ALL INDIA INSTITUTE OF MEDICAL SCIENCES, JODHPUR

COLLEGE OF NURSING

LESSON PLAN
ON
TOPIC: NURSING MANAGEMENT OF PREGNANT WOMEN, MINOR DISORDERS OF PREGNANCY AND
MANAGEMENT

Submitted To: Submitted By:

Mr. Himanshu Vyas Farheen khan

Associate Professor M.Sc. Nursing 1st year

College of Nursing College of Nursing

AIIMS Jodhpur AIIMS Jodhpur

Date of Submission:07/12/2020

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Basic Lesson Plan information:
 Subject: OBG
 Name of the Topic: Nursing management of pregnant women, minor dirorders of pregnancy and
management
 Name of the student teacher: Farheen khan
 Name of the Supervisor: Mr. Himanshu Vyas
 Date and Time of teaching: 07/12/2020
 Method of teaching: Practice Teaching
 Duration: 40 minutes
 Previous knowledge: - Students are having some knowledge about Minor disorders in pregnancy

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General objective: - At the end of the topic/class, the students will be able to understand about Minor
disorders in pregnancy and management, develop desirable attitude and will be able to apply this knowledge
in their personal and professional life.

Specific objective: -At the end of teaching, students will be able to –

 define minor disorders in pregnancy

 explain about concept of management of minor disorders in pregnancy
 list types of immunization given in antenatal period
 discuss about the supplementation
 explain about the processes which are described under management of pregnant women with minor
disorders

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INTRODUCTION:-

Minor disorders during pregnancy with advice on diet, exercise, and with simple home remedies that are
known to be safe and help women feel better. Sometimes these minor problems may become more serious,
or signal a serious underlying health problem that needs referral to a health facility.

Minor disorders of pregnancy are a series of commonly experienced symptoms related to the effects of

pregnancy hormones and the consequences of enlargement of the uterus as the fetus grows during
pregnancy.

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LESSON PLAN
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1. 5 min What are DEFINITION:- Lecture cum What are minor
Minor Minor disorders of pregnancy are a series of commonly Laptop discussion disorders?
disorders in experienced symptoms related to the effects of
pregnancy pregnancy hormones and the consequences of
enlargement of the uterus as the fetus grows during
pregnancy.

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2. 8 min What is Hyperemesis gravidarum, or pernicious vomiting of Laptop Lecture cum Explain about
Hyperemesis pregnancy, is a complication of pregnancy that affects discussion the different
gravidarum? various areas of the woman’s health, including treatment
homeostasis, electrolytes, and kidney function, and may modalities used
have adverse fetal consequences. for
hyperemesis
Diet
gravidarum?
Modification of the amount and size of meals consumed
throughout the day may help relieve symptoms. Having
smaller amounts of food and fluids more often can help
prevent mild cases of nausea and vomiting from

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 worsening. The meals should contain more carbohydrate
than fat and acid.

Lifestyle
Women who are affected by this illness should avoid
stress and try to get as much rest as possible

Intravenous Fluids
Intravenous (IV) fluids should be provided to replenish
the lost intravascular volume. Rehydration along with
replacement of electrolytes is very important in the
treatment of hyperemesis

Thiamine
Thiamine should be a routine supplement in patients with
protracted vomiting. Pregnant women should ingest a
total of 1.5 mg/d. If this cannot be taken orally, 100 mg of
thiamine may be diluted in 100 mL of normal saline and
infused for 30 minutes to 1 hour weekly

Antiemetics
Several common drugs are used as antiemetics to control
nausea and vomiting during pregnancy. They should not
be used before 12 to 14 weeks of gestation due to possible
detrimental effects to the developing fetus.4 However,
there are data showing lack of teratogenicity with the use

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 of dopamine antagonists, phenothiazines, and histamine
receptor blockers

Steroids
The mechanism of action of steroids is assumed to be a
direct effect on the vomiting center of the brain. Because
such high doses are required, it is improbable that there is
a lack of pituitary adrenal reserve in this illness.

Ginger
The GI symptoms of motion sickness and hyperemesis
are similar; therefore, the root of ginger, Zingiber
officinale, has been studied to treat hyperemesis. The
effectiveness of ginger is thought to be dependent on its
aromatic, carminative, and absorbent characteristics. It is
thought to act on the GI tract to increase motility, and its
absorbent property may decrease stimuli to the
chemoreceptor zone in the medulla that sends stimuli to
the emetic center of the brain stem. Ginger may also
block the GI responses and consequent nausea feedback

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3. 8 min What is Heartburn is defined as a sensation of 'burning' in the Laptop Lecture cum Expain about
heartburn in upper part of the digestive tract, including the throat. It discussion the causes of

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 pregnancy? can be associated with oesophagitis. heartburn in
pregnancy?
Aetiology/ Risk factors
The cause of heartburn during pregnancy is
multifactorial. Increased amounts of progesterone or its
metabolites cause relaxation of smooth muscle, which
results in a reduction in gastric tone and motility, and a
decrease in lower oesophageal sphincter pressure. It has
also been found that, during pregnancy, the lower
oesophageal sphincter is displaced into the thoracic cavity
(an area of negative pressure), which allows food and
gastric acid to pass from the stomach into the oesophagus,
leading to oesophageal inflammation and a sensation of
'burning

Management

women may be advised to eat smaller meals; to avoid

food before bed, and certain types of acidic or spicy food
along with tobacco and alcohol; to avoid certain postural
changes that may exacerbate symptoms; and to sleep in a
more upright position. Such strategies are intended to
either reduce acid production, or avoid reflux associated
with postural change.

A range of medications affecting different physiological

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 processes have been used to treat symptoms. These
include antacids such as alkali aluminium, magnesium
and calcium salts which neutralise stomach acid or protect
the lining of the stomach and oesophagus; drugs which
act to reduce the secretion of gastric acids including
antihistamines such as ranitidine (known as
histamine2 receptor antagonists); drugs which inhibit
stomach enzymes involved in acid production (proton
pump inhibitors such as omeprazole); and drugs to
promote gastric emptying and gut motility, or to enhance
sphincter pressure (for example, metoclopramide). It has
also been proposed that heartburn sometimes results from
bile reflux due to the failure of the pyloric sphincter
(located between the stomach and duodenum). Hence,
treatment with dilute acid to neutralise the effects of bile
has been suggested.

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4. 4 min What are the Laptop Lecture cum How laxatives

causes of Cause of constipation during pregnancy depends on the discussion help if
constipation stage at which it occurs. Possible causes include: relieving

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 during constipation?
pregnancy?  Hormones: Changing hormone levels in early
pregnancy cause the intestines to slow down the
movement of stool through the bowel. This delay
increases the amount of water that the colon
absorbs from the stool, which makes it more solid
and difficult to pass.
 Prenatal vitamins: Prenatal vitamins are chock-full
of iron, a crucial mineral that can sometimes be
deficient during pregnancy. Iron can cause
constipation and hard, black stools.
 Pressure from the uterus: In later pregnancy, the
growing uterus can put pressure on the bowel,
making it harder to move stool through the
intestines.

During pregnancy, women can often relieve constipation

using gentle, safe home remedies:

 Fiber: Taking fiber supplements or eating more

fibrous foods, such as fruits, vegetables, and whole
grains, can increase the number of stools and
facilitate their passage through the intestines.
Adults should eat between 28 and 34 grams of fiber
each day.
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  Fluid: Drinking enough water is important to keep
stool soft and easy to pass. If a person feels that
water is not helping, they can try adding clear
soups, teas, and naturally sweetened fruit or
vegetable juices to their diet.
 Activity: Being active helps stool move through the
intestines. Getting regular exercise, with a doctor’s
approval, can help relieve constipation. If
exercising is not a priority or possibility, try to fit
in a gentle walk each day.
 Probiotics: Millions of healthy bacteria live in the
gut and help it function correctly. Probiotics may
help repopulate the gut bacteria with healthy strains
that encourage normal and regular bowel
movements. Foods high in probiotics include
yogurt, sauerkraut, and kimchi.

Bulk-forming agents

Bulk-forming agents mimic fiber by adding material to

the stool and helping it absorb more water. By doing this,
they make the stool larger, softer, and easier to pass.

These types of laxative can cause some cramping or

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 discomfort, so people should start with the lowest dosage
and ensure that they drink lots of water.

Examples of bulk-forming agents include psyllium,

methylcellulose, and polycarbophil.

Stool softeners

Stool softeners add water to the stool to help make it

softer and more comfortable to pass.

The stool softener that doctors most commonly

recommend to pregnant women is docusate (Colace).

Lubricant laxatives

Lubricant laxatives add a slippery coating to either the

stool or the inside of the intestinal tract to aid the passage
of stool out of the body.

Glycerin suppositories are one type of lubricant laxative.

It is essential to always speak to a healthcare professional
before using suppositories, especially when pregnant.

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 Osmotic laxatives

By drawing more water into the intestines, these laxatives

help soften the stool. They also allow the bowel to
contract more to move the stool along. These types of
laxative can also cause cramping and bloating in the
abdomen.

Examples of osmotic laxatives include polyethylene

glycol and magnesium hydroxide.

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5. 5 min Management  The management of varicose veins during pregnancy Lecture cum What is gravida
should be by conservative means consisting of proper Laptop discussion and parity?
of varicose
elastic support, elevation of the extremities at night and
vein during during rest periods in the day, avoiding static dependency
of the legs, and control of body weight. In event of
pregnancy?
venous stasis and severe symptoms of varicosis that
cannot be controlled by conservative measures, limited
surgical intervention is indicated. This should consist of
high ligation and division of the involved venous trunk
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 and the immediate tributaries. Radical extirpation of
varicose veins should be reserved until further pregnancy
is not contemplated.
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6. 10min What are Hemorrhoids are swollen blood vessels in and around the Laptop Lecture cum List the
haemorrhoid anus and lower rectum. To ease the discomfort of discussion important
s during hemorrhoids during pregnancy: points in
pregnancy? management of
 Soak in warm water. Fill the tub with warm water and haemorrhoids?
soak the affected area. Don't put soap or bubble bath in
the water.
 Avoid sitting for long periods of time. Sitting puts
pressure on the veins in your anus and rectum. When
you can, lie on your side or stand up. If you must sit,
take frequent breaks or sit on a hemorrhoid pillow, also
known as a ring cushion or doughnut.
 Use an over-the-counter remedy. Apply witch hazel
medicated pads to your anal area. Or ask your health
care provider to recommend a hemorrhoid cream or
rectal suppository that's safe to use during pregnancy.
Keep in mind that constipation contributes to
hemorrhoids during pregnancy. To relieve or prevent
constipation:

 Include adequate amounts of fiber in your diet by

eating lots of fruits and vegetables
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  Ask your health care provider to recommend a safe
fiber supplement to take during pregnancy
 Ask your health care provider to recommend a safe
stool softener to take during pregnancy
 Drink plenty of fluids
 Include physical activity in your daily routine
If your hemorrhoids get worse, talk to your health care
provider. Surgical treatment might be recommended after
your pregnancy.

SUMMARY:
Today we have discussed about:-
Minor disorders during pregnancy with advice on diet, exercise, and with simple home remedies that are known to be safe
and help women feel better. Sometimes these minor problems may become more serious, or signal a serious underlying
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health problem that needs referral to a health facility. Hyperemesis gravidarum, or pernicious vomiting of pregnancy, is a
complication of pregnancy that affects various areas of the woman’s health, including homeostasis, electrolytes, and kidney
function, and may have adverse fetal consequences. Heartburn is defined as a sensation of 'burning' in the upper part of the
digestive tract, including the throat. It can be associated with oesophagitis.

REFERENCE:

1. Park. K. Preventive and social medicine. 25thed. Jabalpur: BanarsidasBhanot; 2019.

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 2. Rao sunder K. An introduction to obstetrics. 4thed. Chennai: K.V. Mathew for B.I. Publications private limited;
2009.;
3. Antenatal rates (internet), ciated on 20 oct , available athttps://www.worldometers.info/world-population/india-
population/
4. Kamalam.S. Essentials in obstetrics. 2nded. New Delhi: Jaypee brothers;2012

5. Population size (internet), ciated on 20 oct, available at http://mospi.nic.in/statistical-year-book-india/2018/171

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