Minor discomfort during pregnancy

 

 

 

1- Introduction.

2- Definition.

3- During 1^st trimester & their management:

a) nausea & vomiting.       b) urinary frequency.

c) increased vaginal.

d) increase vaginal discharge.

e) nasal stiffness & epistaxis.

f) ptyalism              g) fatigue

h) dizziness/ fainting             I) headache

4- During 2^nd trimester & their management:

a) heart burn                 b) constipation & hemorrhoids

c) flatulence                 d) Braxton hicks contraction

5- During 3^rd trimester & their management:

a) shortness of breath       b) ankle edema

c) varicosities                     d) leg cramps

e) round ligament pain      f ) carpal tunnel syndrome

g) gingivitis & epulis         h) back ache

Introduction :

Most women experience the minor discomforts of pregnancy. Not all woman have these discomforts, & some go through the entire prenatal period without any.

Although the discomforts are not serious, their presence detracts from the women's feeling of comfort & well – being.

Pregnancy is a time of radical charge in a women's whole body. The signs & symptom of these changes can manifest themselves in many ways. A women may experience one, few or all the normal discomforts of pregnancy. It is important to help the pregnant women distinguish between normal discomfort & a signs that may signal real problem in the pregnancy & help pregnant woman to cope & deal with them on herself as these discomforts are usually related to the changes necessary to adapt to the growing fetus that are occurring in the body systems.

Definition:

         The discomforts that woman experience through out pregnancy.

Minor discomfort during 1st trimester:

1- Nausea & vomiting:

·       Nausea : The feeling of an imminent desire to vomit or the physical sensation of vomiting without expulsion of gastric content.

·       Vomiting: Is the forceful oral expulsion of gastric contents.

·       Nausea & vomiting during pregnancy called "morning sickness", for many women, is considered as a sign of pregnancy especially with missed menstrual period.

·       They usually begin about the 6^th week of pregnancy & stop around the time of the 12^th or 16^th week of pregnancy. Some women. May have this condition until the end of their pregnancy. The incidence of vomiting is estimated to beat least 50% ^ the incidence of nausea is estimated to be 70%.

·       The cause of this condition during pregnancy is known but some theories said because increase level of progesterone level of progesterone level as it has a generalized "softening" effect on stomach. Another theory is that elevated levels of steroid hormones & HCG may be involved.

Nursing Intervention:

         If this condition left untreated, severe nausea & vomiting can lead to weigh loss, dehydration & electrolyte imbalance & that can lead to health problems of pregnant women & their fetus, so these problems can more prevented by:

1-    Small, frequent meals, as these are more apt to be retained than 3 large meals a day.

2-    Dry crackers before getting up in the morning.

3-    Something sweet to eat or drink before going to bed or getting up.

4-    Avoidance of foods with strong or offensive odors.

5-    Restriction of fats in her diet.

6-    Reassurance that nausea will end sometimes during the fourth month of pregnancy.

7-    Vitamin B6, 50mg BID po.

2- Urinary Frequency:

Def:

         Frequent passage of urine & increased night urination occurring in the 1^st & 3^rd trimester.

-        Urinary frequency occurs in the 1^st trimester due to the increased weight in the funds of the uterus, with softening of the isthmus causing increased ante flexion the enlarging uterus, which cause direct pressure on the bladder.

-        In the 2^nd trimester, the uterus continues to enlarge & rises out of the pelvis to become an abdominal organ while the bladder remains a pelvic organ so urinary frequency sensation diminished. During the 3^rd trimester this sensation increase especially in primigravidas as the presenting part descends into pelvis & causes direct pressure against the bladder.

N.B:

         The pregnant woman should differentiates between urinary frequency & signs of UTI. If the women has symptoms such as pain or burning urgency when urinating or noticed any blood in her urine, she should notify her health care provider.

Nursing Intervention:

1-    Empty bladder regularly.

2-    Perform kegel exercise to prevent stress incontinence.

3-    Limit fluid intake before bed time.

4-    Wear perineal pad.

5-     Avoid caffeine & cola as they increase urinary frequency.

3- Breast tenderness & enlargement:

Breast tenderness often is one earliest symptoms experienced in pregnancy. For most women the tenderness is minimal & transient. During pregnancy, breasts are going though many changes as: increase amounts of estrogen enhance fat storage & development of the mammary ducts, alveoli & nipples. Progesterone influences glandular tissue & lobular – alveolar growth. The breast size is enlarged, vascular circulation is expanded, the nipples are larger, the areola is deeply pigmented. The hyperplasia of the breast contributes to breast tenderness.

- During pregnancy breast will enlarge but should return to normal after the pregnancy ends & finished breast feeding.

Nursing intervention:

1-    Explain to the women that breast tenderness decreases in the 2^nd trimester.

2-    Wear supportive bras with pods to absorb discharge.

3-    Wash with warm water, keep dry & avoid soap on ripples.

4-    Breast self examination should be conducted throw out pregnancy.

5-    Change sleeps positions.

4- Increased vaginal discharge "leucorrhea" :

Def:

          Profuse, thin or thick, whitish, viscous vaginal secretion. It is a physiologic change due to increased mucus production by endocervical glands & vaginal mucosal hyperplasia. Leucorrhea is consisting of mucus & exfoliated vaginal epithelial cells. Usually these secretions with no odor, irritation, itching, or discomfort unless hygiene is poor. The secretion is acidic by the action of lactic bacilli on the glycogen in the vain gal epithelial cells & that serves the function of protecting the mother & fetus against possible harmful infection.

Nursing intervention:

1-    Don't douche.

2-    Promote cleanliness by daily bathing.

3-    Wear perineal pad.

4-    Use cotton underwear & avoid nylon underwears.

5-    Report if accompanied by pruritus, foul odar, or change in color.

5- Nasal stuffiness & epistaxis:

The capillaries inside the nose become enlarged with blood during pregnancy leading to edema & hyperemia of the nasal passage. These changes can lead to epistaxis & nasal congestion. Increase estrogen levels during pregnancy results in congestion of nasal mucosa. The effect of elevated progesterone which makes the membranes softer & more vascular.

 

Nursing intervention:

1-    Use cool humidifier.

2-    Avoid trauma.

3-    Normal saline nose drops or spray may be used.

6- Ptyalism "excessive salivation":   

Ptyalsim is an unusual condition that may be caused by increase acidity in the mouth or by the intake of starch that stimulate the salivary glands in women & they become susceptible to excessive secretion. The sense of nausea frequent the ptyalism as the desire to avoid nausea causes the patient to swallow less, thus increase the amount of saliva in the mouth.

Nursing intervention:

1-    Use astringent mouth wash.

2-    Chew gum.

3-    Eat hard candy.

7- Fatigue:

Nearly all pregnant women complain of fatigue at same point during pregnancy by the body of pregnant mother as it works very hard to build baby & significant hormonal increase are thought to influence fatigue, poor nutrition, anemia & slowed circulation also may contribute to fatigue.

Nursing intervention:

1-    Reassure the women of the normality of fatigue & its spontaneous remission by the 2^nd trimester.

2-    Help her to have frequent rest periods during the day & go to be earlier.

3-    Mild exercises.

4-    Eat well balanced diet.

5-    Warm milk may induce sleep.

8- Dizziness "drowsiness" fainting:

May women complain of lightheadedness, particularly during the 1^st three months of pregnancy, changes in blood flow during pregnancy contribute to lightheadedness. There is approximately 40% more blood volume in the pregnant women body which means her hurt must work much harder to pump her blood. The enlarging uterus crowds her blood vessels thus making the return of blood to her heart challenging. Sitting or standing too long may cause her blood to pool in her lower extremities. Since here brain is about 5 feet up from her ankles, it some times doesn't get oxygenated sufficiently & light headeness strikes. Also low blood sugar may Cause drowsiness.

Nursing intervention:

1-    Avoid sudden changes in position.

2-    Avoid warm crowded areas.

3-    Avoid hypoglycemia by eating 5-6 meals per day.

4-    Sit as necessary.

5-    Deep breathing.

9- Headache:

The cause of headache during pregnancy as hormonal influences, vascular dilatation, sinusitis, fatigue lowered blood glucose, eye strain, emotional tension, respiratory alkalosis, muscle spasm, noxious fumes, allergens, hypertension & most commonly intestine, stress or tension.

          Headache during pregnancy need Cautiou assessment which includes onset & duration of headache location & radiation. Associated symptoms: relationship to activity & monitor closely for other signs & symptoms such as blurred vision, seeing spots of hyper tension associated with pregnancy.

Nursing intervention:

1-    Get enough sleep at night & enough rest during the day.

2-    Do not go for long periods without eating.

3-    Small frequent meals.

4-    Apply a cool, wet washcloth to forehead & back of neck.

5-    Massage neck, shoulders, face, scalp & forehead.

Minor Discomforts during 2^nd trimester:

1- Heart burn & Indigestion:

          Heart burn "regurgitation": the reflux of acidic gastric contents into the lower esophagus by reversed peristalsis. The gastric contents are acidic & this acidity causes the material to burn the throat & taste bad.

Causes:

-        Diminished gastric & relaxation of the cardiac sphincter by the effect of progesterone.

-        Stress, tension, emotional disturbance, worry & fatigue.

-        Dietary fat. Coffee & smoking.

S & S:

-        Burning discomfort behind the lower sternum, radiating upward along the course of the esophagus.

-        Indigestion Caused also by the hormonal effect as progesterone & relaxin as they relax the smooth muscles of the pregnant body. Certain offending foods & beverages can cause this problem.

Nursing Intervention:

1-    Small frequent meals, to avoid overloading of the stomach.

2-    Good posture, to give more room for the stomach to function as stretching her arms high over head.

3-    Avoidance of fats with meals & beverages.

4-    Avoidance of spicy foods with meals.

5-    Avoidance of spicy foods with meals.

6-    Avoidance of heavy foods or a full meal just before bed time.

 2- Constipation & hemorrhoids:

Constipation :

1-    Slow digestion process due to decrease blood flow to intestine.

2-    The growing uterus crowds intestine & make the passage of stool difficult.

3-    Iron supplementation during prenatal period increase constipation.

4-    Worry, anxiety & low level of Exercise.

S & S:

- Pain & Difficult bowel passage of stool.

Hemorrhoids:

          Hemorrhoids are varicosities of rectal vein "swelling of veins in & around the anus"

Causes:

1-    Pressure Caused by the growing uterus on the veins & around the anus.

2-    Untreated constipation.

S & S:

- Itching, Swelling, pain & bleeding.

A- Nursing care for constipation:

1-    An adequate fluid intake.

2-    Prunes or prune juice & foods that contain roughage, bulk & natural fiber "bran".

3-    Warm liquids & adequate rest.

4-    General Exercise as Daily walk, good posture.

5-    Establishment of regular & good bowel habits.

6-    Mild laxatives, stool softeners.

B- Nursing care for hemorrhoids:

1-    Avoidance of constipating food & straining during defecation.

2-    Sitz path, as the heat water gives comfort & increase circulation.

3-    Witch hazel & Epsom salt compresses & ice bag for reduction.

4-    Reinsertion of the hemorrhoid into the rectum by lubricant.

5-    Kegel exercises.

6-    Bed rest with hips & lower extremities elevated.

3- Flatulence :

          It is commonly accompanying with constipation it is due to decreased gastrointestinal motility by the effect of progesterone from the displacement of & pressure on the intestines by the enlarging uterus. Also air swallowing & bacterial action on food in the intestine produces gas.

Nursing intervention:

1-    Chew foods slowly & thoroughly.

2-    Avoid gas – producing foods.

3-    Avoid fatty & large meals.

4-    Do exercise.

5-    Maintain regular habits.

4- Braxton hicks contractions:

          It is uterine contractions not associated with labor felt "as early as the 12^th week of pregnancy" in the 2^nd & 3^rd trimesters, they are usually in frequent & irregular in timing.

Normally these constrictions are irregular & painless & as the pregnancy progress toward full term, these contractions can become more regular, occur at more frequent intervals & cause discomfort.

Nursing intervention:

1-    Reassurance.

2-    Maintain rest.

3-    Change of position & practice breathing technique.

4-    Effleurage.

Minor Discomforts in the 3^rd trimesters:

1- Shortness of breath "Dyspnea":

          During 3^rd trimester the uterus has enlarged to the point of pressing on the diaphragm.

          In addition, the diaphragm elevates approximately 4cm during pregnancy & there is decrease in both the functional residual capacity & the residual volume of air results & that causes a feeling of difficulty in breathing & shortness of breathing. May woman to this by hyperventilation.

Nursing intervention:

1-    Have the women periodically stand up & stretch her arms above her head & take deep breath.

2-    Encourage good posture.

3-    Teach the women to do intercostals breathing.

4-    Instruct her to do the same stretching when in bed as when standing.

2- Ankle edema:

Def:

         It is swelling of the feet & lower legs.

Causes :

1-           The pregnancy women experience peripheral arterial vasodilatation with a resultant decreased filling of arterial circulation.

2-           Sodium & water retention with changes in the extra cellular fluid & plasma volume.

3-           Pressure on the iliac vein & inferior vena cava caused by an enlarging uterus increase capillary pressure in the lower extremities with a resulting filtration of fluid into the interstitial spaces.

4-           GFR &     RBF.

5-           Positional changes have some effect on sodium & water excretion.

It is important to notice weigh gain, venous sitention & facial puffiness to monitor for pregnancy induced hypertension.

Nursing intervention:

1-    Avoidance of constrictive clothing.

2-    Elevation of legs periodically throughout the day.

3-    Positioning on side when lying down.

4-    A maternity abdominal support or girdle.

3- Varicosities :

Def:

It is dilated veins that occur mostly in women with genetic predisposition.

It is found in the lower extremities they may extend to the vulva.

Cause:

1-    In competency of veins valves which allowing a reverse of blood flow.

2-    The pressure of distended uterus on the veins returing blood from lower extremists.

S & S:

- The veins become engorged, inflamed & painful.

- Severe tortuous & bulging blue veins.

Nursing intervention :

1-    Use elastic stocking & it should be put on after elevating the legs.

2-    Avoidance of tight clothing & standing for long periods.

3-    Laying in the right – angle position & the incline position.

4-    Keeping leg uncrossed when sitting.

5-    Maintain good posture & walking & do kegel exercire.

6-    Wear a maternity abdominal support or girdle.

7-    Taking warm, smoothing baths.

4- Leg cramp:

Deft:

         Sudden, intense gripping contractions of the calf muscle other muscles as the thigh or gluteal muscles may spasm during pregnancy but un common.

Causes:

1-      Serum ionized calcium &     phosphates.

2-    A shift in acid base balance as seen in respiratory alkalosis.

Make assessment for temperature changes & check for Homan's signs to exclude D.V.T.

Nursing intervention:

1-    Leg elevation periodically throughout the day.

2-    Diet includes calcium & phosphorus.

3-    General exercise.

4-    Have the women straighten her affected leg & point her hell. If the women is in bed, she need strong, steady pressure against the bottom of her foot to push against. If she standing, the floor serves this function.

5- Round ligament pain:

          Round ligaments attach on either side of the uterus just below & in front of the insertion of the fallopian tubes, these ligament are composed of smooth muscle that is continuous with the smooth muscles of the uterus.

          This muscle tissue enables the round ligaments to hypertrophy during pregnancy & in essence, stretch as uterus enlarges.

Causes :

1-    Stretching of the ligament.

2-    The pressure of the increasingly heavy uterus on the ligaments.

The feature which aids in differentiation from other abdominal organ diseases is the extension of pain into inguinal area.

Nursing intervention:

1-    Flexing her knees on to her abdomen.

2-    Bending toward the pain to ease the stretch on the ligament.

3-    Take warm baths.

4-    Applying a heat pad to the area.

5-    Wearing a maternity abdominal support or girdle.

6-    When lying on her side, support the uterus with pillow & a pillow between her knees.

6- Carpal tunnel syndrome:

This syndrome results from compression of the median nerve as it passes under the transverse carpal ligament of the wrist & cause numbness, tingling or burning in the fleshy part of hand near the thumb & several fingers.

During pregnancy this syndrome results from deposition of adipose tissue.

 

 

 

 

Nursing intervention:

1-    Avoid aggravating hand movements.

2-    Use splint as prescribed.

3-    Elevate affected arm.

7- Gingivitis & epulis: "Bleeding gum"

Gums are mucus membranes & they swell & become inflamed during pregnancy cause by high estrogen levels which stimulate increase vascularity & proliferation of connective tissue of mouth "hyperemia, hypertrophy, bleeding, & tenderness".

Nursing intervention:

1-      Well balanced diet with adequate protein & fresh fruits & vegetables.

2-      Gentle brushing & good dental hygiene.

3-      Avoid infection.

8- Backache:

Causes :

1-    Postural changes "lordosis" a long with over stretched abdominal muscles & strained back muscles.

2-    Movement of symphysis pupis & lumbosacral joints & relaxation of the pelvic ligaments.

3-    Relaxin may affect the intervertebral joints, making them unstable as they support the increased wight.

4-    Pressure of the abdomen & venous stasis over distention of venous blood vessel make pressure on nerve fibers, innervating the lower back.

Nursing intervention:

1-    It is important for mother to have good posture & use body mechanics.

2-    Avoidance of excessive bending, lifting or walking without rest.

3-    Supportive low – heeled shoes.

4-    Warm shower.

5-    Ice packs on the back.

6-    Massage / back rub.

7-    Sleeping on a hard mattress.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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