NCM 107 MIDTERM lecture # 2
• Management: lessen edema by raising the legs above hip level
VI. NORMAL ADAPTATIONS IN PREGNANCY • Varicosities - specialized stocking for pregnant to promote venous flow and avoid
using constricting garters (knee high socks)
SYSTEMATIC CHANGES • Varicosities in genitalia and rectum - side lying position with the hips elevated with
pillows and/or instruct the patient to perform the modified knee form position
CIRCULATORY/ CARDIOVASCULAR
1.1 -Beginning the end of the 1st trimester there is a gradual increase of about
30%-50% in the total cardiac volume, reaching its peak during the 6th month GASTROINTESTINAL CHANGES
- this causes a drop in hemoglobin and hematocrit values since the increase is only in 2.1 Morning sickness
the plasma volume (physiologic anemia in pregnancy) • Nausea and vomiting during the first trimester is due to increased HCG
• It may also be due to increased acidity or even to emotional factors
Consequences of increased total cardiac volume are: • Management: eat dry toast and crackers 30 mins before arising in the morning and
• Easy fatiguability and SOB because of increased workload of the heart diet must be dry high carbohydrate, low fat and low spices : small frequent
• Slight hypertrophy of the heart causing it to be displaced to the left, resulting in feedings and meals
torsion on the great vessels (aorta and pulmonary artery)
• Systolic murmurs are common due to lowered blood viscosity 2.2 Hyperemesis gravidarum
• Nosebleeds may occur because of marked congestion of nasopharynx as Pregnancy • excessive nausea and vomiting which persists beyond 3 months
progresses • Results in dehydration , starvation and alkalosis
1.2. Palpitations are due to: 2.3 Constipation and flatulence
(1) sympathetic nervous system stimulation during the first half of pregnancy • Due to displacement if the stomach and intestines, this slowing peristalsis and
(2) increased pressure of uterus against the diaphragm during second half of gastric emptying time
pregnancy • May also be to increased progesterone during pregnancy
• Management: increased fluid intake and increase fiber in diet.: establish regular
1.3 Because of poor circulation resulting from pressure of the gravid uterus on the elimination time: increase exercise
blood vessels of the lower extremities:
(1) edema of lower extremities occurs 2.4 Hemorrhoids
(2) varicosities of the lower extremities can also occur • due to pressure of enlarges uterus
• management: hot sitz bath
*Not the same as PIH (pregnancy induced hypertension) which is not normal
2.5 Heartburn
1.4 Because of poor circulation in the blood vessels of the genitalia due to the • during the last trimester, is due to increased progesterone which decreases gastric
pressure of the gravid uterus, varicosities of the vulva and rectum can occur motility, thereby causing reverse peristaltic waves which lead to regurgitation of
stomach contents through the cardiac sphincter into the esophagus, causing
1.5 there is increased level of circulating fibrinogen, that is why pregnant women are irritation.
normally safeguarded against undue bleeding. However, this also predispose them to
formation of blood clots (thrombi) * do not massage
, • Management: avoid gas forming foods: avoid fried fatty foods: small frequent 5.3 Leg cramps
feedings/meals: bent on the knees , not on her waist: take antacids (milk of Causes:
magnesia) not ones with sodium bicarbonate which can cause fluid retention • increased pressure of gravid uterus on lower extremities
• Fatigue
• Chills
RESPIRATORY CHANGES • Muscle tenseness
3.1 shortness of breath • Lower calcium, high phosphorus intake
Causes:
A. Increased oxygen consumption and production of carbon during the first trimester Management:
B. Increased uterine size causes diaphragm to be pushed or displaced thus crowding • frequent rest periods with feet elevated
the chest cavity • Wear warm, more comfortable clothing
• management: lateral expansion of the chest to compensate for SOB increased • Increase calcium intake
oxygen supply and vital lung capacity • Do not massage- blood clots can cause embolism
• Press knee of the affected leg and dorsiflex the foot
URINARY CHANGES
4.1 Urinary frequency TEMPERATURE
• the only sigh in pregnancy seen during the first trimester (increased blood supply slight increase in basal body temp due to increased progesterone, but the body adapts
to the kidney) after the 4th month
• Disappears during the second and reappears during the third trimester (pressure of
the large uterus to the bladder)
* lightening- descending of the fetus to the pelvic brim ENDOCRINE CHANGES
7.1 Addition of the placenta as an endocrine organ, producing large amounts of
4.2 Decreased renal threshold for sugar due to increased production of HCG, HPL, Estrogen and Progesterone
glucocorticoids which cause lactose and dextrose to spill into the urine and also an
effect of the increased progesterone 7.2 Moderate enlargement of the thyroid gland due to hyperplasia of the glandular
tissue and increased vascularity.
- Could also be due to increased BMR to as much as +25% because of the
MUSCULOSKELETAL CHANGES metabolic activity of the products of conception
5.1 because of the pregnant womans attempt to change her center of gravity, she
makes ambulation easier by standing more straight and taller, resulting in a 7.3 increased size of the parathyroid, probably to satisfy the increased need of the
LORDOTIC position “pride of pregnancy” which can cause back ache. fetus for calcium
5.2 Due to increased production of the hormone relaxin, pelvic bond become more 7.4 increased size and activity of the adrenal cortex, thus increasing the amount of
supple and movable, increasing the incidence of accidental falls due to the wobbly circulating cortisol, aldosterone and ADH, all of which affect carbohydrate and fat
gait metabolism, causing hyperglycemia.
• management: advice to wear low heeled shoes (not flat)
• Management: lessen edema by raising the legs above hip level
VI. NORMAL ADAPTATIONS IN PREGNANCY • Varicosities - specialized stocking for pregnant to promote venous flow and avoid
using constricting garters (knee high socks)
SYSTEMATIC CHANGES • Varicosities in genitalia and rectum - side lying position with the hips elevated with
pillows and/or instruct the patient to perform the modified knee form position
CIRCULATORY/ CARDIOVASCULAR
1.1 -Beginning the end of the 1st trimester there is a gradual increase of about
30%-50% in the total cardiac volume, reaching its peak during the 6th month GASTROINTESTINAL CHANGES
- this causes a drop in hemoglobin and hematocrit values since the increase is only in 2.1 Morning sickness
the plasma volume (physiologic anemia in pregnancy) • Nausea and vomiting during the first trimester is due to increased HCG
• It may also be due to increased acidity or even to emotional factors
Consequences of increased total cardiac volume are: • Management: eat dry toast and crackers 30 mins before arising in the morning and
• Easy fatiguability and SOB because of increased workload of the heart diet must be dry high carbohydrate, low fat and low spices : small frequent
• Slight hypertrophy of the heart causing it to be displaced to the left, resulting in feedings and meals
torsion on the great vessels (aorta and pulmonary artery)
• Systolic murmurs are common due to lowered blood viscosity 2.2 Hyperemesis gravidarum
• Nosebleeds may occur because of marked congestion of nasopharynx as Pregnancy • excessive nausea and vomiting which persists beyond 3 months
progresses • Results in dehydration , starvation and alkalosis
1.2. Palpitations are due to: 2.3 Constipation and flatulence
(1) sympathetic nervous system stimulation during the first half of pregnancy • Due to displacement if the stomach and intestines, this slowing peristalsis and
(2) increased pressure of uterus against the diaphragm during second half of gastric emptying time
pregnancy • May also be to increased progesterone during pregnancy
• Management: increased fluid intake and increase fiber in diet.: establish regular
1.3 Because of poor circulation resulting from pressure of the gravid uterus on the elimination time: increase exercise
blood vessels of the lower extremities:
(1) edema of lower extremities occurs 2.4 Hemorrhoids
(2) varicosities of the lower extremities can also occur • due to pressure of enlarges uterus
• management: hot sitz bath
*Not the same as PIH (pregnancy induced hypertension) which is not normal
2.5 Heartburn
1.4 Because of poor circulation in the blood vessels of the genitalia due to the • during the last trimester, is due to increased progesterone which decreases gastric
pressure of the gravid uterus, varicosities of the vulva and rectum can occur motility, thereby causing reverse peristaltic waves which lead to regurgitation of
stomach contents through the cardiac sphincter into the esophagus, causing
1.5 there is increased level of circulating fibrinogen, that is why pregnant women are irritation.
normally safeguarded against undue bleeding. However, this also predispose them to
formation of blood clots (thrombi) * do not massage
, • Management: avoid gas forming foods: avoid fried fatty foods: small frequent 5.3 Leg cramps
feedings/meals: bent on the knees , not on her waist: take antacids (milk of Causes:
magnesia) not ones with sodium bicarbonate which can cause fluid retention • increased pressure of gravid uterus on lower extremities
• Fatigue
• Chills
RESPIRATORY CHANGES • Muscle tenseness
3.1 shortness of breath • Lower calcium, high phosphorus intake
Causes:
A. Increased oxygen consumption and production of carbon during the first trimester Management:
B. Increased uterine size causes diaphragm to be pushed or displaced thus crowding • frequent rest periods with feet elevated
the chest cavity • Wear warm, more comfortable clothing
• management: lateral expansion of the chest to compensate for SOB increased • Increase calcium intake
oxygen supply and vital lung capacity • Do not massage- blood clots can cause embolism
• Press knee of the affected leg and dorsiflex the foot
URINARY CHANGES
4.1 Urinary frequency TEMPERATURE
• the only sigh in pregnancy seen during the first trimester (increased blood supply slight increase in basal body temp due to increased progesterone, but the body adapts
to the kidney) after the 4th month
• Disappears during the second and reappears during the third trimester (pressure of
the large uterus to the bladder)
* lightening- descending of the fetus to the pelvic brim ENDOCRINE CHANGES
7.1 Addition of the placenta as an endocrine organ, producing large amounts of
4.2 Decreased renal threshold for sugar due to increased production of HCG, HPL, Estrogen and Progesterone
glucocorticoids which cause lactose and dextrose to spill into the urine and also an
effect of the increased progesterone 7.2 Moderate enlargement of the thyroid gland due to hyperplasia of the glandular
tissue and increased vascularity.
- Could also be due to increased BMR to as much as +25% because of the
MUSCULOSKELETAL CHANGES metabolic activity of the products of conception
5.1 because of the pregnant womans attempt to change her center of gravity, she
makes ambulation easier by standing more straight and taller, resulting in a 7.3 increased size of the parathyroid, probably to satisfy the increased need of the
LORDOTIC position “pride of pregnancy” which can cause back ache. fetus for calcium
5.2 Due to increased production of the hormone relaxin, pelvic bond become more 7.4 increased size and activity of the adrenal cortex, thus increasing the amount of
supple and movable, increasing the incidence of accidental falls due to the wobbly circulating cortisol, aldosterone and ADH, all of which affect carbohydrate and fat
gait metabolism, causing hyperglycemia.
• management: advice to wear low heeled shoes (not flat)
