Pyrosis, Round Ligament Pain and Fatigue (Nursing)

00:01 Now we're moving on to heartburn or the fancy medical term of pyrosis, which is very fun to say. I love P words, pyrosis.

00:11 So when do you have this symptom? Well, sometimes you have it in the first trimester as you begin to have your new experience of pregnancy, but it's most frequently experienced towards the end of the second and into the third trimester, so let's think about the physiology and then it will make sense.

00:27 Progesterone if you remember from our physiology lecture, relaxes everything.

00:33 It relaxes everything including the sphincters that help keep your food down.

00:40 So, if we have relaxation in our pyloric sphincter, then we're going to have issues with our reflux and we're going to have food that comes back up and causes heartburn.

00:50 Think about third trimester, what's getting really big? You got it. Cletus, Cletus is growing and Cletus is pushing our stomach up into our chest, that also doesn't feel good especially if you combined it with the progesterone that relaxes everything.

01:09 So, I want to call your attention to a problem, however.

01:13 So think about preeclampsia and think about one of the questions that we ask, "Have you had heartburn?" Or we're not really asking about heartburn, what we're really asking is if they have any discomfort in this epigastric region because that's where the liver is which can be problematic during preeclampsia.

01:32 So if a client shows up with heartburn, you want to make sure that you have ruled out preeclampsia because it might show up that way.

01:41 I mean nobody comes in and says, "Oh, I'm experiencing epigastric pain," unless they're a nurse, they might say that.

01:49 So thinking about treatment, again, small meals.

01:53 It worked for nausea and vomiting, it's also going to help with heartburn.

01:57 Remember that pyloric sphincter that's going to be relaxed, if our tummy's not full, then it'll be less food to come up.

02:04 We also don't want to eat and drink at the same time.

02:07 I don't know if you can literally do that, but think about the fact that if you're drinking and eating, the potential for filling up your belly is pretty high so maybe we'll take a 30 minute break between each one of those items to help to keep from over filling the abdomen.

02:22 We don't want to lie down after we eat.

02:25 We want to sit up for at least 30 minutes to at least give that food a chance to move into the small intestines, that would be great, so it's not all sitting in our belly, so that when we lie down, where we have our relaxed sphincter, the food begins to come back up.

02:38 Or, we could try calcium carbonate, also known as TUMS to help sort of neutralize the stomach acid so that if we have a little bit of reflux, it's not as uncomfortable.

02:49 So here's some options for treatment.

02:52 Now we're moving into what I consider perhaps one of those discomforts that anticipatory guidance is definitely needed, and that would be round ligament pain.

03:02 So your round ligaments usually hold up the uterus that's the size of a pear, right? A pear, even a really nice pear is kind of small.

03:12 A pregnant uterus that's about 20 weeks is not really small, but it's using those very same ligaments, so what happens is that those ligaments get really stretched and that happens as a result of the progesterone, but it doesn't feel very good, so sometimes around 18 to 20 weeks, the client will come in and then say, "You know what? Whenever I get up, I have this really sharp pain in my sides and I feel like someone is really stabbing me." And I know that sounds really awful as an example, but that's exactly what it feels like and it happens whenever they change position, so maybe they get in and out of the car, they get up out of bed, they get up out of a chair and they complain about this very stretchy, stabby sort of side pain.

03:58 Now, remember, I said stretchy, stabby sort of side pain, that sounds scary and it is, so if the client is not really told about this symptom that happens to most pregnant clients, then they may be very afraid when they had that very first experience.

04:14 They may think they're having a miscarriage and so we want to make sure that we provided some anticipatory guidance about that, alright? So, we also, when we think about stabbing pain, need to realize that it could be a complication, so we want to make sure that we really know what the cause is of that pain.

04:33 When we have round ligament pain, the client's usually going to say something like they felt it when they sat up, when they change position, when they got out of the car.

04:41 Someone who's having preterm labor or someone who's experiencing abruption, the pain is not going to be associated with any particular type of activity, it will be constant and tend to get worse over time.

04:53 It also could mask a urinary tract infection so you may want to ask exactly where the pain is, the round ligaments is going to be in the lower part of the abdomen on this side if they're describing something that moves to the back or maybe something is just on the right side, we might start to think appendicitis, we might start to think pyelonephritis or some sort of kidney infection.

05:15 What do you do about it? Well, first thing is if it hurt to change positions quickly, then we'll change position slowly, that might help a little bit, not a lot but definitely a little bit.

05:28 We could do ice or heat, either on one side or the other, especially for that lingering round ligament pain.

05:35 So being careful of the temperature, you don't want to use something like a heating pad because that's going to keep the area hot for a really long time, and remember there's a baby in there and we really don't want to heat up the baby, so a heating pad on the back is fine, the heating pad on the abdomen, not such a great idea, but warming up a warm washcloth and lying it on the abdomen that will be okay because the heat will dissipate in enough time that it won't over heat the fetus, but ice or something like that, a nice little ice pack works really well.

06:05 Another thing that we can suggest is a support belt, so this belt would fit actually under the abdomen.

06:11 Now in this picture it looks like there's a strap on the top and sometimes they look like that, and sometimes the belt just goes across the lower part of the abdomen, it actually lifts up the belly so that it doesn't jiggle so much when you change position, that works really well too.

06:26 Now have you ever been really been tired? I mean really tired? Fatigue is definitely something that happens at the beginning of pregnancy.

06:36 Now at the beginning of pregnancy, it might be related to the increase in hormones.

06:40 When we get to the third trimester in the end, the fatigue could still be related to that but also related to the fact that it's difficult to rest at night because you need to get up and go to the restroom every five minutes or the baby is moving or you just can't get comfortable.

06:56 So this would be an expected side-effect.

06:59 However, if we get into a situation where the patient might be anemic, that could also cause fatigue and so we want to make sure that that's okay.

07:10 We also could have a client who's experiencing diabetes and fatigue is definitely a symptom of that, so we want to makes sure that we double check that 24 to 28 week glucose screen to make sure that was okay or check for a preexisting situation where diabetes is part of a diagnosis.

07:29 What do we do in terms of treatment for fatigue? Well, the most obvious thing is that we can encourage rest.

07:35 Rest is not always easy, this is when it's a good time to really dig into those drivers of health, who lives in the house? Is this pregnant client responsible of taking care of other children? Does this client have other responsibilities, an older parent, a stressful job, something else that might keep them from resting, so help them problem solve of ways to get rest.

07:56 We also want to think about underlying causes like anemia.

07:59 So, if their hemoglobin is 10 or a 9, that might explain the fatigue and if we didn't look at it we want to make sure that we know that.

08:08 And, again, remembering things like diabetes and what that might do in terms of feeling fatigue, have we really looked at the entire medical diagnosis? Have we checked the thyroid level? Those kind of things may also contribute to fatigue and we want to know that we've checked all that out and made sure it was okay.