pregnancy are more objective than the presumptive signs. An obstetrician or midwife may observe them during examination. They are more reliable indicators of pregnancy than the presumptive signs, but still are not proof that a pregnancy exists.

Basal Body Temperature Elevation. The body temperature at rest, or basal body temperature (BBT), rises slightly (usually less than one degree) as one of the earliest signs of pregnancy. For accuracy, however, comparisons require that the temperature also must have been taken and recorded before pregnancy occurred.

Positive Urine Pregnancy Tests. Pregnancy tests check for the presence of the hormone called human chorionic gonadotropin (HCG, HCg, or hCG). This hormone is produced by the cells that will become the placenta. It can be found in small amounts in a woman?s urine or blood by about the 7th to 10th day of pregnancy.

Home pregnancy testing allows the woman to know she is pregnant at a very early stage and lets her process the possibility of pregnancy in privacy. She can then make her own decisions about both the pregnancy and her lifestyle. The manufacturers of home pregnancy tests recommend confirmation of the results through professional examination and clinical testing. This advice should be followed because home tests may not have the same accuracy as clinical tests. Errors may occur in as many as 20% to 30% of the home tests performed. The most common error (a false-negative) results from urine testing that is performed too early to obtain an accurate finding. The user must be able to read, follow directions, and perform the test correctly for the results to be accurate.

Cervical Changes. At about the eighth week of gestation, the cervix softens. This is known as Goodell?s sign. Before pregnancy, the cervix feels firm (like the tip of a nose); during pregnancy, it feels softer (more like the earlobe). The cervix also looks blue or purple when examined; this is Chadwick?s sign, and may occur as early as the sixth week of pregnancy.

Vulvar and Vaginal Changes. The blueness due to increased blood supply (Chadwick?s sign) also occurs on the vulva and vagina.

Uterine Changes. At about 6 weeks, the lower uterine segment (the portion between the body of the uterus and the cervix) softens. This softening is called Hegar?s sign. A softening of the uterine fundus, where the embryo has implanted, also occurs by about the seventh week. The fundus enlarges by the eighth week. The uterus as a whole enlarges steadily throughout the pregnancy. The uterus rises above the symphysis pubis by about the 12th week, and reaches the umbilicus between the 20th and 24th weeks.

Ballottement. After about 16-18 weeks of pregnancy, gently tapping one side of the pregnant woman?s abdomen will cause the fetus to ?bounce? in the amniotic fluid?because the fetus is small compared with the amount of fluid. Examiners can feel this rebound tap, known as ballottement, against their hand.

Enlargement of the Abdomen. As the uterus increases in size, the abdomen is forced outward.

Positive Signs of Pregnancy

The positive signs of pregnancy, described below, can only occur in pregnancy.

Visualization of the Fetus. A fetus can be seen either on an ultrasound or, less commonly, on an x-ray examination. Ultrasound is the most common method used to evaluate fetal size, development, and due date. Using ultrasound, it is possible to diagnose pregnancy as early as the fourth week of gestation. The ultrasound examination is safe, painless, and relatively inexpensive.

Fetal Heartbeat. An examiner can detect the fetal heartbeat (fetal heart tones) by using either a Doppler or a special manual stethoscope called a fetoscope (Fig. 65-10). The Doppler (an electronic stethoscope) converts ultrasonic frequencies (high-frequency sound waves) into audible frequencies or onto a video monitor. An examiner can hear fetal heart tones with the Doppler as early as the 10th week. They can be heard with the fetoscope at about the 18 th to 20th week. A normal fetal heart rate ranges from 120 to 160 beats per minute (BPM). When assessing fetal heart rate, the examiner must be aware of two other sounds to avoid confusion. The funic souffle is a swishing sound produced by the pulsation of blood as it is propelled through the umbilical cord. Its rate is the same as the fetal heart rate. The uterine (or placental) souffle is a swishing sound produced by the maternal blood as it flows through the large vessels of the uterus. Its rate is the same as the woman?s heart rate. The examiner should feel the woman?s radial pulse at the same time he or she is checking the fetal heart rate, to avoid confusing the two. Listening to fetal heart tones (FHTs) is an important part of caring for a pregnant woman. FHTs should be evaluated at every prenatal visit and at very frequent intervals during labor.In Practice: Nursing Procedure 65-1 provides information on obtaining fetal heart tones.

Nursing Alert If you are unable to hear fetal heart tones, you must notify the physician, nurse midwife, or nurse practitioner immediately.

Fetal Movement Felt by an Examiner. An examiner may be able to feel fetal movement after about week 20. At first, the movements are faint; however, as the fetus grows and muscle strength increases, the movements become stronger. These fetal movements must be differentiated from other movements within the woman?s body (e.g., peristalsis).

Important Changes in Maternal Anatomy and Physiology

As you learned at the beginning of this topic, many of the changes that occur in a woman?s body are due to the increasing size of the fetus. Other changes result from the altered hormonal environment. The placenta produces so many hormones, and in such great quantity, that some people think of it as a ?hormone factory.? These hormones are needed to help the mother sustain the pregnancy, to nourish the rapidly developing fetus, to prepare for breastfeeding (lactation), and for the mother to still have enough energy to support herself.

FIGURE 65-10 ? (A) Checking fetal heart tones (FHTs) using a Doppler: (B) Checking FHTs via auscultation, using a fetoscope.

Key Concept Hormones and the size of the growing fetus both result in changes in the woman?s body

External Changes. After the first trimester of pregnancy, most women look pregnant. Their abdomen changes in contour, becoming increasingly more round as the pregnancy progresses. As the abdomen enlarges and her center of gravity shifts forward, the woman?s posture and gait alter as well. She develops an inward curve of the lower back, known as lordosis. During late pregnancy, her rib cage flares outward, making more room for the fetus.

Internal Changes. In addition to the visible changes of pregnancy, a woman?s body experiences tremendous internal changes. The hormones of pregnancy cause these changes, which are designed to support the pregnancy and the developing fetus.

Hormone Levels. A woman?s hormone levels change dramatically during pregnancy. Important hormones of pregnancy include progesterone, estrogens, HCG, and HPL (human placental lactogen). Levels of estrogens and progesterone rise steadily from early pregnancy until close to term, when they level off (and then may slowly decline). A similar pattern is true of HPL, except that it is not produced until close to the beginning of the second trimester. It then rises rapidly until about 34 weeks, when it decreases. On the other hand, HCG is the primary hormone of early pregnancy; its level drops significantly during the second trimester.

Together, these hormones create an environment that supports the pregnancy. Some of the most important hormonal effects include:

???? Maintaining the endometrium so that the embryo can implant

???? Causing changes in the mother?s metabolism so that nutrients will be available for her own needs as well as the needs of the growing fetus

???? Causing an increase in the mother?s blood volume and red blood cell mass to provide the extra oxygen needed for both the fetus and her own increased demands

???? Increasing the blood supply to the gastrointestinal tract and slowing the peristaltic waves, changes that result in increased absorption of nutrients

???? Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly to increase the space available for the fetus to pass through

???? Preparing the breasts for lactation, while keeping the milk from coming in until after the baby is born

Anticipatory Guidance About Changes. Anticipatory guidance is a term that means education about expected changes before their occurrence. By providing anticipatory guidance regarding the unusual and unaccustomed changes the woman is experiencing, you will add to her knowledge of her body, helping her to enjoy, or at least to cope with, these events. Examples of anticipatory guidance about pregnancy changes include:

???? A woman should not have bleeding during pregnancy, and she should tell her provider promptly if she does bleed. Note that some women have a spot or two of bleeding when implantation occurs, just about the time they expect a period. However, you should inform the physician, nurse midwife, or nurse practitioner about any bleeding that a pregnant woman reports.

???? A pregnant woman may wake up feeling very hungry. You might advise her that it could help to eat a starchy food, such as a baked potato, just before bedtime. If she eats sweets, she will probably have a rapid rise in blood sugar, followed by a sharp drop. Either of these changes can cause uncomfortable symptoms. Advise her to try to avoid consuming concentrated sweets to prevent this from occurring.

???? As her blood volume rises, the pregnant woman?s heart has to work harder (pump more strongly) to deal with the increased workload. She may feel palpitations or a rapid and pounding heartbeat. This is normal, unless she also feels dizzy or light-headed.

???? The extra blood vessels that form in the gastrointestinal system, along with the slowing of peristalsis, may combine to cause constipation and hemorrhoids. The pregnant woman should consume plenty of fiber and water to prevent this.

???? As the ligaments relax and the pregnant woman?s center of gravity changes, her balance may be ?off.? She should avoid wearing high heels, especially during late pregnancy.

???? Breast enlargement is normal. The pregnant woman may need to buy a larger-sized bra. Some women need a bra that is larger in both chest and cup sizes.

As you study the remainder of this topic, you will find other information that can form a basis for anticipatory guidance.

Signs of Possible Problems During Pregnancy

Each stage, or trimester, of pregnancy carries its own risks. Any time a woman complains of one or more of the following symptoms, she should be advised to visit her healthcare provider or an emergency department promptly.

Danger Signs During the First Trimester

The primary danger of the first trimester is spontaneous abortion (miscarriage) (Box 65-2). Signs of threatened abortion include:

???? Vaginal bleeding or spotting: Bleeding does not mean that the woman will miscarry, but it does indicate that she might do so. Bleeding due to a threatened abortion reflects a partial separation of the placenta from the decidua. Blood may appear either bright red, darker red, or brown. The amount of blood loss does not predict the outcome,unless it becomes very heavy (enough to saturate more than one pad per hour).

BOX 65-2.

Pregnancy Danger Signs

First Trimester

???? Excessive vomiting

At Any Time During Pregnancy

???? Vaginal bleeding

???? Excessive or irritating vaginal discharge

???? Dizziness or fainting

???? Decrease in urine output

???? Burning with urination

???? Persistent vomiting

???? Chills or fever

???? Chest pain

Late in Pregnancy

???? Leaking or gushing of amniotic fluid

???? Swelling in the woman?s extremities or face

???? Dyspnea

???? Blurred vision or spots before the eyes

???? Severe headaches

???? Abdominal, epigastric, or severe back pain

???? Decreased fetal movement

???? Lower abdominal pressure

???? Pelvic/abdominal cramping: Cramping that increases over time, especially if accompanied by vaginal bleeding, indicates threatened abortion.

???? No longer feeling pregnant: If the embryo or fetus has died, and the placenta has ceased to function, the hormonal environment changes rapidly. The most common statement about this change is, ?I just don?t feel pregnant anymore.? Specific symptoms of pregnancy that quickly subside with missed abortions are nausea, breast tenderness, and headaches.

Danger Signs During the Second and Third Trimesters

The complications for which early signs may develop during later pregnancy include incompetent cervix, placenta previa, placental abruption, preterm labor (PTL) and/or preterm premature rupture of the membranes (PPROM or PROM), decreased fetal movement, and pregnancy-induced hypertension (PIH).Danger signs during the second and third trimesters include:

???? Vaginal bleeding, with or without cramping, pressure, or pain: Painless vaginal bleeding may be a sign of placenta previa, a condition in which the placenta lies partly over the cervical opening. The first episode of bleeding often occurs at about 26 to 28 weeks. It may follow sexual activity or occur spontaneously. The bleeding is generally bright red, and the flow is fairly heavy?at least as heavy as a normal menses.

???? Bleeding with severe abdominal pain: This symptom is a sign of placental abruption, or premature separation of the placenta. The fetus can die if not delivered quickly, usually by Cesarean section.

???? Vaginal or lower abdominal pressure: This may occur when the cervix is incompetent, or not strong enough to hold the fetus inside the uterus. This symptom is especially worrisome if the woman also has increased vaginal discharge.

???? PTL: Early signs include backache, pelvic/abdominal cramping, rhythmic pelvic pressure, diarrhea, change in vaginal discharge, vaginal spotting, leaking fluid, and malaise.

???? PPROM/PROM: This condition may cause either a gush of fluid or a continuous steady trickle of fluid. The gush is usually easily recognized, but the woman may not realize that a slow, steady leak is a problem.

???? Decreased fetal movement: Regular fetal movement is a sign of fetal well-being. Each fetus has its own pattern of activity; a marked drop-off in a fetus? activity is a cause for concern about the health of the fetus.

The following symptoms may be signs of PIH:

???? Severe headache, which does not respond to over-the-counter remedies

???? Visual changes: double vision, suddenly blurred vision, seeing spots or flashing lights

???? Sudden edema or swelling, especially of the face, eyes, and hands

???? Epigastric pain, or pain in the upper abdomen

The prenatal period refers to the period between conception and the onset of labor. The goals of good prenatal care are to:

???? Promote physical and mental wellness of the mother during the pregnancy and afterward

???? Help the woman give birth safely and without complications

???? Ensure a healthy baby

Many women seek prenatal care as soon as they suspect pregnancy. In recent years, the healthcare industry has emphasized health promotion measures, such as pre-conceptional examination, to encourage positive maternal and child health for the future. Ideally, the woman?s health at the end of pregnancy will be as good as or better than it was at the beginning. Regular prenatal care is associated with lower infant mortality and better outcomes on measures of child health, such as weight.

Special Considerations :CULTURE & ETHNICITY

Prenatal Care

Although Japanese-American women are expected to go for prenatal care from early in pregnancy, Roma women often avoid prenatal care to avoid having an internal pelvic examination. A different attitude is traditional among Mexican-Americans, who may believe that pregnancy is not an illness, so prenatal care is unnecessary; others within that culture seek prenatal care for reassurance of fetal well-being. Some Mexican-American women view prenatal care as informal home care received from family members.

Pregnancy involves all members of the family. Having a baby has a powerful influence on the family system. Each member of the family reacts to pregnancy from his or her own point of view and as related to individual needs, beliefs, and experiences.

Special Considerations : CULTURE & ETHNICITY

Beliefs About Pregnancy

Traditionally, Ethiopians and Eritreans view pregnancy as a dangerous state; the fetus is easy prey for the evil eye and sorcery, which are believed to cause miscarriage, premature delivery, and fetal malformation. For Samoans, pregnancy is considered an illness. Pregnant women cannot eat alone or be left unattended, especially at night. In many Puerto Rican families, pregnancy is a time of indulgence for women, whereas in Southeast Asian cultures, pregnancy is considered a healthy state.

Pregnancy occurs not only within a family, but also within the environment of a culture. Religious, ethnic, and cultural beliefs influence expectant women. Cultural aspects of prenatal care are extremely important and may affect healthcare practices, pregnancy, childbirth, and family adjustment. Knowledge and understanding of?as well as sensitivity to?cultural differences are invaluable in providing nursing care that addresses the needs of each woman and family in ways that they can understand and accept.

Source: http://what-when-how.com/nursing/normal-pregnancy-maternal-and-newborn-nursing-part-3/

branson mo monkees songs danica patrick school closings top chef texas rail gun harrisburg