MCN CONCEPTS

Pregnancy can be complicated by situations unique to childbearing (e.g., placental bleeding), or by long-standing conditions predating pregnancy and continuing into the childbearing process (e.g., age socioeconomic status, cardiac problems); for common discomforts of pregnancy, see Table 6.5.

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TABLE 6.5 Common Discomforts During Pregnancy

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Discomfort	Trimester	Intervention
Morning sickness	First	Eat dry carbohydrate in am; avoid fried, odorous, and greasy foods; small meals rather than large.
Fatigue	First	Rest frequently, as needed.
Urinary frequency	First, end of third	Kegel exercises, perineal pad for leakage.
Heartburn	Second, third	Small meals, bland foods, antacids if ordered.
Constipation	Second, third	Sufficient fluids, foods high in roughage, regular bowel habits. No laxatives unless ordered, including mineral oil.
Hemorrhoids	Third	Avoid constipation; promote regular bowel habits.
Varicosities	Third	Avoid crossing legs and long periods of sitting or standing; rest with feet and hips elevated; avoid elastic garters and other constrictive clothing.
Backache	Third	Use good posture and body mechanics; low-heeled shoes; exercises to strengthen back muscles.
Insomnia	Third	Conscious relaxation; supportive pillows as needed; warm shower before retiring.
Leg cramps	Third	Flex toes toward knees for relief; ensure adequate calcium in diet.
Supine hypotensive syndrome	Third	Left side-lying position.
Vaginal discharge	Second	Correct personal hygiene, refer to physician. Do not douche.
Skin changes, dryness, itching	All	Interventions are symptomatic; cool baths, lotions, oils as indicated.

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General Nursing Responsibilities

1. Teach danger signals of pregnancy early in prenatal period so that client is aware of what needs to be reported to health care provider on an immediate basis (see Table 6.6).
2. Be aware that early teaching allows the client to participate in the identification and reporting of symptoms that can indicate a problem in her pregnancy.
3. Early recognition and reporting of danger signals usually results in diminishing the risk and controlling the severity of maternal/fetal complications.
4. Interventions are specific for the individual risks.
5. Evaluation centers around whether or not the risk was controlled or eliminated, and how the maternal/fetal reaction was controlled.

1. Anne T. is hospitalized for the treatment of severe preeclampsia. Which of the following represents an unusual finding for this condition?

1. Proteinuria 3+. 2. Blood pressure 160/100. 3. Convulsions. 4. Generalized edema.

Answer Rationale:3 Convulsions are associated with an eclamptic condition. The other findings are usual for severe preeclampsia.

2.

A woman is admitted with severe preeclampsia. What type of room should the nurse select for this woman?

1. The room farthest from the nursing station. 2. The quietest room on the floor. 3. The labor suite. 4. A room next to the elevator.

Answer Rationale:2 A quiet room, in which stimuli are minimized and controlled, is essential to the nursing care of the severely preeclamptic client. Because she will need continuous monitoring, the room farthest from the nursing station is inappropriate. Additionally, this client may not need to be in the labor suite; the first goal of care is to prevent the condition from worsening.

3.

The action of hormones during pregnancy affects the body by

1. blocking the release of insulin from the pancreas. 2. preventing the liver from metabolizing glycogen. 3. raising resistance to insulin. 4. enhancing the conversion of food to glucose.

Answer Rationale:3 Hormonal influences during pregnancy cause a resistance to insulin utilization at the cellular level. It allows sufficient glucose for placental transport to the fetus, and also prevents the blood sugar in the nondiabetic client from falling to dangerous levels. In the diabetic client, it requires increases in her insulin doses. It does not affect the release of insulin. Gluconeogenesis is not altered. The conversion of food to glucose is not the problem in pregnancy; the problem is, rather, the utilization of the glucose.