3rd trimester common discomfort

Question 1

Physiology of lower back pain

Answer 1

Normally occurs due to the increasing weight of the uterus and relaxation of ligaments in your back.

Question 2

Most important factors that indicate normalcy in lower back pain

Answer 2

No groin numbness
No loss of bladder or bowel control
No pelvic pain
Not related to labor
No associated sx

Question 3

Relief measures for low back pain

Answer 3

External abdominal support such as maternity girdle
Heat, ice packs massage
Supportive mattress or positioning with pillow to straighten the back and alleviate pulling and straining.

Question 4

Physiology of dependent edema

Answer 4

Normally caused by improper circulation of the veins and pressure in the lower extremities due enlarged uterus

Question 5

Most important factors that indicate normalcy in dependent edema

Answer 5

Normal B/P readings
No pain in calves
No swelling/redness/warmth in calves
No chest pain or other associated sx.

Question 6

Relief measures for dependent edema

Answer 6

Avoid prolong sitting and standing
Elevate leg when possible
Keep leg uncrossed when sitting
Compression stocking or support hose

Question 7

Physiology of leg cramps

Answer 7

Claims have been that it may be linked to changes in certain electrolytes…such as calcium or calcium entering muscle; however, causes have not been proven

Question 8

Most important factors that indicate normalcy in leg cramps

Answer 8

No redness/warmth in calf
Pain happens only at night
Pain is sharp and sudden in only calf or thigh
No lingering pain
No associated sx

Question 9

Relief measures for leg cramps

Answer 9

Straighten affect leg and dorsiflex the ankle
Muscle massage may help
Adequate fluid intake
Stretching leg before bed

Question 10

Physiology of shortness of breath in 3rd trimester

Answer 10

Enlarged uterus presses on the diaphragm, which decreases the ability of the lungs to fully expand. This can cause shallow breathing giving the sensation of shortness of breath.

Question 11

Most important factors that indicate normalcy in shortness of breath

Answer 11

No chest pain
No dizziness.
No associated symptoms
Normal lung sounds auscultated
Started in 3rd trimester

Question 12

Relief measures for shortness of breath

Answer 12

Good Posture
Lifting the arms over the head when shortness of breath occurs
Sleeping in a more upright position with pillow support

Question 13

Physiology of supine hypotension (syncope)

Answer 13

This is a normal pregnancy discomfort that can happen s your uterus gets bigger. When you are laying on your back, the uterus can press against the part of the body that returns blood back from the heart to the lower half of your body. Due to this compression blood pressure can be decreased which causes the dizziness, increase heart rate, sweaty skin and nausea that you are experiencing.

Question 14

Most important factors that indicate normalcy in supine hypotension (syncope)

Answer 14

Happens only when lying her back
immediate relieve of sx with change of position
Denied associated sx
Witnessed signs of discomfort, anxiety and restless when patient laying supine position

Question 15

Relief measures for supine hypotension (syncope)

Answer 15

Lay on side or sit up when sx occurs
Avoid exercise on your back
Do not lie or sleep on your back
use full body or wedge pillows for sleeping

Question 16

physiology of urinary frequency

Answer 16

Weeks before delivery, your baby turns and the baby head rest in the pelvic region. The baby’s head in the pelvic region pushes on your bladder causing you to urinate frequently. Increase use of bathroom at night is due to laying on your side which causes increased urine output.

Question 17

Most important factors that indicate normalcy in urinary frequency

Answer 17

Started in 3rd trimester
No pain with urination
No blood in urine
No urgency
No pelvic pain
No pain/tenderness with palpation of the suprapubic area

Question 18

Relief measures for urinary frequency

Answer 18

Void soon after feeling urge
Start urination schedule every 2-3 hours
Urinate before and after intercourse
Reduce the amount of fluids later evening hours

Question 19

Physiology cause of varicose veins

Answer 19

Increase in blood volume to help baby grow
Increase uterus causing pressure on the vein
surge of pregnancy hormones that make vein walls less rigid and capable of functioning properly.

Question 20

Most important factors that indicate normalcy in vericose veins

Answer 20

No tenderness/hardness or warmth on varicose veins areas
Only complained is pain, night cramps, numbness/tingling in the area of varicosities;
Leg feeling heavy, achy itchy

Question 21

Relief measures for varicose veins

Answer 21

Compression stocking …put on first thing in the morning
Elevate legs when able
avoid prolonged standing
Avoid crossing leg when sitting

Question 22

Physiology of vulvar varicosities

Answer 22

Increase in blood flow to the pelvic region during pregnancy

Question 23

Most important factors that indicate normalcy in vulvar varicosities

Answer 23

No thrombosis
No bleeding
Visualized vulvar varicosities
Feelings of heaviness, pressure or pain in the vulva.
Swelling or itchiness around the vulva

Question 24

Relief measures for vulvar varicosities veins

Answer 24

avoid prolonged periods of standing
elevate the lower legs when sitting or lying down
use support device such as V2 supporter, similar to male athletics support
support garments such as bicycle shorts worn with peripads can put gentle counter pressure on vulvar varicosities
Try and stay within your recommendation weight gain

Question 25

Physiology of restless leg syndrome

Answer 25

Could be due to increase pregnancy hormones level
Also folic acid and iron deficiency

Question 26

Most important factors that indicate normalcy of restless leg syndrome

Answer 26

Sx started at 3rd trimester
Hx of anemia
Hx of insomnia
The urge to move the legs accompanied by sensation of crawling, creeping and itching.

Question 27

Relief measures for restless leg syndrome

Answer 27

Treat underlying anemia if indicated
moderate intensity exercise such as aerobics
Do yoga
Massage leg

Question 28

physiology of urinary incontinence

Answer 28

The increasing pressure of the growing uterus and fetal weight on pelvic-floor muscles (PFM) throughout pregnancy, together with pregnancy-related hormonal changes, may lead to reduced PFM strength, ability to support the bladder properly

Question 29

Most important factors that indicate normalcy of urinary incontinence

Answer 29

No pain with urination
No urinary urgency
No pelvic pain
Sx only with coughing, sneezing or laughing

Question 30

relief measures for urinary incontinence

Answer 30

Reassurance of normalcy and
empty the bladder frequently
wear panty liners as needed
Do Kegel exercises to increase muscle tone

Question 31

Physiology of insomnia

Answer 31

Sleeping issues could be related to frequent waking from back pain, heartburn, needing to urinate and fetal movement

Question 32

most important factors that indicate normalcy of insomnia

Answer 32

No sleep apnea witnessed
No sx of UTI

Question 33

Relief measures for insomnia

Answer 33

take warm bath, reduce stimulation prior to bedtime
avoid caffeine
regular exercise and regular room temp

Question 34

Physiology of carpal tunnel

Answer 34

This is a common occurrence. During pregnancy, your hormones cause fluid to build up in your body, which causes swelling. This can lead to swelling within the carpal tunnel area of the wrist and compress nerves which runs to your hand.

Question 35

Most important factors that indicate normalcy of carpal tunnel

Answer 35

Positive tinel test
Positive phalen’s test

Question 36

Relief measures for carpal tunnel

Answer 36

Hand splint in neutral position
Avoidance of extreme flexion or extension of the wrist
Decreased use of vibrating tools like lawn mower
Massage and gently stretching of the fingers and wrist

Question 37

Physiology of pelvic pain

Answer 37

Could be due changes in connective tissues as a result of shifting hormone level. Also as your baby grows in the womb, the extra weight and the change in the way you sit or stand will put more strain on your pelvis causing pain.

Question 38

Most important factor that indicate normalcy of pelvic pain

Answer 38

No reports of sx related to early labor
Sx recent onset
Pain only with movement/walking/getting in and out of bed
Report pain as clicking, snapping sound
No issues with walking, standing or sitting noted

Question 39

Relief measures for pelvic pain

Answer 39

Waddling gait with short steps
Warm bath or shower
Exercise to strengthen pelvic floor
Try to balance weight evenly between both feet when standing