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Full download Maternal and Child Nursing Care 4th Edition London Solutions Manual all chapter 2024 pdf
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CHAPTER 9
PHYSICAL AND PSYCHOLOGIC CHANGES OF PREGNANCY
IMAGE LIBRARY
FIGURE 9–1 Supine hypotensive syndrome (vena caval syndrome). The gravid uterus compresses the vena
cava when the woman is supine. This reduces the blood flow returning to the heart and may cause maternal
hypotension.
FIGURE 9–2 Linea nigra.
FIGURE 9–3 Postural changes during pregnancy. Note the increasing lordosis of the lumbosacral spine and the
increasing curvature of the thoracic area.
FIGURE 9–4 Hegar’s sign. The presence of Hegar’s sign, which is a softening of the isthmus of the uterus, can
be determined by the examiner during a vaginal examination.
FIGURE 9–5 Approximate height of the fundus at various weeks of pregnancy.
LEARNING OUTCOME 1
Identify the anatomic and physiologic changes that occur during pregnancy.
Concepts for Lecture
1. Enlargement of the uterus occurs as a result of estrogen-induced hypertrophy of myometrial cells and the
distension caused by the growing fetus. The fibrous tissue between the muscle bands increases markedly,
which adds to the strength and elasticity of the muscle wall. The enlarging uterus, developing placenta, and
growing fetus require additional blood flow to the uterus. By the end of pregnancy, one sixth of the total
maternal blood volume is contained within the vascular system of the uterus.
2. Cell number is increased in the glandular tissue of the cervix. A mucous plug forms due to the secretion of
thick mucus by the endocervical glands to prevent the ascent of microorganisms into the uterus. Increased
cervical vascularity also causes both the softening of the cervix (Goodell’s sign) and its bluish discoloration
(Chadwick’s sign).
3. Under the influence of estrogen, the vaginal mucosa thickens, the connective tissue loosens, and there is an
increase in vaginal secretions.
3.1. The breasts enlarge, with superficial veins becoming prominent, the nipples becoming more erect, the
development of striae, and the areolae becoming darker. Colostrum may be expressed by the last
trimester.
4. To meet the demands of the mother and the fetus, oxygen consumption increases as well as carbon dioxide
production and respiratory functional reserve. The subcostal angle increases, so that the rib cage flares. The
anteroposterior diameter increases, and chest circumference expands, so there is no significant loss of
intrathoracic volume. Breathing changes from abdominal to thoracic as pregnancy progresses, and descent
of the diaphragm on inspiration becomes less possible. Some hyperventilation and difficulty in breathing
may occur. Nasal stuffiness and epistaxis (nosebleeds) may also occur because of estrogen-induced edema
and vascular congestion of the nasal mucosa.
• Have students attend prenatal appointments with several women. In postconference, identify different
system alterations in the three trimesters.
LEARNING OUTCOME 2
Assess the subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy in
patients.
Concepts for Lecture
1. The following are subjective (presumptive) signs of pregnancy: amenorrhea, nausea and vomiting, excessive
fatigue, urinary frequency, breast changes, and quickening.
2. The following are objective (probable) signs of pregnancy: changes in the pelvic organs: Goodell’s sign,
Chadwick’s sign, Hegar’s sign, uterine enlargement, enlargement of the abdomen; Braxton Hicks
contractions; uterine souffle; changes in the pigmentation of the skin; positive pregnancy tests; and
palpation of fetal outline (Ballottement).
3. The following are diagnostic (positive) signs of pregnancy: auscultation of fetal heartbeat, fetal movement,
and visualization of the fetus.
• Ask for a volunteer who has been pregnant from your group of students to share her experience with the
rest of the class. Allow her to highlight the subjective and presumptive signs and symptoms that she
experienced. Allow students to use Tables 9–1 and 9–2 to develop a list of differential diagnoses relative
to the information that the selected student provides.
SUGGESTIONS FOR CLINICAL ACTIVITIES
• Schedule students to rotate to an antepartum unit or prenatal clinic. Select a patient and demonstrate the
positive signs of pregnancy. Allow students to listen to the fetal heart rate, palpate fetal movements, and
visualize the fetus via ultrasound.
Copyright 2014 by Pearson Education Inc.
• Assign students to complete “Critical Thinking in Action” on the Student Resource Site website.
Discuss answers in clinical conference.
LEARNING OUTCOME 3
Contrast the various types of pregnancy tests.
Concepts for Lecture
1. A variety of assay techniques are available to detect hCG in either blood or urine during early pregnancy.
Most healthcare providers use urine screening tests because the results are immediate, the cost is minimal,
the tests are reasonably accurate, and no invasive procedure (blood draw) is required.
2. Most pregnancy tests are based on an approach called enzyme-linked immunosorbent assay (ELISA).
ELISA uses a substance that results in a color change after binding. The assay, which can be done on blood
or urine, is sensitive, quick, and can detect hCG levels as early as 7 to 9 days after ovulation and conception,
which is 5 days before the first missed period.
3. Another approach to testing is called a fluoroimmunoassay (FIA). The FIA uses an antibody tagged with a
fluorescent label to detect serum hCG. The test, which takes about 2 to 3 hours to perform, is extremely
sensitive and is used primarily to identify and follow hCG concentrations.
4. Home pregnancy tests (HPTs) are available over the counter at a reasonable cost. These ELISA tests,
performed on urine, detect even low levels of hCG. A HPT with a sensitivity of 1.2 to 5 International Unit/L
hCG will detect 98% of pregnancies close to the time of missed menses. HPT instructions are quite explicit
and should be followed carefully for optimal results. The false-positive rate of these tests is low, but the
false-negative results are higher, so follow-up is indicated if symptoms of pregnancy occur. If the results are
negative, the woman should repeat the test in 1 week if she has not started her period.
LEARNING OUTCOME 5
Discuss cultural factors that may influence a family’s response to pregnancy in the provision of nursing care.
Concepts for Lecture
1. A universal tendency exists to create ceremonial rituals or rites around important life events. Thus
pregnancy, childbirth, marriage, and death are often tied to ritual. The rituals and customs of a group
reflect the group’s values. In many developed countries (e.g., United States, Canada, England, and
Germany), populations are becoming increasingly ethnically diverse as the number of immigrants
continues to grow. It is not realistic or appropriate to assume that people who are new to a country or
area will automatically abandon their ways and adopt the practices of the dominant culture.
Consequently, the identification of cultural values is useful in planning and providing culturally
sensitive care.
• Learning Outcomes
• Key Terms
• Critical Concept Review
• NCLEX-RN® Review
• Care Plan
• Case Study
• Critical Thinking in Action
• Thinking Critically
• Media Links
• Media Link Applications
• Animations and Videos
MYNURSINGLAB (www.mynursinglab.com)
• Separate purchase
PEARSON ETEXT
• Students can search, highlight, take notes, and more all in electronic format.
• Separate purchase
TEST BANK