Back Pain, Leg Cramps and Varicosities (Nursing)

00:01 Now, let's think about back pain.

00:03 We can think about back pain a lot, because I assure you that a pregnant client thinks about back pain and experiences back pain pretty frequently.

00:11 This happens often in the second and third trimester, and the physiology here is sort of relaxation of the muscle and this change in the center of gravity.

00:20 So, when I think about a pregnant woman walking at the end of pregnancy, I get this waddle going on.

00:25 And so, when you start to do that, it's not because it's sexy, it's not like a sexy look to waddle, or it might be.

00:32 I shouldn't say that. It's sexy to waddle.

00:34 But what we have to understand is the waddle is happening as a way to keep the patient upright because if they walk the way they normally would, they might tip over.

00:44 Well, have you ever started exercising and using different muscles than you usually do and you find that you have soreness? It's the very same thing.

00:52 So, they may have back pain as a result of sort of this change in the way that they have to manage and shift their weight.

00:58 They also have a baby in the front that's sticking out this way, that they have to counterbalance and so, they're using more muscles in their back than they have been, and trying to get comfortable at night, and putting pillows here, there, and everywhere.

01:12 If you have them, sometimes, it's very difficult.

01:15 So, the other thing that we want to think about with back pain that sounds like it could be completely normal is the potential for complications, specifically preterm labor. So, we want to get in there and ask the client, "Tell me about this back pain you're having.

01:29 Is it soreness? Does it come and go? Are you having the back pain every five to 10 minutes? Because that's not back pain, that's likely contractions." So, we want to make sure we differentiate back pain from labor.

01:44 So, ask those questions to help you differentiate that.

01:48 Also, think about what's in the back, like the kidneys and if they become infected then you may notice that you have symptoms of a UTI.

01:56 So, it's not back pain from a waddle, it's back pain from an infection.

02:01 And infections in a pregnant patient can move to sepsis really quick, so it's not something that we sit and rest on.

02:08 If the client has a UTI, we need to get that treated pretty quickly to make sure that it doesn't become pyelonephritis.

02:15 So, thinking about treatment, we can do an exercise called a pelvic tilt.

02:20 Now, we don't really do sit-ups, because trying to do crunches during pregnancy is kind of not productive.

02:28 But we can still do a pelvic tilt where we lie on our back and then we lift up our pelvis and really work to strengthen the back muscle.

02:35 So, sometimes even though the abdomen muscles are really doing all the work, the back muscles are supporting it.

02:41 So, if we strengthen the back then we don't get as much pull on the front, we get rid of some of the back pain, that does work.

02:49 We can use warm compresses or a heating pad that works really well.

02:53 Moving in that exercise, you're going to see exercise a lot, so now you see why it's important that we make this recommendation.

03:00 And then, if it's available, a massage, now, it doesn't have to be a big fancy massage that you pay lots of money for, it could be one of those wonderful support people or you could do it yourself with a tennis ball, and just lie it on the floor and then just roll around, it works really well, too.

03:17 So, massages work great in terms of helping back pain but we want to make sure that we ruled out preterm labor or urinary tract infection.

03:27 What about leg cramps? So much fun.

03:30 When do we expect to have this? Maybe around the third trimester.

03:34 Physiologically speaking, this could be a result of weight changes or changes in the circulatory system where the blood flow is not as good as it used to be.

03:43 We have the weight of the fetus that is actually decreasing venous return and that can absolutely be problematic.

03:50 So, we can try a few things that we'll talk in just a minute in terms of relief but what we want to avoid is missing something like a deep vein thrombosis.

03:59 I can tell you about a client that I had when I first started practice.

04:03 And this was a person who was young and playing basketball and doing all kinds of wonderful, fantastic things that was early in their pregnancy and was describing this leg pain to me.

04:14 And I could not figure out where it was coming from.

04:17 This is a healthy person, never had any complications, no issues whatsoever and I said, "You know, we've tried the warm compresses, we've dorsiflexed the foot, we've done all that, you're still having this pain.

04:28 I don't know, maybe we should send you, and get a scan of your leg and just see." And guess what, they did have a clot, and it went up the entire space of the thigh.

04:40 So, we always want to make sure that we check.

04:42 Pregnancy is a hypercoagulable state and so we can't ignore that even on a fairly young person for whom we normally would not expect the DVT at all.

04:52 So, in terms of treatment, I said dorsiflex the foot, I want you to see it, so this is what it looks like.

04:58 We have a foot in this picture and we actually bend the toes back towards the head.

05:04 So, if here's my foot, we bend the toes back this way and we hold it, that's dorsiflexion and that may help to alleviate some of the cramping.

05:12 We can also apply heat to see if that helps.

05:14 We can also use things like compression hose, especially if the client is working in a situation where they're on their feet all day, that might actually help.

05:23 Speaking of things going on in the legs, let's talk about varicosities.

05:29 So, varicosities typically show up around the second or third trimester, and the physiology of varicosities really are related to the relaxation of the vasculature.

05:40 Again, this is hormonally mediated so when we think about progesterone, And we think about the fact that it relaxes everything, it is still doing that in this case.

05:50 And then, again, poor venous return as we get further along in the pregnancy is going to also contribute to that.

05:57 Any time we have varicosities, we want to be on the look out for DVTs, because they're very close and we have to make sure we know which one is which.

06:06 So, if you remember your symptoms of DVT, we're looking for things that have a rope-y feel, something that's warm to the touch, or has red streaking around it, if you can determine that make sure that you know it's not a DVT and if there's anybody question, then you want to talk to the provider about getting a scan.

06:24 What do we do for varicosities? Compression hose works wonders.

06:29 Again, not necessarily the most attractive look.

06:32 Although, I've seen some nice-looking compression hose.

06:35 And thinking about how long the compression hose are.

06:38 So, sometimes just the short compression hose, they go up to the knees are not going to be enough, they need to come all the way up in order to really help move the blood.

06:47 We want to avoid crossing their legs.

06:50 This is going to really help from cutting off blood flow which actually increases the chances of varicosities so we're going to avoid that.

06:58 We want to rest in the left lateral position because that increases cardiac output, which means it improves blood flow, so resting.

07:06 Now, does it have to be in the left lateral position? No, it's the best one but any sort of resting in any position that is not upright or sitting in a chair is going to be helpful.

07:16 And then guess what, exercise. It shows up again. Definitely helps with varicosities.