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Minor Discomforts of Pregnancy
Minor Discomforts of Pregnancy
 The practical nurse is an invaluable member of the health care
team when working with pregnant patients.
 Being knowledgeable and capable to support the patient and
to give her advice to make her more comfortable is very
important during the pregnancy.
 Since the patient is carrying a new life within her, her body
must make certain adaptations to his presence.
 These adaptations of the body can be very annoying, and by
your intervention, you may help the new pregnant patient to
carry her pregnancy more comfortably and safely.
 Do be aware that all patients do not experience all of the
discomforts and some patients pass through the entire ante
partal period without any complications of this type.
NAUSEA AND VOMITING (MORNING SICKNESS)
Due To
 high levels of human chorionic gonadotropin (HCG) or
progesterone, cultural expectations,
 emotional factors
 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).
Nausea and vomiting usually appear early in the first trimester (4 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.
Nursing interventions
 Reassure the mother
 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.
 Reduce fatty and fried containing foods.
 Rest
 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 .
 Due to increased progesterone
thereby allowing for esophageal
regurgitation, decreased emptying
time of the stomach, and reverse
peristalsis.
 Heart burn is most troublesome at
30-40 weeks gestation because at
this stage is under pressure from the
growing uterus.
NURSING INTERVENTIONS
 Eat frequent, small meals.
 Take sips of milk or hot tea.
 Eat slowly.
 Avoid fatty and gas-forming
 Maintain good posture to
give the gastrointestinal tract
lots of space.
 Do not lie down after eating.
 sleeping with more pillows
than usual.
 For persistence/sever case/
prescribe antacids.
HEART BURN (PYROSIS)
Pica
 This is the term used
when mother craves
certain foods of
unnatural substances
such as coal, soil...etc.
 The cause is unknown
but hormones and
changes in metabolism
are blamed.
 NURSING
INTERVENTIONS
 Seek medical advice if the
substance craved is
potentially harmful to the
unborn baby.
Constipation.
 The gastrointestinal tract
motility is slowed
 Due to
 increased progesterone
resulting in increased
reabsorption of water and
drying of stool
 compression of the intestines by
the enlarging uterus.
 (2) Predisposition to
constipation due to oral iron
supplement (side effect of iron
therapy is constipation)
NURSING INTERVENTIONS
 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).
 Do moderate exercise every
day, especially walking.
 Maintain a regular schedule for
bowel movements.
 Utilize deep breathing and
relaxation techniques.
BACK ACHE
Nursing interventions Backache is caused by relaxation
of the sacroiliac joint
 due to
 increased hormones
(steroid sex hormone and
relaxing) resulting in slight
joint & muscle relaxation
and increased mobility
 exaggerated lumbar and
cervico thoracic curves
caused by changes in the
center of gravity from the
enlarging abdomen and
breasts.
 That maternity girdles are no
longer recommended.
 To practice good posture and
good body mechanics (use the
pelvic tilt and bend at the
knees).
 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.
Muscle Cramps.
1) 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.
(2) Muscle cramps are not considered a serious condition,
but they may be quite painful.
Muscle Cramps.Nursing interventions
. Avoid fatigue and cold legs.
 Eat a diet with adequate
calcium or prescribed calcium.
 Avoid drinking more than one
(1) quart of milk per day. More
than one quart of milk per day
will create too much
phosphorus in the system.
 Take the prescribed vitamins B
and D per doctor's instructions.
Relief of muscle cramp
TREATMENT DURING MUSCLE
CRAMPS
(a) 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.
(b) Heat may be applied to the area of
the muscle cramp.
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
Nursing interventions
 Get up slowly.
 Use the side-lying position, preferably
on the left side.
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.
 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.
 Varicosity involves the veins of the lower extremities (legs),
the external genitalia (vulva or labia), the pelvis, and the
Perineal area (hemorrhoids).
Nursing intervention
 Avoid obesity.
 (b) Avoid lengthy standing or
sitting.
 (c) Avoid constrictive clothing.
 (d) Avoid constipation and
bearing down.
 (e) Elevate legs when sitting.
 (f) Get adequate rest.
 (g) Perform moderate exercise.
 Treatment once varicose veins have
developed.
 (a) Rest with legs and hips elevated.
 (b) Wear support stockings before
rising (getting up) if varicose veins are
severe.
 (c) Lie on the bed with legs extended
at a right angel to the body if ordered
by the physician (see figure 8-3 A).
 (d) If in the vulva, may be relieved by
placing a pillow under the buttocks to
elevate the hips, assuming the Sim's
position (see figure 8-3 B) for a few
minutes several times a day, avoid
standing as much as possible, or
laying down instead of sitting when
practical.
 (e) To relieve pain and swelling, take
hot sitz baths or local application of
astringent compresses (wi
 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 angel to the body (A) if
ordered by the physician .
 If in the vulva, may be relieved by
placing a pillow under the buttocks
to elevate the hips, assuming the
Sim's position (B) for a few minutes
several times a day, avoid standing as
much as possible, or laying down
instead of sitting when practical.
 To relieve pain and swelling, take
hot sitz baths or local application of
astringent compresses .
Positions for treatment of varicose
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.
 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:
(a) Proteinuria (the presence of an excess of serum proteins in
the urine).
(b) Edema of nondependent parts.
(c) Sudden increase in weight.
(d) Hypertension.
Nursing intervention
 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.
 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
patient should notify her
physician
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").
 Dyspnea may be very
troublesome in the last
weeks of pregnancy.
 The patient may have
difficulty sleeping.
NURSING INTERVENTIONS
 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.
 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.
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.
Leucorrhea.
 Leucorrhea is a white or
yellowish mucous discharge
from the cervical canal or the
vagina.
 Caused by the hormonal
stimulation of the cervix,
which becomes hypertrophic
and hyperactive producing
an abundant amount of
mucous.
 Leucorrhea is not
preventable and the patient
should not douche.
 Leucorrhea may lead to
 Pruritis (severe itching),
 Burning on urination,
 Foul odor from the discharge,
 Or edema of the vulva.
NURSING INTERVENTION
 Reassuring the patient
that this is normal.
 Tell the patient to use
Perineal pads and to
change them frequently.
 To cleanse the vulva at
least once a day with soap
and water and to dry
thoroughly.
 Advising the patient to
maintain good hygiene.
Braxton Hicks' Contractions
 These are mild,
intermittent, usually
painless, uterine
contractions.
 These contractions are in
the preparation for the
work of labor
NURSING
INTERVENTIONS
 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.
Urinary Frequency and Urgency
 Caused by the vascular
engorgement and altered
bladder function.
 Caused by an increase in
hormones and by the
reduction of bladder
capacity.
 Due to the enlarging
uterus and fetal
presenting part.
NURSING
INTERVENTIONS
 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.
Stress Incontinence
 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.
 NURSING INTERVENTIONS
 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 out.
Thank you

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Minor disorders of pregnancy

  • 2. Minor Discomforts of Pregnancy  The practical nurse is an invaluable member of the health care team when working with pregnant patients.  Being knowledgeable and capable to support the patient and to give her advice to make her more comfortable is very important during the pregnancy.  Since the patient is carrying a new life within her, her body must make certain adaptations to his presence.  These adaptations of the body can be very annoying, and by your intervention, you may help the new pregnant patient to carry her pregnancy more comfortably and safely.  Do be aware that all patients do not experience all of the discomforts and some patients pass through the entire ante partal period without any complications of this type.
  • 3.
  • 4. NAUSEA AND VOMITING (MORNING SICKNESS) Due To  high levels of human chorionic gonadotropin (HCG) or progesterone, cultural expectations,  emotional factors  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). Nausea and vomiting usually appear early in the first trimester (4 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.
  • 5. Nursing interventions  Reassure the mother  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.  Reduce fatty and fried containing foods.  Rest
  • 6.  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 .  Due to increased progesterone thereby allowing for esophageal regurgitation, decreased emptying time of the stomach, and reverse peristalsis.  Heart burn is most troublesome at 30-40 weeks gestation because at this stage is under pressure from the growing uterus. NURSING INTERVENTIONS  Eat frequent, small meals.  Take sips of milk or hot tea.  Eat slowly.  Avoid fatty and gas-forming  Maintain good posture to give the gastrointestinal tract lots of space.  Do not lie down after eating.  sleeping with more pillows than usual.  For persistence/sever case/ prescribe antacids. HEART BURN (PYROSIS)
  • 7. Pica  This is the term used when mother craves certain foods of unnatural substances such as coal, soil...etc.  The cause is unknown but hormones and changes in metabolism are blamed.  NURSING INTERVENTIONS  Seek medical advice if the substance craved is potentially harmful to the unborn baby.
  • 8. Constipation.  The gastrointestinal tract motility is slowed  Due to  increased progesterone resulting in increased reabsorption of water and drying of stool  compression of the intestines by the enlarging uterus.  (2) Predisposition to constipation due to oral iron supplement (side effect of iron therapy is constipation) NURSING INTERVENTIONS  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).  Do moderate exercise every day, especially walking.  Maintain a regular schedule for bowel movements.  Utilize deep breathing and relaxation techniques.
  • 9.
  • 10. BACK ACHE Nursing interventions Backache is caused by relaxation of the sacroiliac joint  due to  increased hormones (steroid sex hormone and relaxing) resulting in slight joint & muscle relaxation and increased mobility  exaggerated lumbar and cervico thoracic curves caused by changes in the center of gravity from the enlarging abdomen and breasts.  That maternity girdles are no longer recommended.  To practice good posture and good body mechanics (use the pelvic tilt and bend at the knees).  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.
  • 11. Muscle Cramps. 1) 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. (2) Muscle cramps are not considered a serious condition, but they may be quite painful.
  • 12. Muscle Cramps.Nursing interventions . Avoid fatigue and cold legs.  Eat a diet with adequate calcium or prescribed calcium.  Avoid drinking more than one (1) quart of milk per day. More than one quart of milk per day will create too much phosphorus in the system.  Take the prescribed vitamins B and D per doctor's instructions. Relief of muscle cramp TREATMENT DURING MUSCLE CRAMPS (a) 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. (b) Heat may be applied to the area of the muscle cramp.
  • 13.
  • 14. 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
  • 15. Nursing interventions  Get up slowly.  Use the side-lying position, preferably on the left side.
  • 16. 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.  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.  Varicosity involves the veins of the lower extremities (legs), the external genitalia (vulva or labia), the pelvis, and the Perineal area (hemorrhoids).
  • 17. Nursing intervention  Avoid obesity.  (b) Avoid lengthy standing or sitting.  (c) Avoid constrictive clothing.  (d) Avoid constipation and bearing down.  (e) Elevate legs when sitting.  (f) Get adequate rest.  (g) Perform moderate exercise.  Treatment once varicose veins have developed.  (a) Rest with legs and hips elevated.  (b) Wear support stockings before rising (getting up) if varicose veins are severe.  (c) Lie on the bed with legs extended at a right angel to the body if ordered by the physician (see figure 8-3 A).  (d) If in the vulva, may be relieved by placing a pillow under the buttocks to elevate the hips, assuming the Sim's position (see figure 8-3 B) for a few minutes several times a day, avoid standing as much as possible, or laying down instead of sitting when practical.  (e) To relieve pain and swelling, take hot sitz baths or local application of astringent compresses (wi
  • 18.  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 angel to the body (A) if ordered by the physician .  If in the vulva, may be relieved by placing a pillow under the buttocks to elevate the hips, assuming the Sim's position (B) for a few minutes several times a day, avoid standing as much as possible, or laying down instead of sitting when practical.  To relieve pain and swelling, take hot sitz baths or local application of astringent compresses . Positions for treatment of varicose
  • 19. 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.  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: (a) Proteinuria (the presence of an excess of serum proteins in the urine). (b) Edema of nondependent parts. (c) Sudden increase in weight. (d) Hypertension.
  • 20. Nursing intervention  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.  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 patient should notify her physician
  • 21.
  • 22. 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").  Dyspnea may be very troublesome in the last weeks of pregnancy.  The patient may have difficulty sleeping. NURSING INTERVENTIONS  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.  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.
  • 23. 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.
  • 24.
  • 25. Leucorrhea.  Leucorrhea is a white or yellowish mucous discharge from the cervical canal or the vagina.  Caused by the hormonal stimulation of the cervix, which becomes hypertrophic and hyperactive producing an abundant amount of mucous.  Leucorrhea is not preventable and the patient should not douche.  Leucorrhea may lead to  Pruritis (severe itching),  Burning on urination,  Foul odor from the discharge,  Or edema of the vulva. NURSING INTERVENTION  Reassuring the patient that this is normal.  Tell the patient to use Perineal pads and to change them frequently.  To cleanse the vulva at least once a day with soap and water and to dry thoroughly.  Advising the patient to maintain good hygiene.
  • 26. Braxton Hicks' Contractions  These are mild, intermittent, usually painless, uterine contractions.  These contractions are in the preparation for the work of labor NURSING INTERVENTIONS  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.
  • 27.
  • 28. Urinary Frequency and Urgency  Caused by the vascular engorgement and altered bladder function.  Caused by an increase in hormones and by the reduction of bladder capacity.  Due to the enlarging uterus and fetal presenting part. NURSING INTERVENTIONS  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.
  • 29. Stress Incontinence  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.  NURSING INTERVENTIONS  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 out.