NCM 101 Lecture Notes PRELIMS Handout 5_____________________

PSYCHOLOGICAL TASKS O PREGNANCY FIRST TRIMESTER: Accepting the pregnancy Ambivalent about the pregnancy Most women are able to change their attitude towards the pregnancy by the time they feel the baby move inside them The partner also moves towards accepting the woman in her changed state The partner should give the woman emotional support while she is learning to accept the reality of the pregnancy SE !"# TRIMESTER: Accepting the $aby a woman e%periences for herself this proof of child&s e%istence ' ()I *E"I"+ , the woman during this stage is able to give the child an identity She begins to how she will feel during giving birth She also begins to imagine herself as a mother .artners may feel that they are neglected/ and tend to focus on other things li0e wor0/ it is important to note that it is this time that the woman needs emotional support the mostT1IR# TRIMESTER: .reparing for parenthood ouples usually begin nest building activities such as planning the infant&s sleeping arrangements/ buying clothes/ choosing the name for the infant/ and ensuring 2safe passage3 by learning about birth Some attend birthing or pre natal classes Encourage the mother to spend time with other mothers

EMOTIONAL RESPONSES TO PREGNANCY! 4- Ambivalence: interwoven feelings of wanting and not wanting that always e%ist at high levels It is important that the woman is informed that these feelings are normal 5- +rief: before the woman can ta0e on a mothering role/ she has to 2give up3 her present role Sometimes/ this ad6ustment is one of the most difficult that the woman has to go through/ especially for wor0ing 2mothers to be3 7- "arcissism: self8centeredness is generally an early reaction to pregnancy The woman becomes conscious of what to eat/ what to wear/ she may loose interest in her 6ob/ and have difficulty ad6usting to the changes in her career and her usual activities9- Introversion vs- E%troversion: turning inward to concentrate on ones self and ones body is a common finding during pregnancy
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GreywolfRed
Ms. April Anne D. Balanon

NCM 101 Lecture Notes PRELIMS Handout 5_____________________

:- $ody Image and $oundary: she becomes self conscious ' not only because of the physical and physiologic changes she e%periences, but predominantly of the baby growing inside her;- Stress: pregnancy can be a potential source of stress to most women rucial here is the emotional support and encouragement that the woman receives from the people around her<ouvade Syndrome: men sometimes e%periencing symptoms of pregnancy li0e nausea and vomiting

=- Emotional >ability: mood changes and mood swings are common in pregnant womenRO"TINE PRE NATAL CARE! #uring the 7 trimesters/ the woman should fre?uent visiting health centers and going for their pre natal chec0ups 1istory ta0ing will include >M./ +. and previous complications during the past pregnancies if any Iron supplementation shall be given form the : th month of pregnancy up to 5 months following delivery

HELATH PROMOTION #"RING PREGNANCY! 4- Self8care "eeds a, $athing: increased sweating/ increase in vaginal discharge b, $reast care: wearing a firm and supportive brassiere/ washing the breasts with tap water c, #ental are: good tooth care habits should continue throughout the pregnancy/ an increase in calcium is also necessary d, #ressing: avoiding wearing garters and 0nee high stoc0ings/ encouraging the pregnant woman to wear moderate low heels to minimi@e pelvic tilt and possible bac0achee, Se%ual Activity: women who have vaginal spotting should be advised against coitus until further assessed f, E%ercise: this prevents circulatory stasis in the lower e%tremities g, Sleep: a good resting or sleeping position for the woman is the modified Sim&s position/ with the top leg forwardh, Aor0 i, Travel: no restrictions in a normal pregnancy but ris0 pregnancies are often advised to avoid travel until after delivery/ or until further assessed5- "utrition and #iet: a, Ener$% and Car&o'%drates: during the first trimester/ because of loss of appetite/ increasing caloric inta0e is difficult- #uring the 5 nd and 7rd trimester however/ an average of 97B *cal must be added to the normal inta0e to compensate for the increase in the basal metabolic rate/ for better 1!" utili@ation for the growth of the fetus/ placenta and tissues and for the increase in muscular activity of the mother- The use of sugar substitutes is not recommended during pregnancy because the woman needs the sugar to maintain balanced carbohydrate levels5

GreywolfRed
Ms. April Anne D. Balanon

NCM 101 Lecture Notes PRELIMS Handout 5_____________________

b, Prote(n: women who become pregnant after long term contraceptive use have e%hibited altered 1!" synthesisc, AT: the use of vegetable oils that have low cholesterol content rather than animal oils is recommended as a means to preventing hypercholesterolemia and atherosclerosis-

d, )(ta*(ns! most of the vitamin re?uirements can be met by eating a healthy varied diet with plenty of fruits and vegetables- Folic acid found predominantly in fruits and vegetables is necessary for red blood cell formation- Aithout ade?uate folic acid/ megaloblastic anemia may develop- >ow levels of folic acid have also been associated with neural tube defects/ premature separation of the placenta/ and spontaneous abortionCitamin #/ which is essential for calcium absorption should be ade?uate during the duration of the pregnancye, M(nera+s! alcium and phosphorous/ Iodine/ Iron/ Sodium/ and Dinc should be sufficient during the duration of the pregnancyRE !MME"#E# AEI+1T +AI" #)RI"+ .RE+"A" E: A weight gain of 5: to 9B lbs is recommended as a n average weight gain in pregnancy Aeight gain during pregnancy is appro%imated at 4 lb per month during the 4st trimester and 4 lb per wee0 during the 5nd and 7rd trimester Aeight gain is considered e%cessive if it is more than 7 0g in a month during the 5 nd and 7rd trimester/ and it is less than normal if it is under 4 0g per month during the 5nd and 7rd trimesterF!!#S T! AC!I# #)RI"+ .RE+"A" E: 4- affeine 5- Artificial sweeteners MA"A+EME"T !F T1E "!RMA> #IS !MF!RTS !F .RE+"A" E: 4- "ausea and Comiting <- 1emorrhoids 5- 1eartburn 7- Flatulence 9- Edema :- Caricose Ceins ;- S!$ REA#ING ASSIGNMENT! 8.erennial and abdominal e%ercises 8 Tailor Sitting 8S?uatting 8.elvic Roc0ing 8>ama@e and $radley methods 8*egel&s e%ercises #IA+"!SIS !F .RE+"A" E: NORMAL SIGNS AN# SYMPTOMS O PREGNANCY:
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=- >eg ramps F- onstipation 4B- $ac0ache 44- Caginal #ischarge and Itching

GreywolfRed
Ms. April Anne D. Balanon

NCM 101 Lecture Notes PRELIMS Handout 5_____________________

4- .RES)M.TICE SI+"S: Amenorrhea "ausea and vomiting $reast changes Integumentary changes Easy fatigability Fre?uency of urination (uic0ening 5- .R!$A$>E SI+"S: Abdominal enlargement Fetal outline by palpation )terine changes ' 1egar&s sign, ervical changes ' +oodell&s sign, $ra%ton 1ic0s contractions .ositive pregnancy test Caginal hanges ' hadwic0&s sign, Sonographic evidence of gestational sac $allotement 7- .!SITICE SI+"S: Sonographic evidence of fetal outline Audible fetal heart beat Fetal movement felt by e%aminers G8ray outline of fetal circulation ASSESSMENT O PHYSIOLOGICAL CHANGES O PREGNANCY! 1. GENERAL SURVEY: $aseline weight and vital signs should be recorded Aeight gain during pregnancy ' 5:87B lbs, Sudden increase in blood pressure and a sudden weight gain may be indicative of 1." during pregnancy Increase in pulse and respirations may be indicative of bleeding +eneral appearance in dressing/ and body posture may indicate signs of fatigue and depression 2. N!EGUMEN!ARY "#ANGES: Striae gravidarum >inea nigra Melisma Cascular spiders Increased activity of sweat glands $. #EAD AND S"AL%: 1air growth speeds up during pregnancy #ryness of the hair and scalp may indicate deficiency in nutrition &. EARS AND N'SE: "asal stuffiness that accompanies pregnancy is a result of an increase in the levels of estrogen(. M'U!#) !EE!#) AND !#R'A!:
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GreywolfRed
Ms. April Anne D. Balanon

NCM 101 Lecture Notes PRELIMS Handout 5_____________________

*. NE"+: rac0ing of the corners of the mouth secondary to vitamin deficiency is a common finding among pregnant mothers1yperemia/ or redness and hypertrophy of the gums due to estrogen stimulation is also a common findingTeeth deminerali@ation occurs during pregnancy due to an increase in the need of the infant for calcium/ thus predisposing the mother to develop wea0 teeth and tooth abscessSlight thyroid hypertrophy may be observed due to the overall increase in the metabolic rate of the pregnant mother/ and an increased demand for iodine from both the baby and the motherThe mother has to be advised to increase her inta0e of iodine rich foods

,. BREAS!S: $ecome larger/ firmer/ and more tender especially as the pregnancy progresses The areola becomes dar0er and increases in diameter Montgomery&s tubercles become prominent and nipples become elevated olostrum may be e%pressed from the nipple as early as the 4;th wee0 of pregnancy Teaching includes doing self breast e%amination Reporting unusual feelings immediately is also encouraged )sing a well fitting support brassier is also discussed with the mother-. #EAR! AND " R"ULA!'RY: 1eart rate ranges from <B8=B beats per minute .hysiologic palpitations or s0ip beats may occur especially when lying in a supine position- The reason for this is because of the pressure e%erted by the enlarging uterus over the heart/ thus displacing it a little upward to the left Caricosities in the legs/ vulva/ rectum/ and the occurrence of hypotension may occur due to rela%ation of the smooth muscles in the blood vessel walls- This leads to pooling of blood in the lower portions of the body Avoiding constricting clothing/ resting with foot and legs elevated/ and discouraging crossing the legs are a few of the health teachings during the last 5 trimesters of pregnancy.. RES% RA!'RY SYS!EM: S!$ and a little degree of hyperventilation due to the pressure of the enlarging uterus over the diaphragm/ thus lessening the e%pansion capacity of the lungs !%ygen demand and consumption increases by 9BH in the effort to supply both the mother and the baby with ade?uate levels1/. ABD'M NAL 0ALL AND G !: )mbilicus is pushed forward by the <th month so much that no visible depression is observed arbohydrate metabolism/ which is regulated by 1.> leads to a decrease in the levels of blood sugar levels/ however ade?uate amounts of these are readily available for the fetus #isplacement of the stomach and intestines due to the pressure e%erted by the growing uterus leads to delayed gastric emptying and decreased intestinal motility $oth of the abovementioned lead to regurgitation of food/ and nausea and vomiting during the later parts of pregnancy " and C and hyperptyalism during the first trimester however is due to the increase in the levels of 1 + and the decrease in 1! metabolism #elayed gastric emptying also can lead to constipation Aeight gain from the increased fat/ and the products of conception should be appro%imately 5:87B lbs 1emorrhoids are also to be watched out for/ due to pelvic pressure/ which in turn prevents venous return to the heart:

GreywolfRed
Ms. April Anne D. Balanon

NCM 101 Lecture Notes PRELIMS Handout 5_____________________

11. RE%R'DU"! VE SYS!EM: The increase in vaginal discharge happens especially during pregnancy- This can cause vaginal itching and put the mother at ris0 for the development of )TI&s 1A#AI *&S sign is also an observable change in a pregnant mother/ or the bluish discoloration of the vagina due to venous congestionThe cervi% becomes more vascular and edematous due to the action of estrogen !.ER )>)M or the mucus plug that protects the fetus from rising infection is also present +!!#E>>&s sign or softening of the cervi% also is an observable change The uterus increases in si@e from 5 ounces to 5 lbs/ it also softens and becomes elastic thus allowing for the enlargement of the uterus in order to accommodate the growing baby1E+AR&S sign or softening of the lower segment of the uterus happens as a result of an increase in the levels of estrogenThe increase in the fundic height throughout the pregnancy is also one assessment that has to be followed up on$RAGT!" 1I *&s the uterus !"TRA TI!": or the painless intermittent contraction and rela%ation of

$A>>!TEME"T: rebounding of the fetal part when tapped )TERI"E S!)FF>E: a blowing sound heard over the pregnant uterus that is synchronous with the mother&s heart beat and is due to the rush of blood through the large uterine vesselsThe pregnant mother also stops ovulating .ressure of the growing uterus during the first and the last month of the third trimester leads to bladder irritation/ decreased bladder capacity/ and fre?uency of urination

12. MUS"UL'S+ELE!AL SYS!EM AND E1!REM ! ES: .almar erythema and itching in early pregnancy due to high estrogen levels An0le edema/ and varicosities in the lower legs may occur due to pooling of blood as a result of delayed venous return caused by pressure of the uterus over the blood vessels of the lower portion of the body Restrict the inta0e of sodium >eg cramps may occur as a result of changes in the electrolyte levels particularly potassium/ sodium/ and calcium during pregnancy Aidening of the pelvis also occurs causing a waddling gait/ and allowing more passage for the baby $one marrows produce more blood in order to ade?uately supply the growing need of the mother and the baby 1$. END'"R NE SYS!EM: Thyroid functioning increases and enlarges slightly The adrenal corte% hypertrophies and increases its secretion of aldosterone which leads to sodium retention The pancreas also increases insulin secretion-

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Ms. April Anne D. Balanon