WEEK 5: NURSING MANAGEMENT OF THE DISCOMFORTS OF PREGNANCY

CREATED BY S.I.

- Breast tenderness

- palmar erythema/palmar pruritus

- nausea and vomiting

- pyrosis (heartburn)

- flatulence

- constipation

- hemorrhoids

- fatigue and headache

- frequent urination

- abdominal discomfort

- leukorrhea

first trimester discomforts (12)

breast tenderness

one of the first symptoms noticed in early pregnancy

cold air

breast tenderness is most noticeable on exposure to

bra with a wide shoulder strap

If the tenderness is enough to cause them discomfort, encourage a woman to wear a ____ for support and to dress warmly (cold increases symptoms)

pain

If actual ___ exists, the presence of conditions such as nipple fissures or other explanations for pain such as breast abscess need to be ruled out

palmar erythema/palmar pruritus

reddened palms

palmar erythema

Explain that this type of itching in early pregnancy is normal before she spends time trying different soaps or detergents or attempting to implicate certain foods to eat

calamine lotion

can soothe palmar erythema

estrogen

As soon as the woman's body adjusts to the increased level of ___, the erythema and pruritus disappear

pruritus

itchiness of the skin

nausea and vomiting

morning sickness

○ Eat dry crackers or toast. (any carbohydrate will do in the morning, 30 mins before getting up)

○ Get out of the bed slowly.

○ Drink adequate fluids between meals, especially fruit juices.

○ Avoid highly spicy, fatty, and highly seasoned foods.

○ Eat small, frequent meals.

○ Avoid overeating.

what to instruct mother for morning sickness

pyrosis

heartburn

what to advice mother for heartburn

● Avoid coffees, soda, and cigarettes (anything that can increase the acidity of the stomach)

● Avoid greasy and highly seasoned foods.

● Loose clothing at waistline

● Stay upright position for at least 2 hrs after meals(to facilitate digestion)

● May use aluminum-based antacids (Amphogel) as ordered by the doctor.

● Drink 6-8 glasses of water daily

● Chew food thoroughly.

● If they pick things from the floor, it is best to bend at the knees, not at the waist

flatulence advice

- Small frequent feeding and avoiding gas forming foods (chewing gum, soda, hard candies, beans)

advice for constipation

● Increase fluid intake. At least 6-8 glasses of water per day

● Increase roughage in the diet. (food and vegetables)

● Regular exercise.

● Observe daily a regular bowel movement.

● Drink warm water in the morning.

hemorrhoids

can be prevented by preventing constipation and other forms of straining

hemorrhoids instruction

○ Avoid prolonged sitting or standing

○ Knee-chest position for 10-15 mins

○ Good bowel habits

○ Proper dietary management. EOF (encourage oral fluid)

○ Hot sitz bath (if hemorrhoid is already present)

○ Stool softeners or non-steroidal cream as doctors order

advice for fatigue and headache

● Have adequate rest and sleep. Best to have 8 hrs average sleep at night. 1-2 hrs nap during the day.

● Avoid prolonged standing.

● Practice good body mechanics.

● Maintain good posture.

● Report increase in fatigue with regular exercise. (danger sign of heart disease)

frequent urination

attendting to the urge to void in prevention of urinary stasis thus preventing chances of UTI

advice for frequent urination

○ EOF (except at bedtime to prevent nocturia)

○ Practice regular voiding.

○ Perineal hygiene from front to back.

○ Report any burning sensation, dysuria, cloudy urine or tea-colored urine.

○ In cases of stress incontinence, do kegel exercise.

Kegel exercise

- Pretending you have to urinate and holding it

● Relax and tightenmthe muscles thatmcontrol urine flow.

● It is important to find the right muscles to

tighten.

3msecs with 10 repetitions, 3x/day.

When to do Kegel exercises

Abdominal discomfort

Related to round ligament pain

Ectopic pregnancy

abdominal discomfort may also indicate ___ in the first trimester

Leukorrhea

whitish vicious vaginal discharge during first trimester

- daily bath, no tampons, no touching

- underwear w cotton crotch

- check for pruritus

How to manage leukorrhea

Backache, ankle edema, varicosities, leg cramps, shortness of breath, nasal sturdiness

Second and third trimester discomforts

Lumbar lordosis

Backache is common to manifest what

What to do for backache

- supportive shoes

● Proper body mechanics

● Do prenatal exercises

● Maintain normal weight gain

● Heating pad

● Supportive mattress

Pelvic-rocking or tilt and tailor sitting

What prenatal exercises to do for backache

20 minutes

Lie or sit with legs elevated for ___ to promote venous return

What to do for ankle edema

● Lie or sit with legs elevated for 20 mins to promote venous return

● Avoid prolonged standing

● Avoid tight clothing (no rag or constricting garter)

● Avoid high salted foods, eat high protein foods

● Report swelling of hand and face

Varicosities instruction

● No round garter around abdomen and legs

● Leg & hips elevation, as advised

● Stockings before waking up

○ Avoid knee high stockings, rather use

supportive pantihose

● Vitamin C

Vitamin c

A building block for veins and blood vessels

Leg cramps

Happens when low calcium, high phosphorus

- Knee extension, foot dorsiflexion

- calcium supplement

What to do for leg cramps

shortness of breath instruction

● Maintain good posture and avoid fatigue

● Elevate the head with several pillows and avoid supine position

● Avoid constricting bra and tight clothes

● Report increasing dyspnea with minimal activity or dyspnea prior to 36 weeks bc this implies pathologic condition

what to do for nasal stuffiness

- steam inhalation or vaporizers

- saline nose drops

- self medication is discouraged

- warm bath before bedtime

- take hot drink

- conducive environment while ventilated

modified steam inhalation or vaporizer practice

bowl filled with warm water with towel; relieves congestion

- vaginal bleeding

- sudden escape of fluid from vagina

- chills, fever, and dysuria

- persistent vomiting

- increase or decrease in fetal movement

- abdominal or chest pain

- edema or swelling around the face and sacrum

- headache and blurred vision

- sudden increase in bp

- rapid weight gain

danger signs of pregnancy

membranes are ruptured

When a gush of clear fluid is discharged suddenly form the vagina, it means that

uterine cavity

the mother and the fetus are now threatened bc the __ is no longer shield against infection

umbilical cord prolapse

what happens following the membrane rupture If a fetus is small and the head does not fit snugly into the cervix

chills, fever, and dysuria

May indicate infection specifically urinary tract infection, both the mother and fetus

persistent vomiting

common in pregnancy; in the first semester for 1-2 day

extended vomiting

deplete nutritional stores and can cause dehydration

nutritional problem

if persistent vomiting passes 2 weeks with persistence and increased frequency indicates what

need for oxygen and requires further evaluation

Unusual increase and decrease in movement suggest that a fetus is responding to what

false

there is pain when uterus expands

abdominal pain

sign of some other problems such as tubal, ectopic pregnancy, separation of placenta, preterm labor, or something unrelated to pregnancy but is equally serious such as appendicitis, ulcer, or pancreatitis

pulmonary embolus

chest pain may indicate what

pulmonary embolus

complication resulting from thrombophlebitis and is considered a medical emergency

7. EDEMA OR SWELLING AROUND THE FACE AND SACRUM

8. HEADACHE AND BLURRED VISION

9. SUDDEN INCREASE IN BP

10. RAPID WEIGHT GAIN

what dangers are related to pregnancy-induced hypertension or preclampsia

pregnancy-induced hypertension or preeclampsia

potentially severe and even fatal elevation of blood pressure that occurs during pregnancy

edema

normal in ankle esp in late weeks of pregnancy

extended edema to the face

what indicates extensive edema

visual disturbances or continuous headache

may signal cerebral edema or acute hypertension

amniotic sac/fluid

- surrounds the fetus

- filled with amniotic fluid to allow the fetus to move freely within the uterus

ruptured amniotic sac

may not happen as sudden gush but it can be characterized by gas leaking

nitrazine paper

is used to verify if it is amniotic fluid; may be urinary incontinence

vaginal examination or vaginal speculum

membrane rupture can also be verified through what

high risk pregnancy

One in which the mother or fetus has a significantly increased chance of harm, damage, injury or disability and loss of life or death

1. maternal age (dmographic factor)

2. poor nutritional status (post risk) (demographic factor)

3. low socio-economic status

4. hx of obstetrical complications

5. hx or with existing medical problems

6. maternal lifestyle

7. increased parity

8. work exposure to teratogens

9. family or environmental violence

indications of high risk pregnancy (9)

20-30 years

optimal child bearing age

under 16 rs and over 35 yrs old

age of higher risk for pregnancy

low socio-economic status

puts fetus at greater risk including inadequate finances, overcrowding, poor standard of housing, poor hygiene and nutritional deprivation, severe social problems, unplanned and unprepared pregnancy especially among adolescents

obstetric compliactions

history of infertility or multiple gestation, grand multiparity, previous abortion or ectopic pregnancy, previous losses which includes fetal death, still birth, neonatal or perinatal death, previous c-section or forceps delivery, previous uterine or cervical abnormality, previous abnormal labor or having history of high risk infants.

maternal medical history

cardiac or pulmonary disease, metabolic diseases such as Diabetes Mellitus, and Thyroid diseases, Chronic renal

diseases, chronic hypertension, seizure disorders, cancer, and emotional disorders.

maternal habits or lifestyle

smoking during pregnancy, regular alcohol intake, drug use and abuse.

increased parity

Makes the uterus lax and ineffective for further labor.

physical assault or trauma to mother

can ause emotional stress which is teratogenic

physical trauma

preterm labor and premature separation of placenta which can cause bleeding and fetal death.

teratogens

Refers to the agents and conditions including viruses, drugs, chemicals, stressors, and malnutrition which can impair prenatal develop and lead to birth defects or even death.

strength and timing

fators considered that determines d influence of teratogens to the feetus

strength

A certain teratogen potential for causing harm, increases when it is combined with another teratogen or another risk factor. This is referred to as

timing

timing or the effect of a teratogen on the developing organism depends on what period in the preganncy or in the development the child is exposed to the teratogen.

1. malaria

2. toxoplasmosis

3. rubella (german measles)

4. herpes simplex virus 2 (genital herpes)

5. cytomegalovirus

6. syphilis

7. vaccines

8. alcohol

9. cigarette

10. radiation

11. drugs

12. hyperthermia

13. teratogenic maternal stress

different teratogens (13)

anopheles mosquito

where does malaria come from

chloroquine

drug of choice for malaria

uncooked meat or cat stool

where can toxoplasmosis come from

toxoplasma

what parasite causes toxoplasmosis

myxovirus

what virus causes rubella or german measles

rubella (german measles)

acute viral infection caused by myxovirus; cause deafness, eye defects, CNS defects, cardiac malformation, and/or fetal death.

rubella titer

measure level or amount of antibodies against rubella

when titer is low

when are unpregnant women indicated to receive the rublella vax

3 months

until when should women avoid pregnancy after rubella vaccination

herpes simplex virus 2

can cause remission and exacerbation; can be a asymptomatic but symptoms may exacerbate when she is stressed or in the precense of other infections

signs for herpes simplex virus 2 (genital herpes

painful vaginal vesicle in the genitalia which may be transmitted through genital birth. It can also cause spontaneous miscarriage and preterm birth

cesarean section or operative delivery esp during active infection

how is herpes simplex virus 2 managed

cytomegalovirus

can be transmitted transplancentally or through droplets; can be asymptomatic or have flu symptoms which can cause neuro damage to fetus

treponema pallidum

what causes syphilis

1st 16 weeks

placenta has a barrier against syphilis during what period

after 6 weeks AOG

the barrier of the placenta can infect the fetus when

benzathine penicillin at 1st trimester

what is the drug of choice for syphilis and what trimester

1st 16 weeks

when is regular screening schedule done for syphilis if mother had syphilis prior to pregnancy

after 16 weeks AOG

when is screening done to check if fetus was infected

vaccines

should not be administered during pregnancy

3 mnths b4 pregnancy or immediate postpartum

when are vaccines advised to be given

alcohol ingestion

liikely to cause fetal abnormalities