1
Q
Why do nosebleeds occur during pg
A
The increase in blood volume plus the softening effects of higher estrogen levels can make the small capillaries in the nose more likely to rupture= nosebleeds
2
Q
Education and support for nosebleeds
A
- explanation of vascular changes in pregnancy
- increase humidity in environment, mister, humidifier, or boiling pots of water on the stove
- normal saline drops/spray may decrease friability
3
Q
Hx and chart review for nosebleeds
A
- SOCRATES approach
- factors/event꞉ allergies or upper respiratory tract infection, trauma, etc.
- bleeding allergies
- bleeding disorders
- typical nasal hygiene practices
4
Q
Differential Dx of nosebleeds
A
Secondary to the following conditions
- hypertension
- seasonal allergies
- upper respiratory tract infection nasal polyps
- inhalation drug use
- nasal trauma or injury
- coagulation defects
5
Q
What could abdominal pain indicate in pg?
A
- round ligament pain
- UTI
- appendicitis
- gallbladder
- renal calculi
- hydronepheosis
- pancreatitis
- preterm labor
- placenta abruption
6
Q
Hx and chart review for abdominal pain
A
- SOCRATES approach
- review of prior U/S finding
- location of pain
- bowel activity and changes
- relieving and exacerbating factors like activity, specific, movement, food intake
- recent travels or household exposures
- hx of previous abdominal surgery
- recent trauma
7
Q
Diet hx for abdominal pain
A
- timing of pain in relation to meals or empty stomach
- pain associated with types of food
- consider cholecystitis when pain occurs after increase fat meals
overall quality of diet, diet recall - pica
8
Q
Physical Exam abdominal pain
A
- Vital signs
- general appearance level of distress
- fetal evaluation as appropriate to GA
- pain scale rating
- skin꞉ jaundice, pallor, diaphoresis
- abdominal exam꞉ bowel sounds, pain location, presence of rigidity, muscle tone, diastasis, umbilical hernia
- assess rebound tenderness and muscle guarding
- CVA tenderness
- suprapubic tenderness
9
Q
Screening and dx of abdominal pain
A
- u/s꞉ uterus, abdomen, gallbladder
- serial quantitative hCG in early 1st tri
- urinalysis and culture
- 24 hour urine collecting if preeclampsia, HELLP suspected
- CBC w/ differential WBC elevation
- liver enzyme panel
- serum amylase and lipase
- NST in 3rd trimester
- possible endoscopy or laparoscopy
10
Q
Differential diagnosis of Varicose veins
A
- varicose veins of the lower extremities or vulva
- varicose veins complicating pg
- superficial phlebitis and thrombophlebitis
- DVT
11
Q
Hx and chart review varicose veins
A
- SOCRATES approach
- pain
- edema
- redness or change in pigmentation
- sensation of leg heaviness
- current relief measures
- daily activities including employment꞉ long periods of standing increases risk for varicosities, prolonged sitting
- recent immobility
12
Q
Interventions for varicose veins
A
- support garments
- foam pad to support vulvar varicosities use with close fitting but non-constricting undergarment
- maternal abdominal support to receive pressure on pelvic veins
- increase intake of onions and garlic in the diet
- nettle infusion
- vitamin c, b complex, a, e [for maintenance of vessel walls]
- increase vitamin e up to 600 iu daily may help contribute to maintaining vessel wall
- blueberry juice
- positioning
- leg elevation above the heart
13
Q
Physical exam for varicose veins
A
- weight and BMI꞉ obesity increase risk for varicosities
- examination of varicosities꞉ location, severity, number, size
- serial calf measurement
14
Q
what symptoms for conditions to look out for with varicosities
A
- superficial phlebitis꞉ heat, tenderness, redness or discoloration
- deep vein thrombosis
- pain and swelling
- leg or vulvar edema
15
Q
Education for varicose veins
A
- regular mild exercise
- avoid꞉ constrictive clothing, long periods of standing or sitting, crossing legs while sitting, leg massage
16
Q
warning signs for varicose veins
A
- persistent or worsening pain
- unilateral edema of extremity
- localized redness, heat, or tenderness
- fever
17
Q
why do varicose veins occur during pregnancy
A
the relaxation of smooth muscle of vessel walls caused by progesterone and anatomic pressure of the enlarging uterus lead to development or worsening of existing varicose veins
18
Q
Differential Dx for backache
A
- backache of pg
- unspecified
- pyelonephritis
- preterm labor
- UTI
- muscle strain or bruising
- kidney stones
- herniated disc
- IBS
- rheumatoid arthritis
- Pg induced hypertension
- gallbladder disease
19
Q
Backpain solutions
A
- angry cat exercise 2x a day
- belly wrap
- heat application [warm compress/bath with Epson salt ]
- TENS unit
- professional message
- adequate calcium and magnesium
- good body mechanics
- yoga, pelvic tilt
- pillows between leg
- chiropractor
- castor oil pack
- low heeled, comfortable shoes
20
Q
Reasons for backache
A
The enlarging uterus stresses the ligaments which the uterus to the sacrum. [spinal pain may be the fetal position [i.e. posterior babies ]]
21
Q
What is upper backache associated w/?
A
Increased weight of breasts and postural factors often correlates with work. assess posture and well fitting bra
22
Q
Presence of other associated symptoms for backpain
A
- presence or absence of ctx or pelvic pressure
- urinary symptoms- frequency, urgency, flank pain
- presence of neurologic s/s- numbness in legs or feet, sciatica
23
Q
Medical hx to consider with backpain
A
- back injury or disease
- kidney stones or pyelonephritis
24
Q
Physical Exam for Backpain
A
- VS including weight
- abdominal exam꞉ abdominal muscle tone , uterine size, suprapubic tenderness, upper abdominal tenderness
- back exam꞉ mobility-ease of movement, symmetry, point tenderness, posture꞉ presence of lordosis, kyphosis, or scoliosis, CVA tenderness, presence of muscle spasm
- pelvic eval꞉ backache w/ ctx or pressure, hx suggestive of preterm labor, eval of cervical status
- eval of neurologic status꞉ muscle tone, coordination, strength, reflexes
- signs of physical abuse꞉ bruising, burns, partner꞉ present entire visit responds for woman
25
Tests/screening for backpain
- urinalysis
- urine culture
- fetal/uterine
- monitoring
- U/S꞉ kidneys if kidney stones suspected
- upper abdomen if gallbladder disease suspected
- hypertensive disorders of pg screening
26
what other pg changes impact backpain
breast changes, stretching of the round ligament, and low tone of abdominal muscles. changes in the low back and pelvis can cause low back discomfort, aching, numbness, and tingling in lets as pg progresses
27
What could cause leg cramps
common in 2nd 1/2 of pregnancy may be related to mineral metabolism and increase neuromuscular irritability raised phosphate levels are implicated and reducing intake of milk is helpful
28
Physical Exam for leg cramps
- VS
- evaluate foot arch
- evaluate extremities꞉ color, clonus, muscle spasm, varicosities, calf circumference, pulses, muscle strength, sensory integrity
29
Education and support for leg cramps
- reassurance of normalcy
- provide info on꞉ physiologic nature of leg cramps in pg, increase calcium and magnesium intake
- regular daily activity꞉ walking, swimming, yoga
- keep leg warm
- warning signs꞉ increase in muscle spasm, swelling, pain, or redness in leg
30
Causes of carpel tunnel
- during the 2nd and 3rd tri, fluid retention in the writs and hands may lead to compression of the median nerve. there can also be swelling of the carpal tunnel= numbness, tingling, and pain in the fingers and is usually bilateral.
- Quervain's tenosynovitis from compression to inflammation of the tendons in the wrist. fluid retention puts pressure on the tendons and women will describe pain in the wrist radial side of the hand
- tingling from not having good posture and exaggerated lordosis of the upper back causes anterior flexion of the head. position may compress the nerves of the arm
31
when are carpel tunnel symptoms more pronounced
more at night. usually resolves spontaneously within days of delivery or lactation
32
Education and support for tingling
explanation and reassurance that its usually self-limiting to pg. severe enough splinting of the wrist using a removable soft plastic splint shaped to support the wrist in the neutral slight dorsiflexion is the most effective treatment. severe work responsibility may need to be
33
Subjective Data collection
- Description of sleep habits, including bedtime, time, necessary to get to sleep, sleep awakenings, ritual hours of sleep and naps
- identify lifestyle behaviors that may increase fatigue
- identify environmental factors
- description of exercise routine
- hx of depression
34
Differential dx of fatigue
- normal fatigue of pg
- depression
- fatigue secondary to inadequate caloric intake or anemia
35
objective data collection
- general appearance and affect
- current weight and any trend in weight gain or loss
- CBC if chronic or severe fatigue
36
Causes of fatigue during pregnancy
During 1st tri thought to be caused by increase basal metabolism rate, increase demands on cardiovascular and renal systems, and loss of sleep caused by urinary frequency and emotional factors. increase in late pg bc of increase weight, difficulty finding a comfortable position, fetal factors, and urinary frequency, stress, anxiety, and depression can contribute
37
Differential diagnosis for insomnia
- insomnia secondary to꞉ anxiety, pg discomfort
- depression or mood disorder
- substance use
- sleep disturbance`, unspecified
- adjustment insomnia
38
Possible reason for insomnia
hypoglycemia. 7 to 10 hours long time w/o food. keep a increase protein snack nearby see if it helps
- physical cause can be nasal congestion
39
causes w/ difficulty with sleep
early in pg, sleep disturbance may be provoked by psychologic` stresses, frequency of urination, and other 1st trimester discomforts. later in pg, physical discomforts, difficulty finding a position of comfort, fetal movements, SOB
40
Integrative therapies for insomnia
- hydrotherapy, warm bath w/ Epsom salts
- sleep hygiene
- acupressure or acupuncture
- massage
41
Education and support for round ligament pain
Antepartum
flashcards
Decks in class (2)
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