Physiological Changes
Included In This Lesson
Study Tools For Physiological Changes
Outline
Overview
- Physiological changes are changes that affect how the body functions
- Normal changes
- Many of these changes are due to an expanding uterus (and therefore pelvis), an increase in oxygen consumption and circulating blood volume, and fluctuations in various hormones
Nursing Points
General
- Pregnant women should be seen regularly to identify complications early.
- Scheduled of prenatal visits:
- Q4 weeks from 8-32 weeks
- Q2 weeks from 32-36 weeks
- Q1 weeks from 36-40 weeks
Assessment
- Hormones
- Estrogen, Progesterone, HCG, Aldosterone
- Cardiovascular
- More blood volume
- Murmurs can be normal
- Edema/fluid retention
- Increased pulse 10-15 BPM
- Blood pressure decreased in second Trimester
- Increased preload and cardiac output
- Gastrointestinal
- GI track slows down→ progesterone
- Constipation
- Nausea/vomiting
- Bloated feeling
- GI track slows down→ progesterone
- Renal
- Frequent urination
- Uterine weight, fetal size
- Increased risk of UTI
- Frequent urination
- Respiratory
- Increased oxygen consumption
- Increased ventilation
- Musculoskeletal
- Gait changes
- Relaxin hormone
- Changes to pelvic girdle
- Gait changes
- Hematologic
- Increased coagulopathies→ increased risk for DVT
Therapeutic Management
- Not much therapeutic management
- Treat any discomfort that changes are causing
- Band to lift growing uterus and relieve back discomfort
- Medications for GI discomfort
- Diet to manage constipation
Nursing Concepts
- Reproduction
- Human Development
Patient Education
- Normal changes to expect
- Ways to improve symptoms
- Eat crackers before rising from bed
- Don’t let stomach get empty → increases nausea
- Importance of maintaining correct posture→ prevent musculoskeletal discomfort and back pain
- When to be concerned
- Frequent vomiting causing weight loss
- Signs of blood clots, DVTs
- UTI symptoms
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Physiological Changes
Transcript
In this lesson I will explain the physiological changes that occur in pregnancy in a more understandable way
Physiological changes are those changes that occur to the bodies functions. So not the physical looks but how it functions. The changes are normal and caused by mostly hormones (Estrogen, progesterone, HCG, Aldosterone), growing and expanding uterus, and an increase in blood volume. These physiological changes affect the heart, respiratory, musculoskeletal, gastrointestinal, and renal system.
A head to toe assessment should be done to look for any changes. The patient should be Interviewed to identify changes she has noticed and if she has any concerns. Reassuring the patient that the changes are normal can be comforting for the patient.
It is important to know the main cause of these changes. Hormones are a large cause and the ones really involved are estrogen, progesterone, HCG, aldosterone. Estrogen is responsible to an increase in vascularity and nasal congestion. Progesterone is responsible for keeping the body pregnant. So it slows everything down like the gastrointestinal tract. This cause constipation and bloating. It also keeps the uterus from contracting to maintain that pregnancy. HCG is increasing and doubling as the pregnancy gets further along. This is going to cause the nausea and vomiting for the gastrointestinal tract. Aldosterone increases the plasma volume. This will be more work for the heart but helpful post delivery when there is a lot of bleeding. The respiratory system is changes because of an increase in oxygen consumption. Also because of the hormone estrogen there is an increase in nasal congestion and stuffiness. Nosebleeds are common because of this. The gastrointestinal system is going to slow down. This is mainly because of which hormone? Yes, progesterone. So this is going to cause constipation, nausea/vomiting, and bloating. The renal system changes in ways that there is more frequent urination. This is because not just the weight of the uterus/fetus and it grows but also because of rising hormone levels. UTI risk is greater because of the weight of the uterus can cause blockade so not all the unit is able to exit. You can see in this picture how there is a small area to grow a baby. This causes the respiratory system to be crunched and the GI system to be bothered easily. Also with aldosterone increasing the plasma levels and the weight of the uterus hypotension is a big side effect. So let’s switch and talk about this cardiovascular system in more detail.
The cardiovascular system is changing as there is increasing blood volume. This picture gives a better visual. You can see blood volume increases 30-50%. In the third trimester the plasma amounts really increase and this causes anemia. The plasma amounts increase a lot where the red blood cells increase only a small amount. This causes the hematocrit to go down. Because of the increasing volume, murmurs might be heard and are normal. Edema will also occur as well as an increase in pulse by 10-15 BPM. Blood pressure also is reduced in the second trimester. hormonal changes cause the blood vessels to dilate so the blood pressure lowers. The blood pressure is usually at its lowest sometime in the middle of the second trimester. These changes can cause a lightheaded feeling and of course passing out can cause some uneasiness to the patient so just an an example of one of the changes that could concern the patient. The musculoskeletal system changes because of hormones and the uterus. So a hormone called relaxin causes the system to relax. It allows for the system to open up and allow room for the growing fetus. Also we have posture changes. We see lumbar lordosis because of the shift in the center of balance and the growing uterus. The hematologic system sees changes in coagulopathies. These increase, which are needed to clot off and stop too much bleeding post delivery but also increase the risk for DVTs.
There is not much therapeutic management. We want to treat any discomfort that changes are causing if possible. Some of these changes are a band to lift the growing uterus and relieve back discomfort, medications for GI discomfort and diet to manage constipation can also help such as ondansetron (zofran).
It is important that they know these are normal changes and what to expect. We want to give them ways to improve symptoms. Nausea will be a big complaint so ways to improve symptoms are to eat crackers before rising from bed, don’t let stomach get empty. It is also Importance of maintaining correct posture to prevent musculoskeletal discomfort and back pain. We want to tell them when to be concerned and symptoms to call about. These would be frequent vomiting causing weight loss, signs of blood clots, DVTs and UTI symptoms.
Reproduction is a concept because the pregnancy is causing the physiological symptoms to happen. Hormonal regulation is the last concept because hormones are a big cause for all the changes that are occuring.
Let’s review some of the main key points to remember. Many of these changes are due to hormones which are estrogen, progesterone, HCG, and aldosterone. The expanding uterus (and therefore pelvis) will cause musculoskeletal discomforts. There is an increase in oxygen consumption which will affect the respiratory system. We have that increasing circulatory blood volume which is putting more work on the heart. Last it is important to remember and remind the patient that these are normal pregnancy changes.
Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
- Anxiety Disorders
- Depressive Disorders
- Trauma-Stress Disorders
- Substance Abuse Disorders
- Bipolar Disorders
- Psychotic Disorders
- Concepts of Mental Health
- Eating Disorders
- Personality Disorders
- Health & Stress
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Note Taking
- Concepts of Population Health
- Basics of Human Biology