Aijiel Lysent D.
Talisik NCM33-Lec B2 BSN-II
WORKSHEET ON SIGNS AND SYMPTOMS OF PREGNANCY
I. PRESUMPTIVE CAUSE/ PHYSIOLOGIC
BASIS
1) amenorrhea Suppression of follicle-
stimulating hormone (FSH)
caused by rising estrogen levels.
2) nausea & vomiting -rise of HCG and progesterone
- increased estrogen levels; or
- decreased glucose levels
because large amount of glucose
is consumed by the fetus
3) urinary frequency Increase in blood volume which
causes increased in urine
production by the kidney.
4) breast changes & - growth in the mammary alveoli
tenderness and in fat deposits
5) excessive fatigue - due to physiological and
hormonal changes
- Physical and emotional changes
also lower the energy levels.
6) uterine enlargement Due partly to formation of a few
new muscle fibers in the uterine
myometrium but principally to
the stretching of existing muscle
fibers.
September 17, 2020
NURSING ACTION/S IN THE CARE
OF CLIENTS
- Educate the patient about the causes of
amenorrhea.
- Conduct physical examination, enable
the client to have a comprehensive history
of reproduction and health, and interview
the client to determine the issue and
correct deficiency
- acupuncture or wrist bands
- Consult with nutritionist if nausea
interferes with eating in 1 week.
- Examine 24- hour recall history and
analyze for nutrition deficits. Make
suggestions for better intake.
- Educate patient that nausea and
vomiting is common during pregnancy.
Suggest relief measures
 adequate hydration
 Kegel exercises
 use of panty liners
 frequent voiding
 decreasing fluid intake two to three
hours before bedtime.
Discuss the following to the patient:
 the need for changes in bra size
 options for infant feeding,
 strategies to help her prepare for
successful breast feeding. Soft
cotton liners can be used to pad the
bra if leaking of the nipples is
troublesome
Counsel patients to:
 take naps during the day when
possible
 establish a bedtime “ritual” that
includes going to bed at
approximately the same time each
night
 increase daytime exercise
 practice relaxation techniques
Palpate uterine over symphysis pubis
7) quickening - As fetus develops, the fetal baby
will stretch/flex his/her limbs
- The sensation of fetal
movement may also result from
flatus, peristalsis,
and abdominal muscle
contractions
II. PROBABLE CHANGES  CAUSE/ PHYSIOLOGIC
BASIS
1) changes in pelvic organs  
-Goodell sign - softening of the tip of the
cervix), Increased fluid between
cells and increased vascularity
-Hegar sign -extreme softening of the lower
uterine segment
-Piskacek sign -may also be associated with
uterine tumors
2) (+) HCG  presence of trophoblast cells
during preganacy which produce
HCG
3)Uterine souffle  caused by the increased
vascularity
4) Skin pigmentation caused by melanocyte stimulating
hormone coming from the
pituitary
5) Ultrasound Gives information on the site of
implantation and whether
multiple pregnancies exist.
III. POSITIVE WHEN APPRECIATED &
(DIAGNOSTIC) HOW APPRECIATED
CHANGES
1) Fetal heart beat Fetal heart rate ranges between
120 and 160 beats/min.
May be first detected by a vaginal
ultrasound as early as 5 ½ to 6
Make certain the woman knows fetal
movements do vary, especially in relation
to sleep cycles, her activity, and the time
since she last ate.
 NURSING IMPLICATION/S
 
-Take note of the vaginal secretion
-Examine how thin and soft the lower
uterine segment
-Take note of the bulge on the said
location
 Encourages patients to have a regular
intercourse from the day before HCG is
administered before ovulation occurs.
 Note for the souffle sound made by the
blood in the uterine synchronous with the
maternal pulse
- Offer reassurance that these
changes are anticipated during
pregnancy.
- Recommend (if not
contraindicated)
 daily bathing
 use of lotions or oils for dry
skin
 regular use of deodorant
 limited sun exposure with
the diligent use of
sunscreen.
Before an ultrasound examination explain
what the procedure will be like and
rassure that it’s safe and that the process
does not involve X-rays.
NURSING IMPLICATION/S
During assessment,
 it is best heard when the position
of the fetus is determined by
palpation and the stethoscope is
placed over the area of the fetal
 weeks after gestation.
2) Fetal movements Fetal movements may be felt by a
woman as early as 16 to 20 weeks
of pregnancy.
3) Ultrasound (presence of  - a characteristic ring, indicating
fetus) the gestational sac, will be
revealed on an oscilloscope
screen as early as the fourth to
sixth week of pregnancy
- gives information about the site
of implantation and whether a
multiple pregnancy exists
- fetal outline can be seen by the
8th week
back.
 Sounds are more difficult to hear if
a woman’s abdomen has a great
deal of subcutaneous fat or if there
is a larger-than-normal amount of
amniotic fluid present
- To detect changes of first occurrence,
regular monitoring by a fetoscope,
Doppler, or a monitor is needed.
- Fetal movements can be discerned at
about the 20th to 24th week of
pregnancy unless the woman is
extremely obese.
- Advise the mother to count baby’s
movement everyday preferably at the
same time.
To ensure proper fetal and uterine /
placental growth, assess fetal
development, as well as the uterus and
placenta.