Varneys Ch 23 Discomforts of PREG Flashcards
What is the presumed cause of dyspnea in pregnancy?
diaphragm displacement
What are some differential diagnoses of dyspnea in pregnancy?
- w/ tachycardia=anxiety/panic
- respiratory infection
- cardiac d/o
- pulmonary embolism
What is the cause of dependent edema in pregnancy?
Impaired venous circulation, increased venous pressure in lower extremities from enlarged uterus.
What are some differential diagnoses of dependent edema in pregnancy?
- DVT
- Preeclampsia
What are strategies to decrease dependent edema in pregnancy?
- exercise
- avoid prolonged sitting or standing
- Elevate legs periodically
- compression socks
What is the cause of syncope or dizziness in pregnancy?
enlarged uterus impairs venous return causing hypotension.
What are some differential diagnoses of syncope or dizziness in pregnancy?
- hypoglycemia
- seizure d/o
What is the cause of varicosities in pregnancy?
venous distention from increased venous pressure and vasodilation. most common in legs or vulva.
What are strategies to decrease varicosities in pregnancy?
- rest the effected extremity.
- wear compression socks
- wear pregnancy support belt or vulvar varicosity garment.
What is the cause of constipation in pregnancy?
progesterone slows motility of GI tract, pressure on GI tract from uterus, and sometimes iron supplements.
What are strategies to decrease constipation in pregnancy?
- increase fluids
- warm liquids to stimulate peristalsis
- increase fiber
- bulk-forming laxatives, stool softeners, glycerin suppositories
- Avoid stimulant laxatives and castor oil
What are strategies to decrease gas pain in pregnancy?
- exercise
- caffeine - stimulates motility
- knee-chest position
What is the cause of heartburn in pregnancy?
progesterone induced relaxation of the LES, slower emptying of gastric contents, and reduced stomach capacity
What are strategies to decrease heartburn in pregnancy?
- small, frequent meals
- avoid aggravating foods
- Elevate HOB, avoid lying down after eating
- antacids, H2 receptor antagonists, PPIs
What are strategies to decrease ptyalism (excessive saliva production) in pregnancy?
chew gum or suck on hard candy
What are strategies to decrease low back pain in pregnancy?
- proper body mechanics
- exercises-pelvic rock, maternity belt
- heat or ice packs
- chiropractic, acupuncture, massage, yoga
- Acetaminophen, muscle relaxant for sprain/strain, tricyclic antidepressant for chronic low back pain.
What are strategies to decrease leg cramps in pregnancy?
- straighten effected leg and dorsiflex the ankle
- magnesium at bedtime to bowel tolerance
What is the cause of sciatica in pregnancy?
pressure on the sciatic nerve from joint laxity, elicited from twisting, lifting or moving leg.
What are strategies to decrease sciatica in pregnancy?
- heat, ice, abdominal support
- avoid twisting, good body mechanics
- acetaminophen - max 400 mg/day
- chiropractic or PT
What is the cause of dyspareunia (pain with sex) in pregnancy?
progesterone-induced relaxation of veins in pelvis and enlarged uterus causing pelvic venous congestion
What are strategies to decrease dyspareunia (pain with sex) in pregnancy?
- position changes
- water-based lubricant
- treat vaginitis if indicated
- screen for sexual abuse
What is the cause of leukorrhea (vaginal discharge) in pregnancy?
- high estrogen levels causing profuse white or clear discharge.
- r/o STI, BV, Candida, PROM.
What are strategies to decrease dyspareunia (pain with sex) in pregnancy?
- avoid douching, feminine sprays
- education that it is a normal sx
What is the cause of round ligament pain in pregnancy?
increase in length of round ligaments as uterus rises and sudden stretching.
What are strategies to decrease round ligament pain in pregnancy?
- wear maternity belt
- proper body mechanics
What is the cause of urinary frequency and nocturia (nighttime urination) in pregnancy?
decreased bladder capacity from increased pressure of uterus, increased blood volume and GFR=increase urine production
What is the cause of fatigue in pregnancy?
- progesterone, increased energy requirements of pregnancy, and disrupted sleep
- r/o anemia, depression, cardiac d/o, thyroid d/o, infection
What is the cause of gingivitis in pregnancy?
pregnancy changes in oral mucosa increase likelihood of gingivitis.
What are strategies to decrease insomnia in pregnancy?
- warm baths
- avoid caffeine
- regular exercise
- diphenhydramine (Benadryl) 50-100 mg, doxylamine succinate (Unisom) 25 mg
What is the cause of nasal congestion and epistaxis (nosebleed) in pregnancy?
estrogen effect that causes hyperemia (increased blood flow) in nasal passages
What is the cause of numbness/tingling in fingers in pregnancy?
- kyphosis (rounding of upper back) places pressure on nerves in the arm causing tingling and numbness of the fingers.
- edema in wrist/hands causes temporary carpal tunnel syndrome sx
- often occurs at night and exacerbated by edema in arms and hands
What are strategies to decrease numbness/tingling fingers in pregnancy?
- move arms at level of shoulder to decrease pressure on nerves when tingling starts
- wrist splints to keep wrist in neutral position, wear while sleeping, work, activities
When is the usual presentation of N/V in pregnancy?
begins week 5-6, peak at 9 weeks, subsides by 16-20 weeks. Incidence is 88%=some N/V and 6.4%=severe N/V
What screening can be used to evaluate N/V?
PUQUE score, weight, BP, CMP, UA
What are non-pharmacological ways to reduce N/V in pregnancy?
- small frequent meals, q 1-2 hrs
- avoid spicy, high-fat, acidic, very sweet.
- Eat protein dominant, salty, low fat, bland, and/or dry foods
- drink fluids 30 mins prior or after to meals
- acupressure bands
- fresh ginger 250 mg q 6 hrs
- aromatherapy-p[eppermint, lemon, orange
- taking vitamins at night
- vitamin B6 - 10-25 mg TID
Medications for NVP (nausea and vomiting in pregnancy)
