Changes of the Musculoskeletal, Respiratory, and Integumentary System during Pregnancy (Nursing)

by Jacquelyn McMillian-Bohler

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    00:01 Now, let's talk about the musculoskeletal system and all the changes that happen there.

    00:07 So, there are a couple of things we have to consider.

    00:10 But the first one, is progesterone. And what does it do? It relaxes things.

    00:15 And we have lots of joints, that are under the influence of progesterone and also, and its friend, “Relaxin.” So, having movable joints, in general, is usually okay.

    00:27 Having hyper-movable joints however, can sometimes cause some discomfort.

    00:31 So, let's look at what that might be.

    00:33 So, in this first graphic what you notice is a change in the balance point.

    00:37 So, because of the relaxin and also because of that gravity uterus being pulled forward, what a client might experience, is “Lumbar lordosis,” so that's when you have sort of a sway back.

    00:48 And I remember this one and I think about my back hurting and I might say, “Lordy lordy, I got some lordosis.” That may not work for you but give it a try or you might just remember, because, that was so wacky.

    01:01 Let's continue our conversation about relaxed joints.

    01:04 Let's look at this graphic, this is the pelvis, there are lots and lots of joints within the pelvis, they do not escape the influence of relaxin and progesterone, so, all the joints in the pelvis, may also become hypermobile.

    01:19 Now, there's actually some good parts of this, when you're in labor and cletus the fetus needs to navigate the birth canal, you need for all those joints to be mobile to allow the pelvis to open.

    01:31 However, when you need to do almost everything else you do with your pelvis, like walk around or move, that can sometimes become pretty uncomfortable, but it is a normal physiologic change.

    01:42 So, we need to be aware that that increase in relaxin, causes the loosening of the joints and we need to think about recommendations of things, like, exercise, because hypermobile joints, can also increase our chances of having injury, when we're doing our ordinary activities.

    02:00 Now, let's talk about the rectus muscle.

    02:03 So, the rectus muscle helps us to have that nice little six-pack or help somebody, to have a nice little six-pack.

    02:09 But during pregnancy, it actually has to separate and open to allow what to come through? The uterus, exactly.

    02:17 Now, this also can contribute to protrusion of the umbilicus or it may be flat, so you may have had an innie or a flatty and now you have an outie and that can all happen because of that separation.

    02:31 Now, let's look at more detail at the pelvic girdle, so, we're looking at a diagram here and we're specifically going to pay attention to the symphysis pubis, we talked about this a little bit in the softening of the joints, but sometimes the symphysis pubis, can completely separate and you can imagine how that would make walking almost impossible and so, for some unfortunate few, having a disruption that severe can happen.

    02:58 Now let's talk about the respiratory system and all the changes that happen there.

    03:02 So, again, I want to bring you back why do we need more oxygen? Because, we're breathing for two.

    03:09 And so, we want to make sure that we are fully oxygenated with every breath that we take.

    03:14 That's a song, I think.

    03:17 Anyway, let's think about what happens with the diaphragm, so, the diaphragm, in order to accommodate that growing uterus, is actually going to shift up about, four centimeters.

    03:27 And so, why is that important? Because it actually is going to widen the subcostal angle and it also may change the shape of the chest, so, we may go from having a normal sized chest, to having a barrel chest, we normally associate barrel chest with COPD, but it's also a consequence of third trimester pregnancy.

    03:49 We experience a 20 to 40% increase in tidal volume, so, we can have more oxygen.

    03:55 We have a 20% reduction in residual volume.

    03:58 There's also an increased sensitivity to CO2, which will allow the client to take breaths more often, to increase the amount of oxygen in the bloodstream.

    04:09 Now, the client might notice that they're having shortness of air, they may say that, because, they notice their breathing more often, it's an interesting phenomenon, about how you might become aware of your breathing.

    04:23 However, the provider is not going to notice any change and what I mean specifically here, is, if we put a pulse ox on, then what we'll find is that oxygenation is completely normal.

    04:34 Now, we never want to ignore what a client says.

    04:37 If they feel like they're short of air, we always want to listen to their lungs and do a pulse ox, to double check that everything is okay, because maybe something really is wrong, but if we don't find anything, we can reassure them, that this is a normal physiologic change.

    04:53 Now, let's talk about the integumentary system.

    04:57 The integumentary system, also, under the influence of our estrogen and progesterone, undergoes quite a few changes.

    05:04 Now, the estrogen can cause an increase in melanin in our skin.

    05:09 Some clients will notice, a blotchy sort of hyper pigmented look that on their face and on their neck and sometimes on the upper parts of their chest.

    05:18 This is known as, “Melasma” or “Chloasma.” So, two words that mean exactly the same thing.

    05:24 They may also notice this on their cheeks, on their neck and on their forehead.

    05:30 It affects about maybe 50 to 70% of clients, especially clients of color.

    05:35 Now, the good news is, is that, this will go away after pregnancy, so that is reassuring.

    05:43 Next, I want to talk about the, “Linea nigra.” So, you can see on this graphic this sort of line that goes down the middle, it looks like it separates the umbilicus.

    05:52 This, is also from the increase in melanocytes that are a result of the estrogen.

    05:57 Now, this may go above the umbilicus, it may go below the umbilicus and for most clients it's going to fade after pregnancy.

    06:05 Notice, I didn't say go away, because often it will still be there, but it will be much, much lighter.

    06:12 Now, I want to talk about stretch marks, which is, almost the bane, of almost every pregnant person, although I consider it a badge of honor.

    06:19 But the separation of the collagen, comes under the influence of what? We're talking about relaxation? So… Progesterone, exactly.

    06:29 So, the separation of the collagen, is what allows, the stretch marks to begin to develop.

    06:33 This affects about 50 to 80% of clients and it may occur on the abdomen, on the thighs and as we talked about already, on the breast.

    About the Lecture

    The lecture Changes of the Musculoskeletal, Respiratory, and Integumentary System during Pregnancy (Nursing) by Jacquelyn McMillian-Bohler is from the course Physiological Changes in Pregnancy (Nursing).

    Included Quiz Questions

    1. .“Your joints will become less mobile during pregnancy.”
    2. “Pregnancy changes your body’s balance point.”
    3. “It is common for the abdominal muscles to separate during pregnancy.”
    4. “The symphysis pubis may completely separate during pregnancy.”
    1. The diaphragm shifts upwards in the body
    2. Residual volume decreases
    3. Sensitivity to carbon dioxide decreases
    4. Tidal volume decreases
    1. Melasma
    2. Chloasma
    3. Linea nigra
    4. Stretch marks

    Author of lecture Changes of the Musculoskeletal, Respiratory, and Integumentary System during Pregnancy (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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