INTEGRATED REPRODUCTIVE HEALTH

1. Minor disorders in
pregnancy
MR. JONES H.M-MBA
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2. 2

3. Nausea and Vomiting (Morning
Sickness)
One of the most common
discomforts of early
pregnancy is possibly due
to high levels of human
chorionic gonadotropin
(HCG) or progesterone,
cultural expectations,
emotional factors, and
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4.  hypoglycemic reaction as a result of increased basal
metabolism due to the 24-hour a day fetal and
maternal body functions, especially after a period of
fasting (from night to morning).
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5.  Nausea and vomiting usually appear early in the first
trimester (6 to 8 weeks) and subsides by the end of the
12th week of pregnancy.
 This is most bothersome in the morning when a
woman awakes and the stomach is empty. Some
pregnant women may experience this sort of
discomfort at other times of the day.
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6. Nursing interventions consist of advising the mother
to:
 Eat a high-protein snack at bedtime if it's a
hypoglycemic attack.
 Eat crackers or a piece of dry toast before getting up
(keep by bedside if possible).
 Eat frequently spaced, small meals of high-quality
(protein) foods.
 Sip a hot drink before arising.
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7. 2. Heartburn (Pyrosis)
 Heartburn is a burning sensation in the epigastric and
sternal region.
 It results from relaxation of the cardiac sphincter and
the decreased tone and mobility of smooth muscles
which is due to increased progesterone thereby
allowing for esophageal regurgitation, decreased
emptying time of the stomach, and reverse peristalsis.
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8. Heartburn 8

9. Nursing interventions consist of advising the patient to:
 Eat frequent, small meals.
 Take sips of milk or hot tea.
 Eat slowly.
 Avoid fatty and gas-forming foods such as beans.
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10.  Maintain good posture to give the gastrointestinal
tract lots of space.
 Do not lie down after eating.
 The best relief is obtained by sucking on an antacid
tablet until the pain goes away (one or two tablets).
Pepcid AC, Zantac 75, or Prilosec OTC can also be
used safely during pregnancy.
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11. Constipation
 The gastrointestinal tract motility is slowed due to
increased progesterone resulting in increased
reabsorption of water and drying of stool; and
compression of the intestines by the enlarging uterus.
 Predisposition to constipation due to oral iron
supplement (side effect of iron therapy is
constipation). Some patients respond with diarrhea.
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12. Nursing intervention consists of advising the
patient to:
 Drink at least six glasses of water per day.
 Increase roughage in the diet (for example, bran,
coarse ground cereals, and fresh fruits and vegetables
with skins).
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13.  Do moderate exercise every day, especially walking.
 Maintain a regular schedule for bowel movements.
 Utilize deep breathing and relaxation techniques.
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14. 4.Supine Hypotension (Vena
Cava Syndrome) Supine hypotension is caused by pressure of the
gravid uterus on the ascending vena cava when the
woman is supine which decreases the return of the
blood.
 Symptoms include nausea, cold and clammy, feels
faint, and hypotensive (decreased blood pressure).
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15. Supine hypotension 15

16. Nursing interventions consist of advising the patient to:
 Get up slowly.
 Use the side-lying position, preferably on the left side.
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17. 5.Varicose Veins.
 Varicosity is an enlargement of the lumen of a vein
due to thinning and stretching of its walls.
 It is caused by the relaxation of smooth muscle walls
of veins, which is due to increased hormones
(progesterone), which causes pelvic vasocongestion.
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18.  This condition is aggravated during pregnancy due to
the enlarging uterus in the pelvis causing pressure on
the great abdominal veins, which interferes with return
blood flow from the lower extremities.
 It is also aggravated by gravity and bearing down for
bowel movements. This may also be a hereditary
disposition.
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19.  Varicosity involves the veins of the lower extremeties
(legs), the external genitalia (vulva or labia), the pelvis,
and the perineal area (hemorrhoids).
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20. Nursing intervention consists of advising the patient to:
 Avoid obesity.
 Avoid lengthy standing or sitting.
 Avoid constrictive clothing.
 Avoid constipation and bearing down.
 Elevate legs when sitting.
 Get adequate rest.
 Perform moderate exercise.
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21. Treatment once varicose veins have developed.
 Rest with legs and hips elevated.
 Wear support stockings before rising (getting up) if
varicose veins are severe.
 Lie on the bed with legs extended at a right angle to
the body if ordered by the physician
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22.  If in the vulva, may be relieved by placing a pillow
under the buttocks to elevate the hips, assuming the
Sim's position for a few minutes several times a day,
avoid standing as much as possible or laying down
instead of sitting.
 To relieve pain and swelling, take hot sitz baths or local
application of astringent compresses (witch hazel
pads).
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23. 6.Edema (Ankle Edema,
Nonpitting to Lower
Extremities) Edema is very common during pregnancy.
 It most often occurs during the second and third
trimesters.
 Edema is caused by reduced blood circulation in the
lower extremities as the gravid uterus puts pressure
on the large vessels.
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24. Edema is most noticeable at the end of the day and it is
normal in pregnancy as long as it is not accompanied
by the following:
 Proteinuria (the presence of an excess of serum
proteins in the urine).
 Edema of nondependent parts.
 Sudden increase in weight.
 Hypertension.
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25. Nursing intervention consists of advising the patient
to:
 Maintain good posture.
 Avoid prolonged standing or sitting.
 Wear support stockings.
 Avoid constrictive clothing (garters, knee-high hose).
 Drink at least eight glasses of fluid for "natural"
diuretic effect.
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26.  Get adequate rest and exercise; include rest periods to
elevate legs.
Treatment of ankle edema.
 Elevate the feet as often as possible.
 Apply support stockings before getting up.
 Diuretics are contraindicated.
 If condition worsens to a generalized edema, the
doctor should be notified.
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27. 7. Leukorrhea.
 Leukorrhea is a white or yellowish mucous discharge
from the cervical canal or the vagina.
 It is caused by the hormonal stimulation of the cervix,
which becomes hypertrophic and hyperactive
producing an abundant amount of mucous.
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28.  Leukorrhea is not preventable and the patient should
not douche.
 Leukorrhea may lead to pruritis (severe itching),
burning on urination, foul odor from the discharge, or
edema of the vulva.
 NOTE: The physician should be notified immediately if
any of the above symptoms appear. It may be an
infection.
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29. Treatment/nursing intervention consists of:
 Reassuring the patient that this is normal.
 Tell the patient to use perineal pads and to change
them frequently.
 Also, to cleanse the vulva at least once a day with
and water and to dry thoroughly.
 Advising the patient to maintain good hygiene.
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30. 8.Braxton Hicks'
Contractions
 These are mild, intermittent, usually painless, uterine
contractions.
 These contractions are in the preparation for the work
of labor.
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31. Treatment/nursing interventions consist of advising
the patient:
 That these are normal contractions
 To get plenty of rest.
 To change position as often as possible.
 To practice breathing techniques when contractions
are bothersome.
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32. 9.Urinary Frequency and
Urgency
 This is caused by the vascular engorgement and
altered bladder function.
 It is caused by an increase in hormones and by the
reduction of bladder capacity.
 This is due to the enlarging uterus and fetal
presenting part.
 NOTE: The presenting part is that part of the fetus
which lies closest to the internal os of the cervix.
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33. Nursing interventions consist of advising the patient:
 That this is normal.
 To limit fluid intake before bedtime to ensure rest.
 To wear perineal pads.
 Notify the physician if pain or burning is noted.
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34. 10.Stress Incontinence
 This occurs later in pregnancy. The patient may
actually void on herself.
 Stress incontinence is caused by the enlarging uterus
and pressure on the presenting part on the bladder.

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35. Nursing interventions consist of:
 Teaching the mother how to do the Kegel exercise.
 The Kegel exercise is the alternate tightening and
relaxing of the muscles of the perineum.
 Encouraging the mother to wear perineal pads.
 Informing the patient to notify the physician so that
rupture of the membranes can be ruled
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36. 11.Dyspnea
 Dyspnea is caused by the limited expansion of the
diaphragm by the enlarging uterus.
 It may be an increased sensitivity to or compensation
for slight acidosis ("breathing for two").
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37. Diaph early in preg 37

38. Diaph in late preg 38

39.  One contributing factor to the shortness of breath
commonly seen among pregnant women is due to the
expanding abdominal contents, resulting in elevation
of the diaphragm and a widening or flaring of the rib
cage.
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40.  Dyspnea may be very troublesome in the last weeks of
pregnancy.
 The patient may have difficulty sleeping.
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41. Nursing interventions consist of advising the patient
to:
 Sleep on additional pillows.
 Maintain good posture.
 Avoid overeating.
 Stop or decrease smoking.
 Limit activity before becoming dyspenic.
 Decrease anxiety by concentrating on slow, deep
breaths.
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42.  Dyspnea of sudden onset in patients who are known
to have heart disease may be a sign of impending
heart failure. The physician should be notified
immediately.
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43. 12.Nasal Stuffiness
 Nasal stuffiness is caused by increased vascularization
due to the increase in hormone.
 It is not preventable; functioning of the nasal will
return to normal after delivery
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44. 13.Backache
 Backache is caused by relaxation of the sacroiliac joint
which is due to increased hormones (steroid sex
hormone and relaxing) resulting in slight joint and
muscle relaxation and increased mobility; and
exaggerated lumbar and cervico thoracic curves
caused by changes in the center of gravity from the
enlarging abdomen and breasts.
 Prevention of strain, which can cause backache,
should begin early in pregnancy.
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45. Change of posture in
pregnancy
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46. 14.Muscle Cramps
Muscle cramps are caused by:
 Compression of nerves supplying the lower
extremities due to the enlarging uterus.
 Reduced level of diffusible serum calcium or elevation
of serum phosphorus in the bloodstream.
 Fatigue, chilling, or tense body posture.
 Muscle cramps are not considered a serious
condition, but they may be quite painful.
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47. Nursing interventions consists of advising the patient
to:
 Avoid fatigue and cold legs.
 Eat a diet with adequate calcium or prescribed
 Avoid drinking too much milk per day as too much
milk will create too much phosphorus in the system.
 Take the prescribed vitamins B and D per doctor's
instructions.
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48. Treatment during muscle cramps.
 The patient should lie on her back and extend the
affected limb.
 A second individual should apply pressure on the
patient's knee with one hand and sharply flex the foot
with the other hand .
 The affected muscle may also be kneaded with the
heel or palm of the hand.
 Heat may be applied to the area of the muscle cramp.
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49. Nursing interventions consist of advising the
patient:
 That maternity girdles are no longer recommended.
 To practice good posture and good body mechanics
(use the pelvic tilt and bend at the knees).
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50.  To wear appropriate, well-fitting shoes.
 To sleep on a firm mattress or backboard.
 That backaches may indicate a kidney or bladder
infection.
 The patient must inform the physician of backache
problems. Backaches should be carefully evaluated.
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51. Danger signs in pregnancy
 Vaginal bleeding
 Oedema of face or fingers
 Severe or continuous headache
 Blurred vision
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52.  Abdominal pain
 Persistent vomiting
 Escape of fluid from the vagina
 Frequent or regular uterine contractions.
 Pelvic pressure
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53.  Dysuria
 Chills or fever
 Excessive weight gain
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54. THE END!
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