cells (RBCs) by maternal/placental/ fetal unit.
      1. Assessment:
        1. Weight gain: 20-35 lb (11.5-16 kg); depends on Body Mass Index and prepregnant nutritional status.
        2. Normal pattern: first trimester, 2-5 lb (1-2.3 kg); remainder of gestation, approximately 1 lb/wk (0.4-0.5 kg/wk).
      2. Nursing care plan/implementation:
        3. Goal: health teaching
        1. Evaluate diet for adequacy of nutrient and caloric intake.
        2. Evaluate cultural, religious, and economic influences on diet.
        3. Review dietary recommendation for pregnancy with woman.
        4. Avoid dieting in pregnancy (even if obese).
        5. •Supplement diet with vitamins, iron, or folic acid on advice of health provider.
        6. Ptyalism:
          1. Suck hard candies.

          2. Perform frequent oral hygiene.
          3. Maintain adequate oral intake (6-8 glasses/day).
          4. Use lip balm to prevent chapping.
        7. Epulis:
          1. Frequent oral hygiene.
          2. Use soft toothbrush.
          3. Floss gently.
          4. See dentist regularly.

    1. Alterations affecting protective functions - integumentary system
      1. Physiological changes - estrogen-induced vascular and pigment changes.
      2. Assessment:
        1. Increased pigmentation.
        2. Striae gravidarum (stretch marks).
        3. Increased sebaceous and sweat gland activity.
        4. Palmar erythema.
        5. Angiomas-vascular “spiders.”
      3. Nursing care plan/implementation:
        4. Goal: health teaching
        1. Bathe or shower daily.
        2. Reassure woman that skin changes decrease after pregnancy.

    2. Alterations affecting comfort, rest, mobility - musculoskeletal system
      1. Physiological changes
        1. Progesterone, estrogen, and relaxin-induced relaxation of joints, cartilage, and ligaments.
        2. Function in childbearing - increases anteroposterior diameter of rib cage and enlarges birth canal.
      2. Assessment:
        1. Complaint of pelvic “looseness.”
        2. Duck-waddle walk.
        3. Tenderness of symphysis pubis.
        4. Lordosis (exaggerated lumbar curve) - increased weight of pelvis tilts pelvis forward; to compensate, woman throws head and shoulders backward; complaint of leg and back strain and fatigue (see Table 4-6)
      3. Nursing care plan/implementation:
        4. Goal: health teaching
        1. Good body alignment - tuck pelvis under; tighten abdominal muscles.
        2. Pelvic-rock exercises.
        3. Squat; bend at knees, not at waist.
        4. Wear low-heeled, sturdy shoes.
        5. Avoid tight-fitting clothing that interferes with circulatory return in legs.

  1. Psychosocial-cultural alterations
    1. Emotional changes - affected by age, maturity, support system, amount of current stresses, coping abilities, physical and mental health status.
      2. Developmental tasks of pregnancy:
      1. Accept the pregnancy as real: “I am pregnant”; progress from symbiotic relationship with the fetus to perceiving the child as an individual.
      2. Seek and ensure acceptance of child by others.
      3. Seek protection for self and fetus through pregnancy and labor (“safe passage”).
      4. Prepare realistically for the coming child and for necessary role change: “I am going to be a parent.”
    2. Physical bases of changes
      1. Increased metabolic demands may result in anemia and fatigue.
      2. Increased hormone levels (steroids, estrogen, progesterone) - affect mood as well as physiology.
    3. Characteristic behaviors - Table 4-7 describes behaviors commonly exhibited in each trimester.
    4. Sexuality and sexual expression - feelings and expressions of sexuality may vary during pregnancy due to maternal adaptations.
    5. Intrafamily relationships
      1. Pregnancy is a maturational crisis for the family.
      2. Requires changes in lifestyle and interactions:
        1. Increased financial demands.
        2. Changing family and social relationships.
        3. Adapting communication patterns.
        4. Adapting sexual patterns.
        5. Anticipating new responsibilities and needs.
        6. Responding to reactions of others.