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PROJECT TOPIC: Common Complaints of Pregnant Women PARTICIPANTS: The video is intended for all pregnant patients in the De La Salle University Medical Center Obstetrics and Gynecology Out Patient Department. TIME AND TIME ALLOTMENT: March 10, 2012 (Saturday) for the Annual Buntis Day Celebration at the DLSU Medical Center Out Patient Department. VENUE: De La Salle University Medical Center Out Patient Department. SESSION OBJECTIVES General objectives: To obtain knowledge on the common complaints experienced by patients during pregnancy Specific objectives: At the end of this 8-minute educational video presentation, the audience (pregnant women) should be able to:

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OBJECTIVES
1. Familiarize themselves with the most common complaints during pregnancy a. b. c. d. e. f. g. h. i. j. a.

CONTENT
Nausea with or without vomiting Back pains Round ligament pain Varicosities at lower extremities and vulva Hemorrhoids Heartburn Fatigue Headache Leukorrhea Constipation Nausea with or without vomiting Sensation of being about to vomit; colloquially termed as morning sickness but it can happen or last the whole day

STRATEGY
Video of 12 pregnant women in the OPD department saying 1 complaint stated in the session plan

DURATION
10 seconds

RESOURCES
Patients in OPD; Video camera

EVALUATION
Post-quiz; Check which among the list are the complaints that have been discussed in the 8-minute video

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Accurately describe each common complaint to make sure that its actually what they are experiencing

b. Backpains Soreness, stiffness, and pain. Often in starts early in pregnancy and persists until giving birth c. Round ligament pain Often starts in the 2nd term, it is a sharp, shooting pain in the abdomen which is more on the right side rather than left.

Video of group members describing each complaint while an actor portraying a pregnant woman manifesting these complaints will be in the background

2 minutes

Visual aids, Video camera, Actors

Post-quiz; multiple choiceidentifying which among the complaints are correctly described

d. Varicosities at lower extremities and vulva Abnormally enlarged superficial veins seen in the thigh and leg. e. Hemorrhoids Painful, swollen veins in the lower portion of the rectum or anus. This may cause great discomfort and pain and may even bleed Heartburn Common in the late pregnancy, it is a burning substernal sensation, usually reported as a result of excess gastroesophageal reflux of acid Fatigue Loss of energy and motivation that goes with a concomitant need to rest. It is a feeling of tiredness or exhaustion due to lack of energy or strength

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h. Headache Squeezing pain or an ache on the sides of the head or the back of the neck. This may cause snap throbbing pain or a dull ache. i. Leukorrhea Increased vaginal discharge that is not pathologic Constipation Bowel movements fewer than 3 times a week. It is usually characterized by hard, dry, and difficult to eliminate stools which are typically small in size. Often experiencing straining, bloating, and constant feeling of bowel fullness.

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State the pathophysiology/ causes of the common complaints previously stated

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Nausea and vomiting with or without vomiting Combination of factors such as genetic, endocrine, gastrointestinal, psychosocial, and evolutionary adaptations. Increased HcG and estrogen is the leading factor associated with nausea and vomiting during pregnancy

Video of group members describing the causes of each complaint with supplemental pictures or animations in the background

3 minutes

Visual aids, Video camera, Actors

Post-quiz; multiple choiceidentifying which among the complaints have the correct cause

b. Backpains Increased hormone levels released during pregnancy softens the ligaments and loosens the joints to prepare for parturition which lessens the support to the mothers back. The expansion and growth of the uterus and the baby will also cause posture to change leading to back pain. c. Round ligament pain The round ligament, which holds the uterus in suspension within the abdomen, becomes very long and thin as the uterys grows in size and weight. They ligaments pull and tug on nearby nerve fibers and sensitive structures, causing pain. The spasms are more often felt on the right side than the left because of the normal tendency of the uterus to turn to the right. d. Varicosities at lower extremities and vulva Increased pressure in the veins due to the gain of weight and volume that promotes stasis of blood, thereby increasing pressure in the veins of the extremities. Increased pressure may cause the valves to become damaged or defective, the blood flows backwards and causes swelling and engorgement of the veins. Female sex hormones may also cause the walls of the veins to weaken, thus causing them to engorge with blood.

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Hemorrhoids Growing fetus puts pressure on the pelvic veins

and inferior vena cava, causing stasis of blood in the veins of the lower half of the body, increasing the pressure in the veins below the uterus and causing them to dilate. May also be aggravated by constipation. f. Heartburn Progesterone brings about relaxation of the esophageal sphincter. As uterus continues to grow, it causes the compression and displacement of the stomach and so the contents of the stomach move to the most dependent site, the esophagus. Fatigue Pregnancy is an anabolic process which needs to work twice as hard due to accelerating fetal growth. This includes increased in hormone production, increase in metabolism and blood flow, leading to easy fatigability.

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h. Headache May be a consequence of hypertensive disorders later in pregnancy but is usually due to stress, fatigue, caffeine withdrawal, lack of sleep, dehydration and low blood sugar. i. Leukorrhea Due to increased mucus formation by the cervical glands in response to high levels of estrogen in the body. May be caused by Trichomonas vaginalis, candida albicans, and garnderalla vaginalis if the discharge is irritating and accompanied by itching and burning sensation. j. Constipation Due to the pressure of growing uterus on the rectum. Also may be caused by progesterone, which slows the transit of food or increased transit duration through digestive tract

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Provide possible managements for the complaints that they may be experiencing

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Nausea with or without vomiting - Usually self limited - Changes in diet and lifestyle - Eat small frequent meals avoiding fatty foods and foods with strong odors. - Pharmacological therapies including doxylamine-pyridoxine, proven to be safe and effective

Video of group members describing the management of each complaint with supplemental pictures or animations in the background

2 minutes

Visual aids, Video camera, Actors

Post-quiz; multiple choice identifying which among the complaints are the given possible and appropriate management

b. Backpains - Exercise can prevent muscles that support the back from weakening - Warm bath or hot compress - Good posture c. Round ligament pain - Activity modicication-- avoid sudden movements. Shifting positions may provide relief - Rest - Analgesia as needed d. Varicosities at lower extremities and vulva - Elevation of the legs - Avoid standing for prolonged periods - Wear elastic support stockings - Walk or exercise daily to stimulate muscles which push blood away from the leg e. Hemorrhoids - Pain and swelling relieved by topical anesthetics, warm soaks, stool softening agents - Diet modification, taking high fiber diet and many glasses of water daily to avoid constipation - Kegel exercise Heartburn - Take smaller, frequent meals - Refrain from lying flat or bending over; keep head and part of upper torso slightly elevated - Antacids: Aluminum hydroxides, magnesium

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trisilicate, or magnesium hydroxide. g. Fatigue - Frequent rest breaks during the day - Scale back on nonessential activities and responsibilities - Eat a balanced diet and drink plenty of water - Sleep early

h. Headache - Eat well-balanced meals - Application of cold/heat packs to head for sinus head ache and tension head ache, respectively - Rest in dark room and practice deep breathing - Warm shower or bath i. Leukorrhea - Consult doctor and request for lab exams to identify which treatment should be given - Observe proper hygiene Constipation - Eat well-balanced meals which include high fiber foods such as wholegrain cereals, wholemeal bread and fresh fruit and vegetables everyday - Drink plenty of fluids - Exercise

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