MS: Heart Sound

Heart Sounds: Stethoscope Listening

Overview of Heart Sounds  (lub-du ; lub, dub )

·         lub - closure of AV valves, onset of ventricular systole

·         dub - closure of semilunar valves, onset of diastole

Ø  Tricuspid valve (lub) - RT 5th intercostal, medial

Ø  Mitral valve (lub) - LT 5th intercostal, lateral

Ø  Aortic semilunar valve (dub) - RT 2nd intercostal

Ø  Pulmonary semilunar valve (dub) - LT 2nd intercostals

S1  - due to closure of the AV(mitral/tricuspid) valves

      - timing: beginning of systole

      - loudest at the apex

       

S2 -  due to the closure of the semi-lunar (pulmonic/aortic) valves

      - timing: diastole

       - loudest at the base

S3 – Ventricular Diastolic Gallop

         Mechanism: vibration resulting from resistance to rapid ventricular filling secondary to 

         poor compliance

         Timing: early diastole                  

         Location: Apex (LV) or LLSB (RV)

         Pitch: faint and low pitched

S4  - Atrial Diastolic Gallop

Mechanism: vibration resulting from resistance to late  ventricular filling during atrial systole

        Timing: late diastole ( before S1)

        Location: Apex ( LV) or LLSB (RV)

       Pitch: low ( use bell)

  

Heart Murmurs

Murmur - sounds other than the typical "lub-dub"; typically caused by disruptions in flow

Ø  Incompetent valve - swishing sound just AFTER the normal "lub" or "dub"; valve does not completely close, some regurgitation of blood

Ø  Stenotic valve - high pitched swishing sound when blood should be flowing through valve; narrowing of outlet in the open state

Pericardial Friction Rub

Ø  It is an extra heart sound originating from the pericardial sac

Ø  Mechanism: Originates from the pericardial sac as it moves

Ø  Timing: with each heartbeat

Ø  Location: over pericardium. Upright position, leaning forward

Ø  Pitch: high pitched and scratchy. Sounds like sandpaper being rubbed together

Ø  Significance: inflammation, infection, infiltration

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HIV/AIDS Issue: Barebacking Gay Sex

With the recent increase in barebacking, we can expect to see an increase in the rates of HIV and other STDs. In fact, we are already seeing an increase in the rate of gonorrhea specifically among gay men (although the overall rate is going down in other population groups). In addition, with the increase in barebacking, we are now also expecting to see a second wave of HIV infections in the gay community, unless interventions are quickly taken to prevent this from occurring.

Barebacking is an extremely controversial and complicated issue, especially since it is dealing with human behavior. Not all gay men engage in barebacking. Many gay men use condoms every time they have anal sex with every partner. But some gay men prefer to have unprotected anal sex and they are willing to take the risks.

For some gay men, the benefits of unprotected anal intercourse (intimacy, pleasure, etc.) outweigh the risks (HIV and other STDs). On the other hand, if two gay men have unprotected anal intercourse, and neither of them is infected with HIV, nor any other STD, then barebacking would be completely safe as far as infectious diseases are concerned. But if either partner has HIV or another STD, then there are significant risks of infection for these diseases through barebacking. Future HIV and STD prevention efforts targeted toward the gay community must incorporate the issue of barebacking.

The term barebacking generally refers to gay men engaging in unprotected anal intercourse. Barebacking has both its benefits and its drawbacks:

The Benefits of Barebacking:

1. Barebacking simply feels better, it's more enjoyable and more pleasurable, than protected anal intercourse.
2. Barebacking leads to greater intimacy between men during intercourse.
3. Barebacking is more spontaneous than protected sex. There is no need to bother with using condoms.
4. Barebacking is less expensive than having protected intercourse. Using condoms can be expensive, especially if you are on a limited income.
5. If both men are not infected with HIV, nor any other sexually transmitted diseases (STDs), barebacking is 100% safe from infectious diseases. In this case, barebacking falls under the category of "safe sex."
6. Barebacking can sometimes promote monogamy. If two men are monogamous and uninfected, the ability to safely bareback gives them an incentive to stay monogamous with one another. Barebacking also strengthens the emotional ties between a gay couple.

The Drawbacks of Barebacking:

1. If you bareback with a person who is infected with HIV or another STD (even if they do not have any noticeable symptoms), you can become infected and get sick from these diseases. Getting sick from HIV/AIDS and other STDs is not a pleasant experience!
2. If you bareback with a person who is infected with HIV or another potentially fatal STD (such as hepatitis B), you can die from these diseases.
3. If you are infected with HIV or another STD, and you bareback, you can infect other people (including those you care the most about, such as your lover and your friends).

Why do gay men bareback, despite the possible risks? There are many reasons for this, including:

1. Some men no longer fear HIV/AIDS. Some men think that if you just take a few pills everyday (i.e., taking HIV medications), HIV/AIDS is not a problem, it is fully manageable, and it is easy to live with. But talk to many people who have HIV/AIDS and they will tell you a very different story!
2. Some men live only for today, and don't think about the future. Some men think that they need to do everything they can in their life now, since they don't expect to live very long.
3. Some men are dealing with low self-esteem issues. They don't think that their health, or their life, is worth protecting. Low self-esteem is common in the gay community, and is often related to the way that society treats gay men.
4. For some men, they believe that "if it feels good, do it." Some men are willing to take their chances, and the consequences.
5. Some men who are already HIV positive think that they no longer need to use condoms, and are unaware of the health consequences of HIV reinfection and the risks of other STDs.
6. Some men are in denial that they will ever get infected with HIV or any other STD.
7. Some men simply enjoy barebacking better, and think that barebacking is worth the risk. Some men prefer the "skin-to-skin contact," regardless of the risk.
8. Some men simply hate using condoms. Men complain about condoms giving them less sensation, and they also complain that they are more likely to lose their erections while using condoms. Some men also find putting on condoms to be a hassle. A common complaint is that condoms interfere with sex play.
9. Some men hear that "everyone else" is barebacking these days, so they are willing to do it too.
10. When someone is drunk or high on drugs or alcohol, he is more likely to bareback. The overall rates of drug and alcohol use (and abuse) are high in the gay community.
11. Some men are totally unaware of the risks of STDs other than HIV. Although a lot of effort had previously been taken to educate gay men about HIV, almost no effort has been made to educate gay men about other STDs. Besides HIV, other STDs that can be transmitted through barebacking include gonorrhea, hepatitis B, hepatitis C, genital/anal warts, herpes, syphilis and others. Some of these STDs are incurable (like herpes and genital/anal warts), and some are potentially fatal (like hepatitis B and hepatitis C).
12. Some men are so sick of hearing about HIV/AIDS, that they just ignore the whole issue.
13. For some men, if their partner does not bring up the subject of HIV or other STDs, they will just assume that their partner is not infected, and that barebacking would be safe. Some men think that, "if he were positive, he would tell me." This is a dangerous assumption to make, since some men with HIV, or other STDs, will not tell their partner ahead of time that they are infected. This is often due to the fear of rejection, embarrassment, denial, and other reasons.
14. Some men are more likely to bareback with their lovers, or other guys they personally know. Barebacking is used as a way to show intimacy, sharing, and caring between men. The exchange of semen is seen as a way to emotionally bind two men together. Condoms are sometimes seen as a barrier to intimacy.
15. If a man is not worried about getting HIV, chances are very good he isn't worried about getting other STDs either.
16. Some men get completely caught up in the "heat of the moment" and end up having unprotected sex, even though they weren't planning to bareback. Sometimes when a man gets in the mood, his sexual desires overtake his rational thinking.
17. Some men will bareback as long as they are the top partner. There is a common myth that only the bottom partner can get infected during anal intercourse, and that it's safe to bareback as the top partner. This is not true. In reality, when having intercourse with a person who has HIV or another STD, the top partner is at high risk, and the bottom partner is at even higher risk. Note that neither partner is at low risk of infection.
18. In young gay men specifically, they have not experienced the loss, devastation, and death of their lovers and friends (caused by AIDS), that many older gay men have endured. Therefore, younger gay men are less scared of HIV/AIDS, and therefore, are less likely to protect themselves from HIV infection.
19. Even among older gay men, safer sex rates are starting to decrease, and barebacking is on the increase. This is because, realistically, it's difficult for men to use condoms every time they have sex with every partner over a prolonged period of time (months, years, or even a lifetime). Telling a man to use condoms with every single partner, every single time he has sex, for the rest of his life, is a major challenge (and for some men, a very unrealistic goal). Unless there is ongoing education and intervention, it is not surprising if men use condoms less and less as time goes on.
20. It has been suggested that barebacking is a form of rebellion. Gay men hear over and over that they "have to" use condoms. For some men, barebacking is their way of rebelling against "the establishment" telling them what they can, and cannot do.
21. A guy may bareback if his partner tells him that he has tested negative for HIV. But this does notnecessarily mean that barebacking is safe. First of all, since it takes an average of three months for an HIV test to accurately show if someone's HIV positive (and it can take up to six months for some people), a negative test does not always mean that a person is not infected (if they got tested before three months). Also, if a guy who has tested HIV negative has put himself at risk again (even one time), his negative test result would no longer be valid, and he would need to be tested all over again. In addition, some men who have not been tested for HIV recently (or who have never been tested for HIV at all) will tell other men that they tested negative, as a way to get other guys to bareback with them (in other words, as a "pick-up line"). Finally, even if a guy is not infected with HIV, he may still be infected with other STDs. Barebacking would only be safe if a man tests negative for both HIV and other STDs, three months and, just to be sure, at six months or more after his last possible exposure to these diseases.
22. There are even a small number of men who are purposely going out to get themselves infected with HIV. These men are known as "bug chasers"

Although much less common, there are some HIV-negative men who willingly bareback with other men who they know are HIV positive (even when they know the risks). There are many reasons for this including:

1. Some men like to "live life on the edge," and get pleasure out of taking their chances. You can say that these men are "sexual daredevils."
2. If a guy's boyfriend is HIV positive, he is sometimes willing to bareback with his boyfriend as a way of demonstrating his love, even though he knows that he can become infected himself.
3. Some men do not mind getting infected, as long as they get infected only from their boyfriend. They see HIV as a special way to further bond their relationship with their lover.
4. HIV-positive men often have their own social circles and friendships. Some men allow themselves to get infected in order to get into these social circles. Being HIV positive can give some men a "sense of belonging." Some HIV-negative men have also commented that "people with HIV get all the attention, so why am I missing out?"
5. Being positive sometimes brings with it an increase in social services and benefits (housing, food, public assistance, etc.). A person who is HIV positive sometimes qualifies for more social services than someone who is not infected.
6. Some men simply do not care whether they get infected or not.
7. Some men think that if they get infected, they will no longer need to use condoms (not knowing about the problems associated with HIV reinfection, or other STDs).
8. Some gay men are fatalistic. Some of them think that getting HIV is inevitable, so they do not try to avoid it. Some men feel that trying to stay HIV negative is too stressful, and ultimately allow themselves to get infected in order to "just get it over with." There are even some men who think that AIDS is "just part of being gay."

There are several slang terms you may sometimes hear related to barebacking:

Barebacking parties = group sex parties where condoms are not allowed to be used. There are different types of barebacking parties:

1. all positive barebacking parties (where everyone at the party is HIV positive)
2. all negative barebacking parties (where everyone is supposedly HIV negative)
3. Conversion parties 
4. Russian Roulette parties

1. Bug chasers = men looking to get themselves infected with HIV.
2. Gift givers = men with HIV who are willing to infect bug chasers.
3. The gift = HIV
4. Conversion parties = group sex parties where bug chasers allow themselves to get infected by gift givers.
5. Russian Roulette parties = barebacking parties with both positive and negative men. Negative men take their chances that they will be infected when having sex with the positive men there. Depending on the circumstances, the participants may or may not know ahead of time who is positive and who is negative.
6. Bug brothers = a group of positive men.
7. Charged cum or poz cum = semen from an HIV-positive man.
8. Fuck of death = intercourse where HIV infection takes place.

Source: From Rick Sowadsky, M.S.P.H.

http://www.thebody.com/content/art2276.html

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PNLE December 2012 UPDATES: NLE TIPS - MATERNAL AND CHILD HEALTH NURSING

DEC 2012 NLE TIPS MCHN from Mark Fredderick Abejo

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Blessed Pedro Calungsod

Blessed Pedro Calungsod (c. 1654 – April 2, 1672) was a young Roman Catholic Filipino sacristan and missionary catechist, who along with Spanish Jesuit missionary Blessed Diego Luis de San Vitores, suffered religious persecution and martyrdom on Guam for their missionary work in 1672. Calungsod was beatified on March 5, 2000 by Blessed Pope John Paul II. On February 18, 2012, Pope Benedict XVI officially announced at Saint Peter’s Basilica that Calungsod will be canonised on October 21, 2012.

Very little is known about Pedro Calungsod. Historical records never mentioned his exact place of origin or who his parents were. He was merely identified as a teenage native of the Visayas in the Philippines. Historical research identifies Ginatilan in Cebu, Hinunangan and Hinundayan in Southern Leyte, and Molo district in Iloilo as probable places of origin. Loboc in Bohol also makes a claim.

Moreover, no one even really knows how Calungsod looked like. Calungsod is often depicted as a young man wearing a camisa de chino. He holds the martyr’s palm, indicating his death, or sometimes a crucifix, catechism book or rosary, representing his missionary work.

Few details of his early life prior to missionary work and death are known. It is probable that he came to one of the schools run by Jesuits, where he learned Catechism and Spanish language.

Nevertheless, we can be certain of Calungsod’s ecclesiastical provenance since the entire Visayas region was under the old Diocese (now Archdiocese) of the Most Holy Name (Cebu).

MISSIONARY WORK

Pedro was just one of the boy catechists who went with San Vitores from the Philippines to the Ladrones Islands in the western North Pacific Ocean in 1668 to evangelize the Chamorros, according to www.pedrocalungsod.org. In that century, the Jesuits in the Philippines used to train and employ young boys as competent catechists and versatile assistants in their missions. The Ladrones at that time was part of the old Diocese of Cebu.

Calungsod, then around 14, was among the young exemplary catechists chosen to accompany the Jesuits in their mission to the Ladrones Islands (Islas de los Ladrones or “Islands of Thieves”). Around 1667, these were later named Marianas (Las Islas de Mariana) in honor of Queen Maria Ana of Austria who supported the mission.

Life in the Ladrones was hard. The provisions for the Mission did not arrive regularly; the jungles were too thick to cross; the cliffs were very stiff to climb, and the islands were frequently visited by devastating typhoons. Despite the hardships, the missionaries persevered, and the Mission was blessed with many conversions. The first mission residence and church were built in the town of Hagåtña in the island of Guam.

MARTYRDOM

According to Jesuit Martyrs in Micronesia written by Francis X. Hezel, SJ, the Jesuit mission in the Mariana Islands was the first in Oceania; it soon also proved to be one of the bloodiest. On 15 June 1668, San Vitores and a band of five other Jesuits arrived on Guam, the southernmost and largest island in a cordillera of fifteen volcanic islands. With the missionaries came a garrison of thirty soldiers, many of them colonials from the Philippines, whose responsibility was to protect the missionaries and to pacify the local people if need should arise.

At this time, Spanish missionaries were actively converting Chamorros to Roman Catholicism. This relationship was peaceful at the beginning with the Spaniards, who were led San Vitores. The initial reception of the missionaries by the Chamorro people was enthusiastic and reassuring. However, that changed over time when Chamorros grew resentful of the way their language and other customs were being replaced. Chamorro deaths had also increased due to foreign-borne illnesses. www.guampdn.com

Very soon, a Chinese quack, named Choco, envious of the prestige that the missionaries were gaining among the Chamorros, started to spread the talk that the baptismal water of the missionaries was poisonous,www.pedrocalungsod.org explained. And since some sickly Chamorro infants who were baptized died, many believed the calumniator and eventually apostatized. The evil campaign of Choco was readily supported by the Macanjas who were superstitious local herbal medicine men, and by the Urritaos, the young native men who were given into some immoral practices. These, along with the apostates, began to persecute the missionaries, many of whom were killed.

The most unforgettable assault happened on April 2, 1672, Saturday just before the Passion Sunday of that year. At around seven o’clock in the morning, Pedro – by then already about seventeen years old, as can be gleaned from the written testimonies of his companion missionaries – and San Vitores came to the village of Tomhom [Tumhon; Tumon], in Guam. There, they were told that a baby girl was recently born in the village; so they went to ask the child’s father, named Matapang, to bring out the infant for baptism. Matapang was a Christian and a friend of the missionaries, but having apostatized, he angrily refused to have his baby christened.

Meanwhile, despite the growing distrust and animosity between Chamorros and the Spanish, San Vitores and Calungsod visited Matapang’s home and baptized Matapang’s daughter. It is unclear whether San Vitores came unannounced or if he had been invited into the home by Matapang’s wife.

To give Matapang some time to cool down, Padre Diego and Pedro gathered the children and some adults of the village at the nearby shore and started chanting with them the truths of the Catholic Faith. They invited Matapang to join them, but the apostate shouted back that he was angry with God and was already fed up with the Christian teachings.

Determined to kill the missionaries, Matapang went away and tried to enlist in his cause another villager, named Hirao, who was not a Christian. At first, Hirao refused, mindful of the kindness of the missionaries towards the natives; but, when Matapang branded him a coward, he got piqued and so he consented.

When Matapang learned of the baptism, he became even more furious. He violently hurled spears first at Pedro. The lad skirted the darting spears with remarkable dexterity. Witnesses said that Pedro had all the chances to escape because he was very agile, but he did not want to leave Padre Diego alone. Those who personally knew Pedro believed that he would have defeated his fierce aggressors and would have freed both himself and Padre Diego if only he had some weapon because he was a valiant boy; but Padre Diego never allowed his companions to carry arms. Finally, Pedro got hit by a spear at the chest and he fell to the ground. Hirao immediately charged towards him and finished him off with a blow of a cutlass on the head. Padre Diego could not do anything except to raise a crucifix and give Pedro the final sacramental absolution. After that, the assassins also killed Padre Diego.

Matapang took the crucifix of Padre Diego and pounded it with a stone while blaspheming God. Then, both assassins denuded the bodies of Pedro and Padre Diego, dragged them to the edge of the shore, tied large stones to their feet, brought them on a proa to sea and threw them into the deep. Those remains of the martyrs were never to be found again.

The companion missionaries of Pedro remembered him to be a boy with a very good disposition, a virtuous catechist, a faithful assistant, a good Catholic whose perseverance in the Faith even to the point of martyrdom proved him to be a good soldier of Christ. www.pedrocalungsod.org

BEATIFICATION

A year after the martyrdom of San Vitores and Calungsod, a process for beatification was initiated but only for San Vitores. Political and religious turmoil, however, delayed and eventually killed the process. In 1981, when Agaña was preparing for its 20th anniversary as a diocese, the 1673 beatification cause of Padre Diego Luís de San Vitores was rediscovered in the old manuscripts and taken up anew until Padre Diego was finally beatified on October 6, 1985. It was his beatification that brought the memory of Pedro to our day.

Beatification is the act by which the Church, through papal decree, permits a specified diocese, region, nation, or religious institute to honor with public cult under the title “Blessed” a Christian person who has died with a reputation for holiness.

In 1994, then Cebu Archbishop Ricardo Cardinal Vidal asked permission from the Vatican to initiate a cause for beatification and canonization of Pedro Calungsod. In March 1997, the Sacred Congregation for the Causes of Saints approved the Acta of the Diocesan Process for the Beatification of Pedro Calungsod. That same year, Cardinal Vidal appointed Fr. Ildebrando Jesus A. Leyson as vice-postulator for the cause and was tasked with the compilation of a Positio Super Martyrio to be scrutinized by the Sacred Congregation for the Causes of Saints in Rome. The positio, which relied heavily on the documentation of San Vitores’s beatification, was completed in 1999.

Blessed John Paul II, wanting to include young Asian laypersons in his first beatification for the Jubilee Year 2000, paid particular attention to the cause of Calungsod. In January 2000, he approved the decree super martyrio (concerning the martyrdom) of Calungsod, setting his beatification on March 5, 2000 at Saint Peter’s Square in Rome. www.wikipedia.com

SAINTHOOD

On December 19, 2011, the Holy See officially approved the miracle qualifying Calungsod for sainthood by the Roman Catholic Church. The recognised miracle dates from 2002, when a Leyte woman who was pronounced clinically dead by accredited physicians two hours after a heart attack was revived when a doctor prayed for Calungsod’s intercession.

Cardinal Angelo Amato presided over the declaration ceremony on behalf of the Congregation for the Causes of Saints. He later revealed that Pope Benedict XVI approved and signed the official promulgation decrees recognising the miracles as authentic and worthy of belief. The College of Cardinals were then sent a dossier on the new saints, and they were asked to indicate their approval. On 18 February 2012, after the Consistory for the Creation of Cardinals, Cardinal Amato formally petitioned Pope Benedict XVI to announce the canonization of the new saints. The Pope set the date for 21 October 2012 (World Mission Sunday).

After Saint Lorenzo Ruiz, Calungsod will be the second Filipino declared a saint by the Roman Catholic Church. The Roman Catholic calendar of Martyrology celebrates Calungsod’s feast along with Blessed Diego Luis de San Vitores every 2 April.  www.wikipedia.com

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10 Signs You’re Falling in Love

For whatever reason, our bodies seem to be programmed to fall in love when the weather is warm and everything outside is in full bloom. Whether your feelings are requited or not, be sure and revel in them. Sometimes, just the feeling of falling in love can be all the inspiration you need to help pull you out of a rut.

You don’t have to act on your lovey-dovey feelings. Crushes are likely to pass, so try not to be too vexed if you or the object of your affection is unavailable. If one of the things below is happening to you, just try to enjoy it.

Here are 10 Signs You’re Falling in Love, whether you like it or not!

1. You forget to eat.

Super telltale. Forgetting to eat means you’re not only distracted, but that you also want that person more than you want food, so you forget all about it.

2. You catch yourself smiling.

A little love in your system can surprise you so much, you can’t help but smile. It’s half because you feel so good, and half because you’re laughing at yourself.

3. You can’t look at the person.

Suddenly, it’s impossible to hold a decent conversation with the object of your affection, because you’re afraid if you look them in the eye, they’ll be able to tell you’re melting for them inside. A good trick: talk to their forehead.

4. You think about them when you’re getting dressed in the morning.

Don’t pretend you’ve never done it. You start analyzing whether he or she would like the blue shirt better, and putting a little more effort into your hair. No harm done!

5. You realize you miss them when they’re not around.

If you’re used to seeing the object of your affection at work or class and then one day they’re not there, you’ll feel like your whole day was wasted.

6. You get jealous about odd things.

You find out they saw a movie last night and now you are enraged. Why didn’t they think to invite you? Who did they go with?? Your ears turn red as you try and mask your jealousy.

7. You’ve pictured what your children would look like.

Oops.

8. People say you’re glowing.

The feeling of being in love is physical, and like laughter, it can have healing, rejuvenating benefits. This is one of the reasons it’s okay to revel in your feelings, even if they’re for the wrong person — just don’t make any stupid mistakes.

9. You’ve suddenly become Donna Reed.

Male or female, you start bringing cookies and brownies to share with the office or class, and you glance to see that the object of your obsession has noticed. And, you keep your apartment neat and tidy in case they might come over — these are definitely signs you’re falling.

10. You can’t concentrate on work.

Maybe even as you read this article, you’ll glance and realize that half an hour has gone by. That’s because you’re daydreaming. And you are in looo-oooove.

By: Annie Scott, Tonic of http://www.care2.com

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Lecture Notes: Bowel Elimination

Bowel Elimination from Mark Fredderick Abejo

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MCHN: Signs of Pregnancy

Signs of Pregnancy:

Presumptive Signs

·    Amenorrhea – absence of menses

·    Nausea and Vomiting

·    Increased breast sensitivity and breast changes

·    Increased pigmentation

·    Constipation

·    Frequent urination

·    Quickening

·    Abdominal enlargement

Probable Signs

·    Uterine enlargement

·    Hegar’s Sign

·    Goodell’s Sign

·    Chadwick’s Sign

·    Ballottement

·    Braxton Hick’s contraction

·    Positive Pregnancy Test

Positive Signs

·    Fetal Heart Tone

·    X-ray or Ultrasound of fetus

·    Palpable fetal movements

Discomforts of Pregnancy

Changes	Reason	Health Teachings
Nausea and Vomiting	Increased HCG	·    Dry crackers 30 min. before arising ·    Small, frequent, low fat meals ·    Liquids bet. meals ·    Avoid anti-emetics.
Heartburn	Increased progesterone which dec. gastric motility causing esophageal reflux.	·    Pats of butter before meals ·    Avoid fried , fatty foods ·    Sips of milk at frequent intervals. ·    Small, frequent meals taken slowly. ·    Bends at the knees, not at the waist ·    Take antacids
Constipation	Due to displacement of the stomach and intestines; iron supplements	·    Increased fluids and roughage in the diet. ·    Regular elimination time. ·    Increase exercise ·    Avoid enemas, harsh laxatives and mineral oil.
Hemorrhoids	Pressure of growing fetus, Increase venous pressure	·    Warm sitz bathing ·    High fiber diet and increase fluid. ·    Sit on soft pillow
Urinary Frequency	Increase blood supply to the kidney/ Pressure of enlarged uterus in the 3rd Tri	·    Sleep on the side at night. ·    Limit fluid intake during evening ·    Bladder training
Backache	From exaggerated lumbo-sacral curving during pregnancy.	·    Back exercise (pelvic rock) ·    Wear low-heeled shoes. ·    Avoid heavy lifting
Leg Cramps	Increase pressure of gravid fetus, low calcium	·    Frequent rest with feet elevated ·    Regular exercise like walking ·    Increase milk intake
Ankle Edema	From venous stasis	·    Elevate legs at least twice a day. ·    Sleep on left side
Varicose Veins	From faulty valves or weakened vessel walls	·    Elevate feet when sitting. ·    Use support hose ·    Apply elastic bandage ·    Avoid use of constricting garters
Shortness of breath	From pressure on diaphragm	·    Sleep with feet elevated or on ·    regularly.
Nasal stuffiness and epistaxis	Elevated Estrogen levels	·    Direct pressure to the nasal area ·    Avoid blowing of nose.
Fatigue	Due to hormonal changes	·    Get regular exercise ·    Sleep as much as needed. ·    Avoid stimulants.
Breast Tenderness	Increase estrogen and progesterone level	·    Wear well fitted bra ·    Warm compress
Increased Vaginal discharges	Due to hyperplasia of mucosa and increase mucus production	·    Consult physician if infection is suspected ·    Wash carefully and keep it dry.

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