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Nursing Process Overview
For Healthy Adaptation to Pregnancy
Ideally, begins before the pregnancy. During a
preconception assessment
 Woman's health status
 Nutritional intake

 Lifestyle

 Identify any potential problems

 Identify the woman's understanding and

expectations of conception, pregnancy, and
Establish a trusting relationship
Assess the woman's health and nutritional
status, as well as the well-being of the fetus,
throughout pregnancy.
 Document the woman's physiologic
adaptations and the family's psychological
adaptations to pregnancy
Physical findings are gained through the health
history, physical assessment, and laboratory
Assessment in psychological areas
 interviewing
Nursing Diagnosis
Examples of nursing diagnoses
 Anxiety related to unexpected pregnancy
 Altered breathing pattern related to respiratory
system changes of pregnancy
 Disturbed body image related to weight gain with
 Deficient knowledge related to normal changes of
 Imbalanced nutrition, less than body requirements,
related to morning sickness
 Outcome Identification and Planning
Plan to review concerns of the woman as well
as a plan to ask about the individual responses
she is experiencing.
Help women at prenatal visits to voice their
concerns about either physiologic or
psychological changes of pregnancy,
May need suggestions on exercise and nutrition
to prepare for pregnancy and to follow during
Nursing interventions can be instrumental in
not only guiding a woman safely through a
pregnancy but also connecting her back with
ongoing health care.
Outcome Evaluation
Client states she is able to continue her usual
lifestyle throughout pregnancy.
Family members describe ways they have
adjusted their lifestyles to accommodate the
mother's fatigue.
Couple states they accept the physiologic
changes of pregnancy as normal.
Psychological Changes of
Woman's attitude toward a pregnancy
depends a great deal on psychological aspects
the environment
the messages about pregnancy her family
communicated to her as a child
the society and culture in which she lives as an
whether the pregnancy has come at a good
time in her life.
Social Influences
cultural background
their personal experiences
the experiences of friends and relatives
current public philosophy of childbirth.
People's opinions about adolescent
pregnancies, “late in life” pregnancies, or
lesbian pregnancies have changed markedly.
Cultural Influences
may strongly influence how active a role she
wants to take in her pregnancy
certain beliefs and taboos may place
restrictions on her behavior and activities
To learn about the beliefs of a particular woman
and her partner, ask at prenatal visits if there is
anything they believe should or should not be
done to make the pregnancy successful and
keep the baby healthy.
Supporting these beliefs shows respect for the
individuality of the woman and her knowledge
Family Influences
Loving family: more likely to have a
positive attitude toward her pregnancy
“People love as they have been loved”
Woman who views mothering as a
positive activity is more likely to be
pleased when she becomes pregnant
than one who devalues mothering
Individual Influences
Woman's ability to cope with or adapt to stress
Security in her relationship with the people
around her, especially the father of her child, is
usually also important to her acceptance of a
A woman who thinks of brides as young but
mothers as old may believe pregnancy will rob
her of her youth.
The Psychological Tasks
of Pregnancy
First Trimester: Accepting the Pregnancy
Accept the reality of the pregnancy.
A diagnosis of pregnancy is a similar rite of
In reality, as many as 50% of pregnancies are
still unintended, unwanted, or mistimed
Often women immediately experience
something less than pleasure and closer to
disappointment or anxiety at the news that
they are pregnant.
The Partner
Partner may go through some of the same
psychological changes.
Accepting the woman in her changed state.
A partner should try to give the woman
emotional support while she is learning to
accept the reality of pregnancy
Often partners are proud and happy about the
pregnancy, facilitating acceptance of it.
An unwed father may have a great deal of
difficulty accepting a pregnancy unless he is
actively involved in prenatal care.
Second Trimester:
Accepting the Baby
The Woman
Accept that she is having a baby, a separate
step from accepting the pregnancy.
Second turning point in pregnancy :
quickening, or the first moment a woman feels
fetal movement.
She begins to imagine herself as a mother
Realize that not only is she pregnant but also
there is a child inside her.
Second Trimester:
Accepting the Baby
The Partner
Feeling of being left out
Some men may have difficulty enjoying the
pregnancy if they have been misinformed about
sexuality, pregnancy, and women's health.
Many men comment that the information they
receive about childbirth and pregnancy is too
concerned with their partner or the child and
not enough with how they feel to be relevant to
Third Trimester:
Preparing for Parenthood
“nest-building” activities”
It is helpful for couples to attend
childbirth education classes or
classes on preparing for parenthood.
Emotional Responses to
may want to be pregnant, and yet she may not
be enjoying it. This leads to some degree of
refers to the interwoven feelings of wanting and
not wanting that can exist at high levels.
It is important to emphasize that this
ambivalence is normal.
Partners also experience ambivalence,
sometimes more so than pregnant women.
To help partners resolve some ambivalence,
provide an outlet for them to discuss concerns,
Before a woman can take on a
mothering role, she has to give up or
alter her present roles.
She must incorporate her new role as a
mother into her other roles as a
daughter, wife, or friend.
Her partner must incorporate a new role
as a father into his other roles of son,
husband, or friend.
Self-centeredness (narcissism) is generally an
early reaction to pregnancy.
Dressing becomes a time-consuming, mirror-
studying procedure.
She makes a ceremony out of fixing her meals.
May lose interest in her job or community
Men may demonstrate the same behavior by
reducing risky activities
Need to protect her body has implications for
nursing care.
Introversion Versus Extroversion
Introversion, or turning inward to
concentrate on oneself and one's body,
is a common finding during pregnancy.
They become more active, appear
healthier than ever before, and are more
Time of extreme stress for a woma
May cause people who were dependent on
the woman before pregnancy to feel
To help families keep their perspective,
remind them that a decrease in the
responsibilities that a pregnant woman takes
on is a reaction to the stress of pregnancy, not
the pregnancy itself.
A woman with few support people around her
almost automatically has more difficulty
Couvade Syndrome
Men experience physical symptoms such as
nausea, vomiting, and backache to the same
degree or even more intensely than their
partners do during a pregnancy.
These symptoms apparently result from
stress, anxiety, and empathy for the pregnant
The more the partner is involved in or attuned
to the changes of the pregnancy, the more
symptoms he may experience.
 For the most part, these are healthy
Changes in Sexual Desire
1st Trimester: decrease in libido
nausea, fatigue, and breast tenderness that
accompany early pregnancy.
2nd trimester: libido and sexual enjoyment
rise markedly.
 blood flow to the pelvic area increases to
supply the placenta
3rd trimester: sexual desire may remain high,
or it may decrease
because of difficulty finding a comfortable
position and increasing abdominal size.
Reproductive System

Uterus (UterineMeasurements)

Uterine Pregnancy Term Pregnancy

Wt. 50 gm. 1100 gm.
Thickness 2 cm 0.5 cm
Length 6.5 cm 32 cm
Depth 2.5 cm 20 cm
Width 4 cm 24 cm
Capacity 10 ml 5000 ml
Reproductive System
Blood Flow : Uterine blood flow increases
from 20 ml before pregnancy to 700 to 900
ml at the end of pregnancy. ¾ of the
blood supply goes to the placenta.

Shape : From pear shape before

pregnancy to spherical and later on to
ovoid shape in the last months of

Position : After 12 weeks gestation, the

uterus loses its anteflexed position.
Reproductive System
Location of the Fundus :

12 weeks - at the level of the symphisis

16 weeks – halfway between symphisis and
20 weeks – level of the umbilicus
24 weeks – 2 fingers above the umbilicus
30 weeks – midway between umbilicus and
xiphoid process
36 weeks – level of the xiphoid process
40 weeks – 2 fingers below the umbilicus, drops
at 34 weeks level because of lightening
Reproductive System
Contractility :
uterus is a highly contractile organ.
Beginning on the first trimester,
the uterus undergoes irregular
Late in pregnancy, these
contractions, known as Braxton-
Hicks, becomes more intense and
frequent causing some discomfort
Reproductive System
Color : Change from pink to purplish due to
increase blood supply
Leukorrhea : Estrogen stimulation results in
increase mucus production that leads to the
formation of operculum, the mucus plug of
the cervix that protects against bacteria
and infection.
Consistency: Softening of the cervix, known
as Goodel’s sign, is observable by 6 to 8
weeks gestation.
Reproductive System

During pregnancy, the isthmus
softens and elongates up to 25 mm.
It will later form the lower uterine
segment, together with the cervix.
Hegar’s sign – softening of the
lower uterine segment begins as
early as 5 week gestation
Reproductive System
Increase blood supply results in:
 Chadwick sign – change color from
pinkish to purplish or dark-blue
Increase sensitivity and heightened
sexual responsiveness
Vaginal ph 3.5 to 6, acidic
Reproductive System

No Graafian follicle develop and no

ovulation occurs during pregnancy
Corpus luteum is the chief source
of hormone progesterone during
the first 12 weeks gestation, it also
produces estrogen, relaxin, inhibins
and sometimes oxytocin.
Reproductive System
Increase breast size due to alveolar tissue
growth, fat deposition and increase vascularity.
associated with pregnancy includes
 feeling of fullness and tingling sensation

 darkening of the skin around the areola.

 Montgomery’s gland becomes prominent and

nipples stand out.
 A clear fluid called colustrum, can be
expressed from it as early as the 4th month.
Blood Volume
Total volume increases by 45 to 50%
for which 75% is plasma and 25% is
Increase volume leads to increase in
cardiac output by 25 to 50%
Increase in blood volume reaches its
peak at about 24 weeks, cardiac
workload also reaches its peak during
the 2nd trimester.
Blood Constituents
Increase production of RBC by the bone marrow
Hemodilution occurs causing pseudoanemia
Increase protein requirement of the fetus and
hemodilution contribute to the reduction of
maternal plasma protein level. Reduction of
protein level lowers osmotic pressure within
intravascular spaces which causes fluid shift from
intravascular to interstitial space. This contributes
to the normal ankle and foot edema of pregnancy.
Blood lipid and cholosterol level increases to
provide an available supply of energy for the fetus
Increase level of clotting factor making woman
prone to thrombus formation. Instruct to avoid
The heart is displaced to the left
and upward of the diaphragm
Slight cardiac enlargement
Palpitation during pregnancy.
In the 1st trimester is due to
parasympathetic stimulation
In the latter part of pregnancy, it
is due to enlarged uterus.
Cardiovascular System
Blood Pressure
Blood pressure remains the same as
pre-pregnancy level. It may drop
slightly on the 2nd trimester but
returns to normal levels on the 3rd
Arterial blood pressure is highest in
sitting position, intermediate in
supine and lowest in left lateral
Respiratory system
Increase oxygen requirement
Effects of estrogen and progesterone
Mechanical effect of the enlarge uterus
Hyperventilation – in an effort to blow off
the extra CO2 from the fetus.
Displacement of the diaphragm – because
of the enlarged uterus
 Chest crowding – compensate by
expanding the lung horizontally
 Decrease residual volume – less air is
left in the lung after expiration
Shortness of breath
Respiratory system
Total body comsumption of O2 increase by 15 –
 Nasal congestion occurs due to estrogen
Urinary System
Urinary frequency during pregnancy is due to:
1st trimester – uterus exerts pressure on the
bladder as it rises out of the pelvic cavity
2nd trimester – pressure of the presenting part
on the bladder after lightening
Increase blood flow to the kidney which increases
glomerular filtration rate and consequently,
urinary output.
 presence of lactose in the urine is considered
 Lactose is secreted by the mammary glands but
since it is not yet used during pregnancy, it normally
spills in the urine.
Nocturia – increase urination at night
Nausea and vomiting on the 1st
trimester is attributed to:
increase HCG level
Increase estrogen level
decrease maternal glucose level is being
utilized for fetal brain development
Effects of Progesterone
Decrease GIT motility – constipation
Pyrosis / Heartburn – relaxation of
cardiac sphincter
Slowed bile movement from gall bladder
result in reabsorption of bilirubin in the
maternal blood stream – pruritus
Effects of Estrogen
 Ptyalism – increase salivation
 Epulis – hypertrphy or swelling of the
Melasma – facial discoloration
Linea Negra – dark line from the umbilicus
to the symphisis
Darker areola
Increase melanin production
Striae gravidarum
Palmar erythema
Vascular Spider nevi
Activation of sweat and oil glands

Endocrine System

Thyroid glands – slightly enlarge due to

increase metabolic rate
Pancreas – elevated glucocorticoid level
increase insulin production
Parathyroid gland – increase needs for
Adrenal gland – increased corticosteroid
production and aldosterone promote
sodium reabsorption and water
retention.Posterior pituitary secretes
increase amount of oxytocin and prolactin
as pregnancy nears.
Skeletal System

Softening of joints and ligaments,

especially symphisis and sacroiliac joint is
caused by relaxin and estrogen

Leg cramps is caused by pressure of

gravid uterus on nerves and imbalance of
calcium in the body.
Pressumptive Probable Positive
Amenorrhea Hegar’s sign Positive FHT
Breast change Uterine growth Funic Shuffle
Urinary frequency Ballotement Fetal movement
Quickening Uterine Shuffle X-ray visualization
Easy fatigability Goodel’s sign Positive Ultrasound
Leukorrhea Braxton-Hicks
Nausea and vomiting Contraction
Chadwick sign Fetal outline
Striae Positive Pregnancy
Linea negra