Chapter 10

Nursing Care Related to

Psychological and Physiologic
Changes of Pregnancy
Psychological Changes #1

Social
Cultural
Family
Personal influences

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Psychological Tasks #1

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Psychological Tasks #2

Emotional responses
o Grief- can be associated with such a positive process as
having a child seems at first incongruent.
o Narcissism-Self-centeredness (narcissism) may be an
early reaction to pregnancy
o Introversion versus extroversion- turning inward to
concentrate on oneself and one’s body
o Body image and boundary-the way your body appears to
yourself
o Stress-pregnancy brings with it such a major role change,
it can cause extreme stress

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Psychological Tasks #3

Emotional responses—(cont.)
 Depression- a feeling of sadness marked by loss of interest in
usual things, feelings of guilt or low self-worth, disturbed
sleep, low energy, and poor concentration—is a common
finding in late adolescents.
 Couvade syndrome -Many partners experience physical
symptoms such as nausea, vomiting, and backache to the
same degree or even more intensely than their partners during
a pregnancy; some begin to gain weight along with their
partner.
 Emotional lability- mood swing
 Changes in sexual desire -Women who formerly were
worried about becoming pregnant might truly enjoy sexual
relations for the first time during pregnancy. Others might feel
a loss of desire because of their increase in estrogen, or they
might unconsciouslyCopyrightview sexual
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Physiologic Changes #2

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Physiologic Changes #3

Reproductive system changes

o Uterine changes
o Amenorrhea
o Cervical changes
o Vaginal changes
o Ovarian changes

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Physiologic Changes #4

Changes in breasts
Systemic changes
o Endocrine system
 Placenta
 Pituitary gland
 Thyroid and parathyroid glands
 Adrenal glands
 Pancreas

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Physiologic Changes #5

Systemic changes—(cont.)
o Immune system
 Competency decreases
 IgG is decreased
 Increase in WBC
o Integumentary system
o Respiratory system
o Temperature

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Physiologic Changes #6

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Physiologic Changes #7

Systemic changes—(cont.)
o Cardiovascular system
 Blood volume
 Iron, folic acid, and vitamin needs
 Heart
 Blood pressure
 Peripheral blood flow
 Supine hypotension syndrome
 Blood constitution

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Physiologic Changes #8

Systemic changes—(cont.)
o Gastrointestinal system
o Urinary system
 Fluid retention
 Renal function
 Ureter and bladder function

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Physiologic Changes #9

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Physiologic Changes #10

Systemic changes—(cont.)
o Musculoskeletal system
 Progressive cartilage softening
 Possible back or pelvic girdle pain

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2020 National Health Goals Related to the
Psychological and Physiologic Changes of
Pregnancy

 Increase abstinence from alcohol, cigarettes, and

illicit drugs among pregnant women from baselines
of 89.4%, 89.6%, and 94.9% to target levels of
98.4%, 98.6%, and 100%.
 Reduce maternal deaths from a baseline of
12.7/100,000 live births to a target of
11.4/100,000.
 Increase the proportion of pregnant women who
receive early and adequate prenatal care from a
baseline of 70.5% to a target level of 77.6%.

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Nursing Process: Psychological and
Physiologic Changes of Pregnancy

Assessment
Nursing diagnosis
Outcome identification and planning
Implementation
Outcome evaluation

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Nursing Care Planning Tips for Effective
Communication

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Assessing Events That Could Contribute to
Difficulty Accepting a Pregnancy

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Presumptive Indications of Pregnancy #1

Breast changes-Feelings of tenderness, fullness,

tingling; enlargement and darkening of areola
Nausea, vomiting-Nausea or vomiting on arising or
when fatigued
Amenorrhea- Absence of menstruation
Frequent urination- Sense of having to void more
often than usual
Chadwick’s-Color change of the sign vagina from
pink to violet
Goodell’s sign- Softening of the cervix
Fatigue- General feeling of tiredness
Uterine enlargement-Uterus can
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Presumptive Indications of Pregnancy #2

Hegar’s sign-Softening of the lower uterine segment

Quickening - the first moment a woman feels fetal
movement
Fetal heart audible-Doppler ultrasound reveals
heartbeat
Linea nigra- line on dark pigment form on the
abdomen
Melasma- dark pigment forms on the face
Striae gravidarum – stretch mark form on the
abdomen
Sonographic evidence of gestational sac-
Characteristic ring is evident
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Probable Indications of Pregnancy

Maternal serum test

Chadwick’s sign
Hegar’s sign
Sonographic evidence of gestational sac
Ballottement-When lower uterine segment is tapped
on a bimanual examination, the fetus can be felt to
rise against the abdominal wall
Braxton Hicks contractions- Periodic uterine
tightening occurs
Fetal outline felt by examiner-Fetal outline can be
palpated through abdomen
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Positive Indications of Pregnancy

Sonographic evidence of fetal outline

Fetal heart audible
Fetal movement felt by examiner

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Assessing Physiologic Changes of
Pregnancy #1

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Assessing Physiologic Changes of
Pregnancy #2

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Hegar’s Sign

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Nursing Diagnoses: Psychological and
Physiologic Changes of Pregnancy #1

Altered breathing patterns related to respiratory

system changes of pregnancy
Disturbed body image related to weight gain from
pregnancy
Deficient knowledge related to normal changes of
pregnancy
Imbalanced nutrition, less than body requirements,
related to early morning nausea

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Nursing Diagnoses: Psychological and
Physiologic Changes of Pregnancy #2

Powerlessness related to unintended pregnancy

Possible impaired health and prenatal care behaviors
associated with cultural beliefs

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Outcomes: Psychological and Physiologic
Changes of Pregnancy

Patient states that she is able to continue her usual

lifestyle throughout the pregnancy.
Family members describe ways they have adjusted
their lifestyles to accommodate the mother’s fatigue.
Couple states they understand the physiologic
changes of pregnancy.

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Quality & Safety Education for Nurses
(QSEN)

Patient-Centered Care
Teamwork & Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics

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Nursing Care for Psychological and
Physiologic Change of Pregnancy

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Question #1

Which of the following tasks is the most important

task of the first trimester of pregnancy?
A. Accepting the pregnancy
B. Accepting a coming child
C. Making plans for the baby
D. Sharing time with a significant other

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Answer #1

A. Accepting the pregnancy

Rationale: Before a fetus moves, adjusting to pregnancy is a
primary task; later, adjusting to having a baby becomes the
primary task.

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Question #2

As a pregnant woman lies on the examining table, she

grows very short of breath and dizzy. The nurse
recognizes which as the probable cause?
A. Her cerebral arteries are growing congested with blood.
B. The uterus requires more blood in a supine position.
C. Blood is trapped in the vena cava in a supine position.
D. Sympathetic nerve responses cause dyspnea when a woman
lies supine.

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Answer #2

C. Blood is trapped in the vena cava in a supine

position.
Rationale: Supine hypotension syndrome, or an interference
with blood return to the heart, occurs when the weight of
the fetus rests on the vena cava.

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Question #3

Blood volume normally increases during pregnancy.

The extent of this increase is what percentage of
prepregnancy volume?
A. 1% to 10%
B. 20% to 30%
C. 30% to 50%
D. 70% to 90%

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Answer #3

C. 30% to 50%
Rationale: To supply adequate blood for fetal circulation,
blood volume increases 30% to 50%.

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Question #4

A woman during her first trimester questions how

much longer she will have urinary frequency. Which
should the nurse advise her regarding urinary
frequency?
A. It is a common complaint during the first trimester and again
later in the third trimester.
B. It is a common concern reported during the entire
pregnancy.
C. It will subside after the first trimester.
D. It is a concern until the last trimester of pregnancy.

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Answer #4

A. It is a common complaint during the first trimester

and again later in the third trimester.
Rationale: The weight of the growing uterus causes urinary
frequency during the first trimester. After lightning occurs in
the last trimester, urinary frequency reoccurs.

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