Deck 23: The Pregnant Woman and Functional Assessment of the Older Adult

Question 1

Discuss pregnancy and the endocrine placenta.

Answer 1

One follicle ruptures and ovulation occurs. If the ovum meets a viable sperm, then fertilization occurs. Progesterone helps to maintain a rich vascular endometrial wall where the fertilized ovum will implant. A specialized layer of cells becomes the placenta, which functions as an endocrine organ and produces several hormones. These hormones help in the growth and maintenance of the fetus and direct changes in the woman's body to prepare for birth and lactation. The average length of pregnancy is 280 days.

Question 2

Differentiate the three types of signs and symptoms of pregnancy.

Answer 2

Presumptive signs are those that the woman experiences, such as amenorrhea, nausea, fatigue, and breast tenderness. Probable signs are those detected by the examiner, such as an enlarged uterus. Positive signs are those that are direct evidence of the fetus, such as the detection of fetal heart tones.

Question 3

Discuss the changes associated with each trimester of pregnancy.

Answer 3

Pregnancy is divided into three trimesters: (1) the first 12 weeks, (2) from 13 to 27 weeks, and (3) from 28 weeks to delivery. Recommendations for weight gain are outlined in the chapter.
First trimester (first 12 weeks)
Blastocyst implants in uterus
Breast tingling and tenderness begin
More than half of women experience nausea and vomiting
Uterus becomes globular, softens, and flexes easily over the cervix
Urinary frequency increases
The cervix softens and becomes bluish purple
Blood pressure may drop because of falling peripheral vascular resistance
Second trimester (weeks 13 to 27)
Colostrum may be expressed from nipples
Skin changes-areolas and nipples darken, abdominal skin becomes pigmented, and stretch marks may be found on the breast, abdomen, and areas of weight gain
Stomach displacement occurs
Altered esophageal sphincter and gastric tone often cause heartburn
Constipation is more likely to occur
Increased tidal volume is observed
"Quickening," or fetal movement, is felt
Third trimester (weeks 28 to delivery)
Increased blood volume may cause a functional systolic murmur
Uterine enlargement causes diaphragm to rise, causing decreased lung expansion space
Pulse rate rises 15 to 20 beats per minute
Hemorrhoids may occur
Lordosis frequently occurs
Engagement ("lightening" or "dropping") occurs approximately 2 weeks before delivery

Question 4

State methods of determining weeks of gestation.

Question 5

Discuss developmental care associated with pregnancy.

Question 6

List genetic testing that may be done during a pregnancy.

Question 7

Differentiate activities of daily living and independent activities of daily living.

Question 8

Describe the various functional assessments that may be performed with the older adult.

Question 9

List the other domains of assessment that may be performed with the older adult.

Question 10

Discuss the aspects of assessment for elder mistreatment.