Varneys Ch 23 Discomforts of PREG

Question 1

What is the presumed cause of dyspnea in pregnancy?

Answer 1

diaphragm displacement

Question 2

What are some differential diagnoses of dyspnea in pregnancy?

Answer 2

1. w/ tachycardia=anxiety/panic
2. respiratory infection
3. cardiac d/o
4. pulmonary embolism

Question 3

What is the cause of dependent edema in pregnancy?

Answer 3

Impaired venous circulation, increased venous pressure in lower extremities from enlarged uterus.

Question 4

What are some differential diagnoses of dependent edema in pregnancy?

Answer 4

1. DVT
2. Preeclampsia

Question 5

What are strategies to decrease dependent edema in pregnancy?

Answer 5

1. exercise
2. avoid prolonged sitting or standing
3. Elevate legs periodically
4. compression socks

Question 6

What is the cause of syncope or dizziness in pregnancy?

Answer 6

enlarged uterus impairs venous return causing hypotension.

Question 7

What are some differential diagnoses of syncope or dizziness in pregnancy?

Answer 7

1. hypoglycemia
2. seizure d/o

Question 8

What is the cause of varicosities in pregnancy?

Answer 8

venous distention from increased venous pressure and vasodilation. most common in legs or vulva.

Question 9

What are strategies to decrease varicosities in pregnancy?

Answer 9

1. rest the effected extremity.
2. wear compression socks
3. wear pregnancy support belt or vulvar varicosity garment.

Question 10

What is the cause of constipation in pregnancy?

Answer 10

progesterone slows motility of GI tract, pressure on GI tract from uterus, and sometimes iron supplements.

Question 11

What are strategies to decrease constipation in pregnancy?

Answer 11

1. increase fluids
2. warm liquids to stimulate peristalsis
3. increase fiber
4. bulk-forming laxatives, stool softeners, glycerin suppositories
5. Avoid stimulant laxatives and castor oil

Question 12

What are strategies to decrease gas pain in pregnancy?

Answer 12

1. exercise
2. caffeine - stimulates motility
3. knee-chest position

Question 13

What is the cause of heartburn in pregnancy?

Answer 13

progesterone induced relaxation of the LES, slower emptying of gastric contents, and reduced stomach capacity

Question 14

What are strategies to decrease heartburn in pregnancy?

Answer 14

1. small, frequent meals
2. avoid aggravating foods
3. Elevate HOB, avoid lying down after eating
4. antacids, H2 receptor antagonists, PPIs

Question 15

What are strategies to decrease ptyalism (excessive saliva production) in pregnancy?

Answer 15

chew gum or suck on hard candy

Question 16

What are strategies to decrease low back pain in pregnancy?

Answer 16

1. proper body mechanics
2. exercises-pelvic rock, maternity belt
3. heat or ice packs
4. chiropractic, acupuncture, massage, yoga
5. Acetaminophen, muscle relaxant for sprain/strain, tricyclic antidepressant for chronic low back pain.

Question 17

What are strategies to decrease leg cramps in pregnancy?

Answer 17

1. straighten effected leg and dorsiflex the ankle
2. magnesium at bedtime to bowel tolerance

Question 18

What is the cause of sciatica in pregnancy?

Answer 18

pressure on the sciatic nerve from joint laxity, elicited from twisting, lifting or moving leg.

Question 19

What are strategies to decrease sciatica in pregnancy?

Answer 19

1. heat, ice, abdominal support
2. avoid twisting, good body mechanics
3. acetaminophen - max 400 mg/day
4. chiropractic or PT

Question 20

What is the cause of dyspareunia (pain with sex) in pregnancy?

Answer 20

progesterone-induced relaxation of veins in pelvis and enlarged uterus causing pelvic venous congestion

Question 21

What are strategies to decrease dyspareunia (pain with sex) in pregnancy?

Answer 21

1. position changes
2. water-based lubricant
3. treat vaginitis if indicated
4. screen for sexual abuse

Question 22

What is the cause of leukorrhea (vaginal discharge) in pregnancy?

Answer 22

1. high estrogen levels causing profuse white or clear discharge.
2. r/o STI, BV, Candida, PROM.

Question 23

What are strategies to decrease dyspareunia (pain with sex) in pregnancy?

Answer 23

1. avoid douching, feminine sprays
2. education that it is a normal sx

Question 24

What is the cause of round ligament pain in pregnancy?

Answer 24

increase in length of round ligaments as uterus rises and sudden stretching.

Question 25

What are strategies to decrease round ligament pain in pregnancy?

Answer 25

1. wear maternity belt 2. proper body mechanics

Question 26

What is the cause of urinary frequency and nocturia (nighttime urination) in pregnancy?

Answer 26

decreased bladder capacity from increased pressure of uterus, increased blood volume and GFR=increase urine production

Question 27

What is the cause of fatigue in pregnancy?

Answer 27

1. progesterone, increased energy requirements of pregnancy, and disrupted sleep 2. r/o anemia, depression, cardiac d/o, thyroid d/o, infection

Question 28

What is the cause of gingivitis in pregnancy?

Answer 28

pregnancy changes in oral mucosa increase likelihood of gingivitis.

Question 29

What are strategies to decrease insomnia in pregnancy?

Answer 29

1. warm baths 2. avoid caffeine 3. regular exercise 4. diphenhydramine (Benadryl) 50-100 mg, doxylamine succinate (Unisom) 25 mg

Question 30

What is the cause of nasal congestion and epistaxis (nosebleed) in pregnancy?

Answer 30

estrogen effect that causes hyperemia (increased blood flow) in nasal passages

Question 31

What is the cause of numbness/tingling in fingers in pregnancy?

Answer 31

1. kyphosis (rounding of upper back) places pressure on nerves in the arm causing tingling and numbness of the fingers. 2. edema in wrist/hands causes temporary carpal tunnel syndrome sx 3. often occurs at night and exacerbated by edema in arms and hands

Question 32

What are strategies to decrease numbness/tingling fingers in pregnancy?

Answer 32

1. move arms at level of shoulder to decrease pressure on nerves when tingling starts 2. wrist splints to keep wrist in neutral position, wear while sleeping, work, activities

Question 33

When is the usual presentation of N/V in pregnancy?

Answer 33

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

Question 34

What screening can be used to evaluate N/V?

Answer 34

PUQUE score, weight, BP, CMP, UA

Question 35

What are non-pharmacological ways to reduce N/V in pregnancy?

Answer 35

1. small frequent meals, q 1-2 hrs 2. avoid spicy, high-fat, acidic, very sweet. 3. Eat protein dominant, salty, low fat, bland, and/or dry foods 4. drink fluids 30 mins prior or after to meals 5. acupressure bands 6. fresh ginger 250 mg q 6 hrs 7. aromatherapy-p[eppermint, lemon, orange 8. taking vitamins at night 9. vitamin B6 - 10-25 mg TID

Question 36

Medications for NVP (nausea and vomiting in pregnancy)

Answer 36