CARE OF MOTHER, CHILD, AND FAMILY

FIRST SEMESTER - MIDTERMS

CARE OF MOTHER, CHILD, AND FAMILY
65%. The most common of these are: variations in appetite,
ANTEPARTUM nausea, insomnia and weight gain.

Concepts
 Conception and Implantation FAMILY’S EMOTIONAL AND PSYCHOLOGIC CHANGES
 Fetal Growth and Development
Siblings
 Embryonic Structures
 May view the baby as a threat to the
Normal Changes in Pregnancy
security of their relationships with parents
 Emotional Changes and Psychological
 Reaction depends on the age of siblings
Tasks of Pregnancy
 Signs and Symptoms of Pregnancy  Preparation for birth is essential
Grandparents
 Local and Systemic Changes in
 Usually supportive
Pregnancy
 Assessment  Excited about the birth
 Nursing Care and Management  May be unsure about how deeply to
become involved
NORMAL CHANGES DURING PREGNANCY  Impending difficulty for the family

A. Emotional Changes and Psychological Tasks of SIGNS AND SYMPTOMS

Pregnancy
Presumptive Signs
 First Trimester:
 Disbelief  Nausea and vomiting
 Ambivalence  Amenorrhea
 Grief  Skin discoloration (melasma/chloasma)
 Narcissism  Abdominal changes (uterine enlargement,
linea nigra, striae gravidarum)
 Introversion
 Laging pagod (fatigue)
 Changes in sexual desire
 Overactive bladder (frequent urination)
 Second Trimester:
 Quickening
 Quickening; view fetus as separate
 Breast changes
 Body image disturbance
 Emotional lability Probable Signs
 Third Trimester:  Chadwick’s sign
 Anxiety  Goodell’s sign
 Nesting occurs  Uterine softening - Hegar’s sign
 Changes in expectant family  Rising of the fetus when tapped
(Ballottement)
B. Psychological Tasks by Reva Rubin  Outline of fetus felt by examiner
 First Trimester: Seeking acceptance of this child by  Positive pregnancy test
others
 Braxton Hicks contractions
 Second Trimester: Seeking commitment and
 Ultrasound shows evidence of gestational
acceptance of herself as a mother to the infant
sac
 Third Trimester: Learning to give of oneself on Positive Signs
behalf of one’s child
 Ultrasound shows evidence of fetal outline
PARTNER’S EMOTIONAL AND PSYCHOLOGIC CHANGES  Beating of fetal heart audible
 Movement of fetus felt by examiner
First Trimester:
 May feel left out LOCAL & SYSTEMATIC CHANES IN PREGNANCY
 Disbelief
Hormonal Changes During Pregnancy
 May be confused by partner’s mood
changes
Gastrointestinal System
 Might resent the attention she receives  Epulis (gingival granuloma gravidarum)
Second Trimester: Begins to decide which  Nausea and vomiting (“morning sickness”)
behaviors of own father he wants to imitate or  Heartburn (pyrosis)
discard  Gastric reflux
 Hemorrhoids
Third Trimester: Anxiety about labor and birth  Hyperptyalism
WHAT IS COUVADE SYNDROME? Reproductive System
The couvade syndrome can be considered to be the UTERUS:
psychosomatic equivalent of primitive rituals of initiation into
paternity. Various symptoms have been described in the
 Amenorrhea
husbands of pregnant women with an incidence from 11% to  Braxton Hicks contractions
CARE OF MOTHER, CHILD, AND FAMILY
FIRST SEMESTER - MIDTERMS
 Hegar’s  HCG
 Goodell’s  HPL/HCG
 Operculum  Relaxin
 Uteroplacental bloodflow  Prostaglandin
 Uterine anteflexion  Pituitary gland
 Thyroid and parathyroid gland
Vaginal Changes  Adrenal glands
 Chadwick’s sign  Pancreas
 Leukorrhea
 From alkaline (7) to acidic pH (3-4) Immune System
 Immunologic competency
Breast Changes  IgG production is ↓
 Increase in size  ↑ in WBC
 Estrogen—mammary ductal tissue
 Progesterone—lobes, lobules, and alveoli Neurologic System
 Nipples increase in size and become more  Sensory changes in the lower extremities
erect; areola widens and darkens  Pain
 Carpal tunnel syndrome
Skeletal System
 Tension headache
 Lordosis
 Lightheadedness, faintness, or syncope
Integumentary System  Muscle cramps or tetany
 Stretching
Vital Signs
 Striae gravidarum
 Blood pressure
 Diastasis recti abdominis
 Pulse
 Stretching of the umbilicus
 Respiratory effort
 Hyperpigmentation
 Temperature—slight increase
 Linea negra
 Chloasma/melisma Weight Gain
 Increased vascularity  Recommended
 Palmar erythema—redness and/or
itchiness
 Vascular spider
 Hirsutism

Cardiovascular System
Total blood volume ↑ during pregnancy:
45%
 Pseudoanemia (physiologic anemia)
 About 800 mg additional iron needed
 Heart – To handle the ↑ in blood volume
 CO increases by about 25-50%
 Palpitation is common (due to
SNS stimulation and ↑ thoracic
pressure)
 ↓ blood flow to the lower extremities during
the 3rd trimester
 Supine hypotensive syndrome
 Blood constitution
 ↑ in fibrinogen, and clotting
factors
 Slight increase in total WBC
 ↓ in blood protein level
 ↓ protein and hypervolemia

Urinary System
 Fluid retention
 Renal function

Endocrine System
 Placenta – produces hormones
 Estrogen
 Progesterone