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LESSON PLAN ON PEER GROUP TEACHING

MINOR DISORDER IN PREGNANCY & MANAGEMENT

SUBMITTED TO: Mrs. Debjani Nayak SUBMITTED BY: Ms.Sushruta Mohapatra


Associate prof. Msc nursing 1st year
OBG department OBG speciality, Sum nursing college
Sum nursing college
SUBJECT : OBSTETRIC & GYNAECOLOGICAL NURSING

TOPIC : MINOR DISORDER DURING PREGNANCY & MANAGEMENT

GROUP : Msc nursing 1st year students

STRENGTH : 4

VENUE : MSc nursing 1st year class room

DATE & TIME :

DURATION: 1 hr.

METHOD OF TEACHING : Lecture cum discussion

AV AIDS : chart, Power point & black board

NAME OF THE STUDENT TEACHER : Ms. Sushruta Mohapatra

NAME OF THE EVALUATOR : Associate prof. Mrs. Debjani Nayak

GENERAL OBJECTIVES : At the end of the class the group will be able to acquire some knowledge regarding the minor
disorders of pregnancy & its management.
Sl Time Specific objectives Content Teaching learning activity Evaluation
no.
1. 3min. Introduce the INTRODUCTION: Student teacher will able to explain
topic. the introduction by lecture method.
Many women experience some minor
disorders during pregnancy. These
disorders should be treated adequately as
they may cause life threatening conditions
in progress of pregnancy.
Minor disorders may occur due to
hormonal changes, accommodation
changes, metabolic changes& postural
changes. Every system of the body is
affected by pregnancy. The mother needs
knowledge to cope with the experience of
pregnancy.

2. 15min List out the minor MINOR DISORDERS ACCORDING TO Student teacher will able to explain What are the
. ailments of DIFFERENT SYSTEMS the minor ailments by lecture method minor ailments
pregnancy? DIGESTIVE SYSTEM through showing chart. during pregnancy?
1. Nausea & vomiting:
It is a common disorder seen in about
50%women between 4th & 16th week of
gestation. Hormonal influences are
thought to be the most likely cause.
Human chorionic gonadotropin that is
present in large amounts in the 1st
trimester, estrogen & progesterone are
all contribute to this. The sickness is
confined to “early morning” but can
occur at any time in the day. The smell
of certain cooking food will cause the
symptom.
Management:
The midwife should encourage the
mother to look positively towards the
resolution of the problem.
 Salads & light snacks are given
than full meals.
 Carbohydrate snacks at bed
time can prevent
hypoglycaemia.
 Dry toast or biscuits are given
on waking up &breakfast after
half an hour.
*If vomiting becomes severe the mother
may lose weight& becomes dehydrated
this condition is called hyperemesis
gravidarum& specialized care &
appropriate referral should be needed.
2. Constipation:
This is due to smooth muscle relaxant
effect of progesterone causing decreased
peristalsis of gut. Pressure of the gravid
uterus on the colon near term makes it
worse as the colon gets displaced. It is
usually overcome by adjusting diets.
Management:
The women may be advised to:
 Increase the intake of water.
 Add green leafy vegetables, fruits
& bran cereals to her diet.
 Take a glass of warm water in the
morning before tea or breakfast
which would activate the gut &
help regular bowel movements.
 Do exercise by regular walking.
3. Acidity & heartburn:
This is a burning pain in the mediastinal
position caused by reflux of stomach
contents into the esophagus. It occurs
because the cardiac sphincter relaxes
during pregnancy due to the effect of
progesterone. The condition tends to
worsen as pregnancy advances because
the stomach is displaced upward by the
enlarging uterus.
Heartbern is most troublesome at about
30th to 40th week of gestation because at
this stage the stomach is under pressure
from the growing uterus.
Management:
The advice given according to the severity
of the condition:
 If the heartburn is occasional the
reflux can be prevented by avoiding
bending & kneeling while doing
household works.
 Advice to take small meals which
will be more easily digested.
 Fried & fatty foods should be
avoided.
 Sleeping with more pillows & lying
on right lateral side can be helpful.
 For persistent heartburn antacids
may be prescribed by the physician.
4. Excessive salivation (Ptyalism):
This occurs from 8th week of gestation
which is caused due to the hormones of
pregnancy.
Management:
 This problem is usually self-limiting
and may be overcome by
decreasing intake of carbohydrates.
 It is not associated with any
adverse pregnancy outcome.
5. Abdominal discomfort:
 Due to Pressure, pelvic heaviness,
is caused by the weight of the
uterus on the pelvic supports and
the abdominal wall.
 Round ligament tension,
tenderness along the course of the
round ligament (usually the left)
during late pregnancy, is due to
traction on this structure by the
uterus, which is displaced by the
large bowel to be rotated slightly to
the right.
 Flatulence and distention can be
due to large meals, gas-forming
foods, and chilled beverages. These
are poorly tolerated by pregnant
women.
Management:
 Provide rest frequently,
preferably in the lateral
recumbent position.
 Local heat should be applied
and change of position
frequently.
 Dietary modifications should be
needed.
 Regular bowel function should
be maintained, and exercise is
beneficial.
 Acetaminophen 0.3–0.6, 2–3
times daily may be given to
reduce discomfort.
 Intra abdominal disorders must
be diagnosed and treated
appropriately.
6. Pica:
This the term used when the mother
craves certain foods or unnatural
substances such as coal. The cause is
unknown but hormones & changes in
metabolism are thought to contribute to
this. If the substances craved are harmful
to the unborn baby, the mother must be
helped to seek medical advice.
MUSCULO-SKELETAL SYSTEM
1. Fatigue: What are the
13min The pregnant patient is more subjected to ailments of
. fatigue during the last trimester pregnancy musculoskeletal
because of altered posture & extra weight system?
carried.
Management:
 Frequent rest period should
recommended.
 Anemia & other systemic diseases
should be ruled out.

2. Backache:
The gradual weight gain & the changes in
the body’s center of gravity combined with
the stretching of weak abdominal muscles
often lead to hollowness of lumbar spine.
There is a tendency for back muscles to
shorten as the abdominal muscles
stretched & extra strain is put on the
ligaments this results in backache.
Management:
 Excessive weight gain should be
avoided.
 Rest with elevation of legs to flex
the hips may be helpful.
 Improvement of posture with well
fitted pelvic girdle belt may be
reduce the pain.
 Advice the mother to wear low
healed shoe.
 Apply local heat or light massage is
helpful.
 Recommended sleep on a firm
mattress.
 Provide back exercise under the
supervision of physician.
 Give acetaminophen 0.3-0.6 g
orally.
3. Leg cramps:
These are quite common & worsen at
night. The cause is not known but has
been attributed to deficiency of vit-B1 &
decreased level of calcium. It may be due
to ischemia or changes in pH or electrolyte
level.
Management:
 Make gentle leg movements,
massage the leg & also apply local
heat which may be beneficial.
 Sleep with foot end of the bed
elevated by 20-25cm.
 Take vit-B complex & calcium
supplements.
4. Round ligament pain:
Stretching of the round ligament during
movement in pregnancy may cause sharp
pain in the groins which may be unilateral
or bilateral. It is usually felt in 2nd trimester
onwards. This is more common in right
side as a result of dextrorotation of uterus.
Pain may be awaking at night time because
of sudden roll over movements during
sleep.
Management:
 Pain may be reduced by making
movements gradual instead of
sudden.
 Local heat application is helpful.
 Analgesics may be needed.

CIRCULATORY SYSTEM
10min 1. Varicose vein: List out the
. Progesterone relaxes the smooth muscles disorders of
of veins & results in slow circulation, the circulatory
valves of the dilated veins become system?
inefficient & varicosities results. It
generally occurs in legs, anus& vulva. The
mothers with a family history of varicose
vein & those doing work with long period
of standing & sitting usually develop
varicose veins.
Management:
 Exercising the calf muscles by rising
onto the toes or making circular
movements with the ankles.
 Resting with the legs vertical
against the wall for a short time.
 Wearing support tights before
rising or after resting with legs
elevated.
 Avoid forceful massage & point-
pressure over legs.
2. Hemorrhoids:
It may cause due to any complications like
bleeding & get prolapsed that produce
severe pain.
Management:
 Prevent constipation first for that
use laxatives.
 Apply hydrocortisone ointment to
reduce pain & swelling.
 Advice for sitz bath.
3. Syncope (Fainting):
In early pregnancy fainting may occurdue
to vasodilation under the influence of
progesterone. It may subside following the
compensatory increase in blood volume.
Management:
 Avoid long period of standing as
well as sitting or lying down when
she feels slightly faint.
 In later pregnancy advice the
mother not to sleep with her back
except during abdominal
examination because this can cause
venacaval compression which leads
to slow return of blood to heart.
 Encourage the mother to eat small
meals rather than large one.
4. Ankle edema:
It develops in at least two thirds of
women in late pregnancy but mainly
occur in 2nd &3rd trimesters. It is the
results of venous & lymphatic stasis, as
well as occurs due to changes in
osmotic pressure of blood & tissue
fluids & altered capillary permeability.
Management:
 No treatment is required for
physiological or orthostatic edema.
 Elevate the legs while sleeping &
sleep in left lateral position &
avoiding sitting with the feet
hanging down.
 Restrict excessive salt intake &
provide elastic support for varicose
veins.
 Diuretics should not be given. Discuss about the
8min. NERVOUS SYSTEM disorders of
1. Insomnia: nervous system
It is relatively common in late pregnancy and their
owing to discomfort caused by fetal management?
movements, frequency of micturition &
difficulty in finding a comfortable position.
It may also be due to some deep seated
anxiety or fear.
Management:
 Take rest in afternoon.
 Drink a glass of warm milk at bed
time.
 Tuck a pillow under the abdomen
when lying in a lateral position.
 Talk about her fears & anxieties so
that she can have a sense of
normality & lightness.
2. Headache:
Headache in pregnancy is common
and usually due to tension. Refractive
errors and ocular imbalance are not
caused by normal pregnancy. Severe,
persistent headache in the third
trimester must be regarded as
symptomatic of pre-eclampsia and
eclampsia.
Management:
 Advice the mother to take
adequate rest.
 If there is any pregnancy induced
hypertension then symptomatic
management should be done.
3. Carpal tunnel syndrome:
Mothers complain of numbness & pins &
needles in their fingers & hands. This
usually happens in the morning, but it can
occur at any time of the day. It is caused by
fluid retention which creates edema &
pressure on the median nerve.
Management:
 Wearing a splint at night with the
hands resting on 2or 3 pillows.
 Restriction of salt intake & flexing
the fingers while the arm is held What are the
5min. above the head. disorders of
 It usually resolves spontaneously. genitourinary
GENITO URINARY SYSTEM system?
1. Leukorrhea
This is the increased white non irritant
vaginal discharge in pregnancy. If the
mother finds the discharge disturbing, it
needs management.
Management:
 Advice her to maintain personal
hygiene.
 Frequently wash the vulva i.e.3-4
times per day with plain water.
 Advice her to wear cotton
underwear & avoid tights.
 Educate her about the possibility of
infections such as thrush&
Trichomonas.
2. Urinary symptoms/ frequency of
micturition
This occur in the 1st trimester when there
is pressure on the gravid uterus on the
urinary bladder. It is spontaneously
relieved when the uterus rises up in the
abdomen. It may recur in late pregnancy
when the fetal head descends into pelvis.
Management:
 Advice her to take adequate rest.
2min.  Advice her to maintain proper
perineal hygiene.
RESPIRATORY SYSTEM
Breathlessness
It is not actual dyspnea which is occurs due
to progesterone effects. It occurs as early
as in 12th week of pregnancy & most
women have it upto 30th week.
Management
 There is no effective management
2min. but rest will help in reducing the
condition.
INTEGUMENTARY SYSTEM
Skin
Some mothers complain of generalized
itching that starts over the abdomen. This
occurs due to livers response to certain
hormones in pregnancy & with raised
bilirubin level.
Management
 It clear soon after the baby is born
& comfort can be gained from local
application.
 An anti-histamine can be given.
4. 2min Summary The student teacher will able to
Minor ailments during pregnancy are more summarize the minor ailments during
common disorders that are present in all pregnancy.
cases of antenatal period. So adequate
education to the mother during antenatal
visit are helpful to reduce the severity of
the symptoms.

5. 2min. Conclusion
Minor disorders are the common disorders
that occur during pregnancy which needs
home management and these are
common so advice the mother not to
worry about this in depth these are mainly
disappear after the pregnancy is complete.

Bibliography:
1. Jacob Annamma; A Comprehensive Textbook Of Midwifery And Gynecological Nursing; jaypee publishers, 3 rd edition 2012,Pg.102-105.

2. Dutta D.C ;Text Book Of Obstertrics ; New Central Book Agency Ltd. Sixth Edition 2004.page no.-151-52.