EX ER C ISE

should be done in moderation

should be individualized: according to age,

physical condition, customary amount of

exercise ( swimming or tennis) not
contraindicated unless done for the first
time ; & stage of pregnancy
Walking is best
Swimming is good as long as the
membranes are intact

SLEEP AND REST

Assess activities to identify need for rest and

sleep
Average number of hours of sleep is 8
hours;may need 1 to 2 hours of after few
hour afternoon nap.
In the second half of pregnancy, advise to
avoid the supine position in bed( position on
SIMs position
Plan rest time during the day
At work, get to stand and walk about for few
minutes at last once in every 2 hours(if task
requires prolong standing, there should be
time to walk about and sit at intervals

TR AV ELLIN G

no travel restrictions but postpone a trip during the

last trimester. on long rides , 15-20 minute rest periods
every 2-3 hours to walk about or empty the bladder is
advisable.

Long distance travel by land needs stop-overs so

pregnant women can get out of the car and walk.

Seatbelts are needed
Traveling by air requires pressurized planes;In late

pregnancy, airlines will require a medical certificate

indicating fitness to travel by air
Best time to travel is during the second trimester

because:
The pregnant women is most comfortable
The danger of abortion is not great
The threat of premature labor is at a minimum

EM P LO YM EN T
as long as the job does not entail handling

toxic substances or lifting heavy objects , or

excessive emotional strain, there is no
contraindication to working.
advise to walk about every few hours of her

workday during long periods of standing or

sitting to promote circulation thereby
minimizing varicose veins.

H .PhysicalExam ination
Baseline Height/Weight
Vital Sign measurement
Assessment of Systems
Measurement of Fundal Height
Fetal heart sounds

Assessment of Systems
1. General Appearance and Mental

Status

Manner of dressing
Way of speaking
Body posture

Head and scalp

Symmetry
Normal contour
Tenderness
Hair distribution, thickness, excessive

dryness or oiliness,cleanliness

Eyes
Edema of the eyelids combined with a

swollen optic disk suggests edema from

pregnancy induced hypertension
Assess for diplopia(double vision)

Nose
Increase level of estrogen associated

with pregnancy cause nasal congestion

or the appearance of swollen nasal
membranes

Ears
The nasal stuffiness that accompanies

pregnancy may lead to blocked

eustachian tubes and therefore a feeling
of fullness in the ears or dampening of
sound during early pregnancy
Usually this disappears as the body
adjusts to the new estrogen level.
Normal hearing level and normal
tympanic landmarks should be present

Mouth, Teeth and Throat

Gingival(Gum) hypertrophy may result

from estrogen stimulation

Gums slightly swollen and tender to
touch but not reddened
Prone to vitamin deficiency due to rapid
fetal growth
Assess for cracked corners of the mouth
which would reveal Vitamin A deficiency
Assess for pinpoint lesions with an
erythematous bas e on the lips(suggest

 Teach dental hygiene

Dental carries are source of infection

and should be treated before

abscesses develop and cause more
serious problems

NECK
Slight thyroid hypertrophy due to

increased metabolic rate

LYMPH NODES
No palpable lymph nodes should be

present

BREASTS
Areola darken
Secondary areola develop
Montgomery tubercles(sebaceous glands

in the areola) become prominent

Overall breast size increases
Breast consistency firms
Blue streaking of veins becomes
prominent
Colostrum may be expelled as early as
the 16th week of pregnancy

Heart
Ranges 70 to 80 beats/minute
accessory sounds or murmurs should be

absent
Occasional palpitations(heart skipping a
beat) especially when lying supine
should rest or sleep on their left side

TETA N U S TO X O ID
IM M U N IZATIO N :
TT1 GIVEN ANYTIME DURING

PREGNANCY
TT2 ONE MONTH AFTER TT1 ( 3 YEARS

PROTECTION)
TT3 SIX MONTHS AFTER TT2 ( 5 YEARS

PROTECTION)
TT4 ONE YEAR AFTER TT3 ( 10 YRS)
TT5 ONE YEAR AFTER TT4 OR NEXT

PREGNANCY ( LIFETIME PROTECTION)