Week 4- beginning of minor complaints through pytalsim Flashcards
Fatigue usu resolves by what wks? When does it reappear? What are the two causes for fatigue with PG?
resolves by 12-14 wks gestation- due to increased basal metabolic rate
reappears in 3rd trimester dt increased fetal wt
ddx of fatigue?
anemia
5 types of anemia we are concerned with?
B-12 deficiency hemolysis thalassemia physiologic malabsorption (nutritional deficiency)
name 5 ssxs of anemia
fatigue dizziness h/as weakness SOB on exertion and w/rest pica (ice) sore tongue n/v depression palpitations jaundice pallor of skin and/or mucous membranes and nail beds nail spooning
risks assoc w/anemia during PG? (5)
pre-term birth IUGR preeclampsia in primips high ratio of placenta wt:infant wt (predicts adult HTN) post-partum hemorrhage
name 3 etiologies of nutritional deficiency anemia (NDA)
inadequate intake or absorption of iron genetic d/os BM damage renal dz hyperactive spleen chronic infxn iron loss
what iron-rich food(s) could you recommend for NDA? what supplement to increase absorption of iron? name 3 things to avoid with iron supplements
dark green leafy veggies, dried fruit, legumes, nuts, dark molasses, egg yolks, meat (liver, poultry), shrimp, oysters
add ascorbic acid
avoid: fiber, oxalates, phytates, phosphates, excessive zine and vit E, polyphenols, calcium
if a PG woman is anemia what is the tx while she is PG? after the anemia has been corrected?
cont tx during PG and 3 mo after anemia has been corrected
how many weeks of folic acid deficiency will result in anemia for how many weeks?
20 weeks deficient= 20 weeks of anemia
name 5 predisposing factors for folate deficiency and possible pernicious anemia
enzyme deficiencies EtOH abuse low income adolescence folate antagonists malabsorption syndromes anticonvulsant meds renal dialysis d/o of erythropoiesis malignancy mult PG multiparity hyperemesis gravidarum assoc anemia smoking cigs
name 5 predisposing factors for B12 deficiency and possible pernicious anemia
vegan diet acid-pepsin in stomach pancreatic proteases gastric fxnal intrinsic factor functioning cobalamin EtOH intake abx H2 blockers and other acid reducing meds metformin nicotine
folate deficiency can result in what two defects?
NTD and cleft palate defects
name 3 sequelae of B12 deficiency in PG
anxiety, depression neuropathy insomnia memory issues/foggy thinking muscle weakness dizziness heart palpitations bleeding gums mouth sores nausea poor appetite diarrhea
to correct for folate deficiency, prescribe what dose of supplemental folate a PG woman could take along with 3 foods high in folate
800-1000 ug/d dark leafy greens asparagus okra brussel sprouts artichokes broccoli chili peppers orange juice yeast organs meats lean beef fish legumes fresh fruit and veggies eggs cheese and milk
to correct for B12 deficiency, prescribe what dose of supplements a PG woman could take along with 3 foods high in B12
2.6 mcg of B12 (including dietary intake)
take sublingually if concerned about absorption or B12 injections
red meat
fish and shellfish (caution)
dairy
breakfast cereals w/B12 fortification
name 5 treatments for PG mom with blood sugar imbalance
small frequent meals (q3h) 200 mcg GTF chromium w/meals decrease refined sugar and refined CHOs increase protein: 60-90 g/d min botanicals: devil's club, gymnema sylvestris, syzygium, taraxacum, fenugreek, blood sugar stabilizing formula
3 generals causes for insomnia in PG? when is it usually worst and why?
discomfort
nocturia
worry and anxiety
bad in 1st tri dt anxiety, nausea, hormona changes, nocturia
bad in 3rd tri dt difficulty finding comfortable position dt size of baby, anxiety about labor, nocturia
name 4 possible txs for insomnia in PG
counseling warm baths pillows wet sock botanicals: chamomile, scutallaria, valerian increase exercise decrease caffeine protein snack before bed homeopathy
increase in what hormone causes drowsiness? suggestion to deal with drowsiness?
progesterone
TAKE NAPS! esp in 1st & 3rd tri
rest for 1/2 an hour, don’t fight it
name 3 causes of n/v in pregnancy. when does n/v usu start? when is it most severe? av amount of days it will continue for?
Beta Hcg- slows peristalsis
prog- slows peristalsis and decreases HCl in stomach
low E intake stimulates placental growth (aka n/v may contribute to fetal growth)
dietary habits
emotions
fatigue
nutritional factors
usu starts at 8.2 weeks, can cont for 34 d, most severe at week 11
can be all day long…
n/v can be worse in what scenarios?
mult gestation
hydatidiform mole (r/o w/persistent sxs after 1st tri)
did not take multi-vit before or w/in 6 weeks of conception
if they have pre-existing heartburn and acid reflux
n/v can be a ‘positive’ thing for what reasons? (what can it decrease risk of?)
decreased risk of SAB, preterm birth, IUGR, perinatal death
list 5 txs to combat n/v in PG
dry crackers before getting out of bed or even before opening their eyes
foods high in B vitamins
light protein snack at bedtime
small meals every 1-2 h, avoid full stomach
easily digested foods
cold, clear or carbonated fluids or sour b/w meals
avoid food sensitivities
almonds
yogurt or kefir w/cinnamon
barley or oat broth
fresh air
hard candies
1 tsp apple cider vinegar per 8 oz warm water in morn and w/meals
ginger
discorea
raspberry leaf tea
homeopathy
botanicals: zingiber off, dioscorea villosa, raspberry leaf tea, peppermint tea, catnip tea, meadowsweet, peach leaf, spearmint, lemon balm, basil, cardamom, umeboshi paste
specifically, name 3 homeopathics good for treating n/v in PG
ipecac, keosotum, tabacum, coffea, sepia, symphoricarpus, asarum, lactic acid, nat mur, phosphorous
what 3 supplements could one take to combat n/v in PG (and dose)?
B6: 50 mg TID x 3-4d then 50 mg qd
vit K- 3 gtt K quinone orally
vit C- 500 mg QID
what is hyperemesis gravidarum? what does it mean? name 3 possible etiologies
severe intractable n/v, worst b/w 8-12 wks, normally over by 16 wks
means it’s a viable PG!
can be dt hormonal changes, psychological and social stresses, thyroid issues possibly
name 3 ddx of hyperemesis gravidarum
pancreatitis hepatitis cholecystitis pyelonephritis gastroenteritis peptic ulcer acute fatty liver of PG appendicitis diabetic ketoacidosis pseudotumor cerebri
labs to hyperemesis gravidarum? pts w/this are at increased risk for what possible complication of PG?
electrolytes hct LFTs urine osmolality, urine analysis, ketonuria serum bicarb TSH serum amylase/creatinine at increased risk of preeclampsia!!
first line rx tx for hyperemesis gravidarum? second line? third line? adjunctive meds?
first line: antihistamines (unisom)
second line: dopamine antagonists
third line: serotonin antagonists
adjunctive meds: acid reducing agents
name 5 naturopathic txs of hyperemesis gravidum
homeopathy (esp tabacum, ipecac, nux vom, sepia)
liver support (silybum and protomorphogens)
counseling
drainage
acupuncture
etiology of hearburn? (5)
relaxation of cardiac sphincter (prog caused)
decreased gastric motility
decreased eso peristalsis
displacement of stomach up and to the R
increased intragastric P and decreased intraesophageal P
name 3 management (food related) techniques for heartburn in PG
slow relaxed meals avoid trigger foods (coffee, EtOH, chocolate, fats) avoid cold foods and drink pat of butter at start of meal more raw foods 1 tbsp apple cider vinegar in water no lying down for 3 hrs after eating avoid carbonated bevs, processed foods, sugar, cigs good posture wear loose fitting clothing raw almonds, yogurt, dry popcorn, papaya digestive enzymes liquid cal-mag
name 3 medical interventions for heartburn in PG
antacids
antisecretory antihistamines
complementary txs: osteopathy, chinese medicine, reflexology, botanicals (papaya, peppermint tea, marshmallow, catnip, ginger, slippery elm)
ddx of dyspepsia, flatulence, eructations
preterm labor
UTI
round lig pain
5 ways to prevent dyspepsia, flatulence and eructations naturally. name 1 medical intervention. name 5 complementary medicines
consume 4 or more fruits and veggies/d (steamed)
avoid gas forming foods
avoid CHO and prots in same meal
exercise
abd massage
medical intervention: simethicone
complementary: homeopathy (carbo veg, nux vom), yogurt, kefir, probiotics, digestive enzymes, botanicals (dill, papaya, ginger, fennel), fennel, chamomile and mint celestial times tea
what causes constipation? name 3 ways to manage constipation. name 2 medical interventions. name two complementary measures.
increase in prog slows peristalsis
management: increase fruit, veggies and fiber, exercise, decrease stress, increase rest, 8 glass of decaf fluid/d (H2O), regular bowel habits, avoid laxatives
medical: natural bulk laxatives, digestive enzymes
complementary: homeopathy (sepia, nux vom, calcarea carb, sulphur, pulsatilla, kali-c, merc) and botanicals (yellow doc, dandelion tea, psyllium seeds)
what is ptyalsim? etiology? 3 management techniques?
drooling, increased saliva
etiology: excess acidity in mouth, starchy foods, cycles w/nausea
management: decrease starch intake, avoid diary, increase fruit, homeopathy (ipecac, merc, keosotum, coffea, helonias, kali-iodum)
