Nursing 209

N209: Reproductive Health Study Guide • Pregnancy does not affect the indication for or safety of cardioversion Hematologic changes: • Total blood volume increases in proportion to cardiac output; plasma volume is increased greater than RBC mass • Hemoglobin is lowered by dilution from 13.3 to 12.1g/dl as result • WBC increases slightly to 9-12,000 • Iron requirements increase by approximately 1g during pregnancy o Fetus and placenta use about 300mg o Excretion accounts for 200 mg o Iron supplements are needed because the amount from diet and iron stores are insufficient to meet pregnancy demands Urinary changes: • Renal function changes are parallel to cardiac function changes • GFR increases by 30-50% and peaks at 16-24 weeks • Progesterone effects and pressure on enlarging uterus can cause hydronephrosis • Postural changes in renal function noted more during pregnancy o Supine: Increase in renal function o Upright: Decrease in renal function o Lateral (LLR): Markedly increased renal function o Relieves pressure on the vena cava o The reason why pregnant women urinate more with sleep Respiratory changes: • Changes are due to an increase in progesterone and enlarging uterus interfering with lung expansion • Progesterone signals the brain to decrease CO2 levels • O2 consumption increases by 20% to meet pregnancy metabolic needs and decreased CO2 • Mild dyspnea on exertion is common • Nasal stuffiness and voice changes from hyperemia and edema to respiratory tract GI and Hepatobiliary changes: • Pressure from enlarged uterus on rectum and colon can cause constipation • Decreased mobility from elevated progesterone levels; heartburn and belching are common • HCL production decreases; PUD uncommon and severity of existing ulcers decreases • Gallbladder disorders increase due to effects of pregnancy on liver function and bile transport

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