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We're Expecting

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by

Naomi Kariuki

on 2 February 2015

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Transcript of We're Expecting

Outline
Topic 1

Changes to the mother during first trimester
Uterus
Enlargement
Shape of the uterus changes from an upside-down pear to an oval shape

Changes Continued...
Complications during first trimester
Hyperemesis gravidarum (HG)
: severe bouts of nausea/vomiting
Clinical presentation
: elevated HR, low BP, weight loss, dehydration, electrolyte imbalances, fatigue, hyperketonemia, ketonuria, proteinuria, renal and liver damage, headache, confusion, syncope
Paying Attention...?
A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of Goodell's sign. The nurse determines this sign indicates:

a. Softening of the cervix

b. Soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus

c. The presence of hCG in the urine

d. The presence of fetal movement
Fetal development during first trimester
Preconception
Covered by Group A

Thank You!

We're Expecting
Group C
Jin Theresa Nancy
Cindy Jen Breanne

Changes to the mother during first trimester


Topic 3

Complications during first trimester
Topic 2
Fetal development during first trimester
Abdomen
Depends on the tone of abdominal muscles
Cervix
Goodell's Sign: cervical tip may begin to soften
Tissue becomes loose and swollen, and increases in volume and elasticity
Circulatory System
Blood volume increases by 10-12 weeks, peaks at 33 weeks
Changes Continued...
Neurological System
Feeling light-headed/faint, and even syncope can be common in early weeks
Fetal Development
(weeks 9 – 13)
Continued development and refinement of body systems and organs
Some systems start functioning
Question Break...
The developing cells are called a fetus from the:

a. Time the fetal heart is heard

b. Eighth week to the time of birth

c. Implantation of the fertilized ovum

d. End of the second week to the onset of labour
GI System
Morning sickness: nausea/vomiting that begins to occur around 4-6 weeks, and ends around the 3rd month or end of first trimester
Increased hCG levels or changes in carbohydrate metabolism
Fluctuation of appetite and intake of food
Heartburn
Pre-embryonic Development
(weeks 1 – 2)
Fertilization of the ovum, first cellular divisions and implantation in the uterus
Fetal development...
Embryonic Development
(weeks 3 – 8)
Development of organs – most vulnerable to infections/toxins
Development of environment in which the embryo/fetus will continue to grow

References
Complications...
Ectopic Pregnancy
: abnormal implantation of ovum outside the endometrial cavity
Sites of implantation
: fallopian tube (95%), abdominal cavity, ovary, and cervix
S/S triad
: abdominal pain, amenorrhea, vaginal bleeding
Causes
: dysfunctional fallopian tube related to –> history of ectopic pregnancies, pelvic inflammatory disease, and sexually transmitted diseases; tubal ligation; smoking; and age >35 years
Complications
Hydatidiform mole (molar pregnancy)
: a gestational trophoblastic disease (GTD) diagnosed in the 1st trimester
Malignant trophoblastic tumors (choriocarcinoma) simulate pregnancy due to hCG-producing cells
Assessing and monitoring for signs of hydatidiform in the first 24 weeks of gestation using ultrasound, serology
Source: Perry, et al., 2013, pp. 314 (Chapter 10)
Breast
May feel full, heavy, more sensitive and tingle
Blood vessels may become more visible
Changes...
Mouth
Non-specific gingivitis: Gums may swell and bleed easily
May have excessive salivation
Management
:
Chewing gum, hard candies, or astringent mouthwash
Well balanced diet and good dental hygiene
First trimester is the period in which miscarriages, congenital disorders and defects are most likely to take place
Complications...
Miscarriage
Spontaneous end of pregnancy before week 20
Clinical presentation: vaginal bleeding, abdominal pain


Carson-DeWitt, R. (2014). Ectopic pregnancy. Nursing reference center. Retrieved from http://search.ebscohost.com.login.ezproxy.library.ualberta.ca/login.aspx?direct=true&db=nrc&AN=2009544704&site=nrc-live

Lewis, R. A., Schub, T., & Pravikoff, D. (2014). Hyperemesis gravidarum. Nursing reference center. Retrieved from http://search.ebscohost.com.login.ezproxy.library.ualberta.ca/login.aspx?direct=true&db=nrc&AN=T702853&site=nrc-live

Perry, S.E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2013). Anatomy and Physiology of Pregnancy. In C. Sams & L. Kennan-Lindsay (Eds.), Maternal Child Nursing Care in Canada (pp. 188-202). Toronto: Mosby Elsevier.

Perry, S.E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2013). Nursing Care During Pregnancy. In C. Sams & L. Kennan-Lindsay (Eds.), Maternal Child Nursing Care in Canada (pp. 231). Toronto: Mosby Elsevier.

Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2013). Preconception, Genetics, Conception, and Fetal Development. In C. Sams & L. Kennan-Lindsay (Eds.), Maternal Child Nursing Care in Canada (pp. 157-185). Toronto: Mosby Elsevier.

Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2013). Pregnancy and risk: gestational conditions. In C. Sams & L. Kennan-Lindsay (Eds.), Maternal Child Nursing Care in Canada (pp. 310-321). Toronto: Mosby Elsevier.

Sepilian, V. P., Wood, E., Casey, F. E., & Rivlin, M. E. (2014). Ectopic pregnancy. Medscape. Retrieved from http://emedicine.medscape.com/article/2041923-overview

Wilcox, S. R. (2013). Hyperemesis gravidarum in emergency medicine. Medscape. Retrieved from http://emedicine.medscape.com.login.ezproxy.library.ualberta.ca/article/796564-overview#a0199

Wood, D. (2014). Miscarriage. Nursing reference center. Retrieved from http://search.ebscohost.com.login.ezproxy.library.ualberta.ca/login.aspx?direct=true&db=nrc&AN=2009544011&site=nrc-live

ANSWER:
b.
In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.
ANSWER:
a
. In the early weeks of pregnancy, the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes Goodell's sign.
A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to:

a. Avoid wearing a bra

b. Wash the nipples and areola area daily with soap and massage the breasts with lotion

c. Wear tight fitting blouses or dresses to provide support

d. Wash the breasts with warm water and keep them dry
ANSWER:
d.
The woman should avoid using soap on the nipples to prevent drying and wear a supportive bra with wide adjustable straps to decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.
NCLEX Question
A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates the need for further education?

a. "I will maintain strict bed rest throughout the remainder of pregnancy."

b. "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding."

c. "I will count the number of perineal pads used on a daily basis and note the amount and colour of blood on the pad."

d. "I will watch for the evidence of the passage of tissue."
ANSWER:
a.
Strict bed rest throughout the remainder of pregnancy is not required.
Final One...
Which of the following symptoms occurs with a hydatiform mole?

a. Heavy, bright red bleeding every 21 days

b. Fetal cardiac motion after 6 weeks gestation

c. Benign tumors found in the smooth muscle of the uterus

d. "Snowstorm" pattern on ultrasound with no fetus or gestational sac
ANSWER:
d.
The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatiform mole is often dark brown and may occur erratically for weeks or months.
Changes...
Changes...
Vagina
Chadwick’s sign
: color of the vagina mucosa may become violet/bluish
Leukorrhea
: Increase in a whitish-grey mucus-like discharge
Management
: cannot be prevented, do not douche, wear perineal pads, practice good hygiene, report purulent drainage, foul odor or changes in color
Increased risk of yeast infection because vaginal secretions increase in acidity to fight off other organisms
Renal System
Bladder becomes more sensitive which may result in urinary frequency, urgency and nocturia
Kidneys have increased capacity to excrete water
causing increased water loss and increased thirst for some women
Management
:
Void often and monitor fluid intake (especially before bed)
Perform kegel exercises
GI System
Management
:
Avoid an empty or too full stomach
Intake of dry carbohydrates when awakening may help
Eat smaller, more frequent meals
Ginger supplementation or acupuncture/pressure may help
If continues, may need prescription from health care provider
Nursing Priorities?
Nursing priorities
:
Comfort measures to minimize maternal and fetal effects:
Teach patient to eat smaller, frequent meals and avoid foods/odors that trigger gag reflex
Assess anxiety and coping skills
Frequent oral hygiene and care to maintain dental and mucosal health
Avoid sudden movements (hypotensive) = fall risk
Monitor for signs of aspiration
IV fluid and electrolyte replacement, supplemental nutrition therapies, antiemetics
Types of miscarriage
:
Threatened
: spotting, mild cramping, no cervical dilation
Inevitable
: moderate bleeding, mild cramping, rupture of membranes → termination with dilation and curettage
Incomplete
: profuse bleeding, severe cramping, expulsion of fetus, retention of placenta → termination with dilation and curettage
Complete
: slight bleeding, mild cramps, all tissues passed and cervix closed
Missed
: minimal bleeding, spotting

Miscarriage

Nursing Priorities

Expected orders following termination: (comfort measures, alleviate pain, control bleeding)
Psychological stress and trauma with loss
Ectopic Pregnancy

Treatment
:
Surgical
Methotrexate-folic acid antagonist that terminate proliferating fetal cells (also used in chemotherapy for cancer cells and as a immunosuppressant)
Psychological support for grief of loss of pregnancy and referral to counseling
Full transcript