Case Analysis:

Twenty-three-year old Marie Cutler is an aerobic instructor, G0 P000 in her first trimester of pregnancy. She presents to you at the local
clinic complaining of frequent nausea, urinary frequency and fatigue. You obtain her vital signs as: BP 108/60 mm Hg, temperature 97*F, pulse
68 bpm, respirations 12 cpm, weight 125 lbs, height 65 inches. Her urine test negative for ketones, albumin, leukocytes and sugar. You note that
Marie has lost 3 lbs since her last visit. You assist the certified nurse midwife with physical exam, the findings of which are essentially normal.
Marie says that she knows it could become an issue, she would like to continue working as an aerobic instructor for as long as she possibly can
during the pregnancy. You identify Marie’s complains as normal discomforts of pregnancy, and proceed with prenatal education.

1. FDAR
2. NCP
3. DRUG STUDY
4. READINGS (based on the case)
5. PA

1.) FDAR
DATE/TIME FOCUS DATA, ACTION and RESPONSE
27/12/20 State of D: Pregnant patient in first trimester complaining of nausea with vital signs of BP 108/60 mm Hg, temperature 97*F,
10:00 am nutrition pulse 68 bpm, respirations 12 cpm, weight 125 lbs, height 65 inches. Her urine test negative for ketones, albumin,
leukocytes and sugar. You note that Marie has lost 3 lbs since her last visit.

A: Encourage verbalization of feeling.

Encourage small, frequent meals.
Encourage to eat crackers before rising.
Avoid pungent odors, spicy or greasy foods.
Discuss limited time frame for nausea (subsides around 12 weeks’ gestation).
Note and report excessive vomiting (more than 3-4 times within 8 hours).
Offer fruits and vegetable.
Encourage fluid intake of 1-2 liters a day.
Promote light body exercises as tolerated.
Encourage frequent OB check-up.
Health teaching: Provide the importance of balance diet, rest and exercise.
 R: Marie was able to manage her nausea, urinary frequency and fatigue after intervention was taken.
Ongoing monitoring on the present intervention given.

2.) NURSING CARE PLAN (1)

Assessment Nursing Diagnosis Planning Implementation Evaluation
Subjective: Nutritional * After 24 hours of  Provide an emesis basin within  Goal met, the
Patient complaining of imbalance: Less intervention easy reach of the patient because patient reports
nausea. than body patient reports nausea and vomiting are closely decreased in
requirements decrease severity related. nausea after 24
Objectives: related to nausea or elimination of  Eliminate strong odors from the hours of
Pregnant woman in first secondary to nausea. surrounding like perfumes, strong intervention.
trimester. pregnancy. detergent and others that may  Patient gained 4
* After 1 month
 Vital Signs: BP induce nausea. pounds in her 1st
the patient gain
108/60 mm Hg,  Advise patient to increase trimester of
weight proportion
temperature 97*F, hydration to 1-2 liters per day. pregnancy.
for her age of
pulse 68 bpm,  Allow the patient to use
gestation.
respirations 12 nonpharmacological nausea
cpm, weight 125 control techniques such as
lbs, height 65 relaxation, guided imagery, music
inches. therapy, distraction, or deep
 Decrease 3 pounds breathing exercises to divert
from last visit. attention but needs to use before
it occurs.
Laboratory Investigation:  Introduce cold water, ice chips,
Urine test negative for ginger products, and room
ketones, albumin, temperature broth or bouillon if
leukocytes and sugar. tolerated and appropriate to the
patient’s diet to aid hydration and
help relieve nausea.
 Give frequent, small amounts of
foods that appeal to the patient
 because this approach will help
maintain nutritional status of the
patient.
 Instruct patient to eat dry food
like crackers or toast before rising
up in the morning to not lessen
nausea.
 Tell patient to avoid foods and
smells that trigger nausea
because strong and noxious odors
can contribute to nausea.
 Review about the prenatal
vitamins the patient is taking
because having too much iron
may cause nausea, and switching
to a different vitamin could help.
 Inform the patient or caregiver to
seek medical care if vomiting
develops or persists longer than
24 hours because persistent
vomiting can result in
dehydration, electrolyte
imbalance, and nutritional
deficiencies.
NURSING CARE PLAN (2)
Assessment Nursing Diagnosis Planning Implementation Evaluation
Subjective: Impaired comfort related  After 8 hours  Encourage frequent  Goal met, after 8
Patient complaining of to frequent urination. of emptying of bladder. hours of
urinary frequency. intervention,  Discourage limiting intervention,
patient oral fluid intake. patient verbalized
discomfort  Increase fluid intake by relieved of
Objectives: from will 1-2 liters a day to urinary
Pregnant woman in first lessen or replace in urinary discomfort.
trimester. relieve. output.  After 8 hours of
 Vital Signs: BP  After 8 hours  Report burning or pain duty, the patient
108/60 mm Hg, of with urination because intake is balance
temperature 97*F, intervention it indicates urinary with the patient
pulse 68 bpm, the patient tract infection and reported output.
respirations 12 intake and need to have a prompt
cpm, weight 125 output will medication.
lbs, height 65 be  Cleanse perineal area
inches. maintained and keep dry because
 Decrease 3 pounds and balance. proper perineal
from last visit. hygiene decreases risk
of skin irritation or
Laboratory Investigation: breakdown and
Urine test negative for development of
ketones, albumin, ascending infection.
leukocytes and sugar.  Teach Kegel exercises
to improve pelvic floor
muscle tone and
urethrovesical junction
sphincter tone.
 Monitor intake and
output to note
hydration imbalance.
NURSING CARE PLAN (3)
Assessment Nursing Diagnosis Planning Implementation Evaluation
Subjective: Fatigue related to  After 48  Establish rapport to  After 48 hours of
Patient complaining of physiological factor: hours of make the patient intervention,
fatigue. Pregnancy intervention, comfortable, verbalize patient verbalize
patient will feelings about the enough rest and
learn how to impact of the fatigue productivity.
Objectives: conserve because living with
Pregnant woman in first and utilize fatigue is both
trimester. her energy. physically and
 Vital Signs: BP emotionally
108/60 mm Hg, challenging that needs
temperature 97*F, coping.
pulse 68 bpm,  Encourage naps during
respirations 12 the day to have
cpm, weight 125 enough rest.
lbs, height 65  Encourage prenatal
inches. vitamins to have
 Decrease 3 pounds supplement that can
from last visit. fill the dietary gap for
the nutrition of the
Laboratory Investigation: baby.
Urine test negative for  Encourage healthy diet
ketones, albumin, with suggested 300
leukocytes and sugar. healthy calories
additional to have
energy and enough
nutritional source for
the baby.
 Report syncope and
vertigo to reduce the
risk of injury and have
a further health
 teaching.
 Assist the patient with
the body toleration
and limitation of
exercise for preferred
work as an aerobic
instructor.  Attaining
desired goals can
develop the patient’s
mood and sense of
emotional health while
utilizing available
energy.

3.) DRUG STUDY

 Drug Classification Dosage and Mechanism of Indication Contraindication Adverse effect Nursing intervention
route action

Generic Name: Vitamin B9 All women An exogenous  Folate Prior to therapy Allergic -Ask for patient
FOLIC ACID Pregnancy of source of deficiency with folate, in sensitization, history for allergy of
(VITAMIN B9, category A. reproductive folate is  Hemolytic megaloblastic flushing, folic acid.
Pteroylglutami age is advice required for anemia anemia, vitamin irritability, -Give oral vitamin and
c acid) (fol’ic) to take 400 nucleoprotein  Juvenile B12 deficiency difficulty instructions if
micrograms synthesis and idiopathic must be sleeping, tolerated.
Brand Name: (mcg) of the arthritis excluded, as malaise, may -With severe GI
Folvite folic acid maintenance  Methotrexat neuropathy may occur rarely. malabsorption or very
each day of normal e induce be precipitated. GI disturbances, severe disease, give
until week erythropoiesis nausea hypersensitivity IM, IV, or
12 of . Folic acid,  Megaloblastic Folic acid is reactions; subcutaneously.
pregnancy. whether given anemia contraindicated bronchospasm. -Test using Schilling
by mouth or  Methanol in patients who test and serum
parenterally, deficiency have shown vitamin B12 levels to
stimulates the  Neural tube previous rule out pernicious
production of defects intolerance to anemia.
red blood cell, (effect of the drug. -Therapy may mask
white blood deficiency in signs of pernicious
cells, and pregnant anemia while the
platelets in woman in the neurologic
persons baby) deterioration
suffering from continues.
certain -Do skin test and
megaloblastic monitor patient for
anemias. hypersensitivity
reactions.
-Report rash, difficulty
breathing, pain or
discomfort at injection
site.
-Keep supportive
 equipment and
emergency drugs
readily available in
case of serious allergic
response.
-When the cause of
megaloblastic anemia
is treated or passes
(infancy, pregnancy),
there may be no need
for folic acid because
it normally exists in
sufficient quantities in
the diet.

3.) READINGS
Categories of pregnancy symptoms:

 presumptive signs — possibility of pregnancy

 probable signs — most likelihood of indicating pregnancy
 positive signs — confirmation of pregnancy  (1)
Occasionally a person with an immense desire for, or fear of, pregnancy can develop presumptive, even probable, signs of pregnancy. This is
known as a false pregnancy (pseudocyesis) and truly shows how the brain can influence physiology (1).

Sidenote: sympathetic pregnancy (also known as couvade syndrome) is when a non-pregnant partner experiences similar symptoms to the
pregnant partner (2).

Most people notice the symptoms of pregnancy start about two weeks after conception, a couple of days after a missed period, or when there is
a positive pregnancy test (1).
The most common early pregnancy symptoms are increased urinary frequency, tiredness, poor sleep, and back pain (3).
Presumptive signs of pregnancy — possibility of pregnancy

 Amenorrhea (no period)

 Nausea — with or without vomiting

 Breast enlargement and tenderness

 Fatigue

 Poor sleep

 Back pain

 Constipation

 Food cravings and aversions

 Mood changes or "mood swings"

 Heartburn

 Nasal congestion

 Shortness of breath

 Lightheadedness
 Elevated basal body temperature (BBT)

 Spider veins

 Reddening of the palms

Probable signs of pregnancy — most likelihood of indicating pregnancy

 Increased frequency of urination

 Soft cervix

 Abdominal bloating/enlargement

 Mild uterine cramping/discomfort without bleeding

 Increased skin pigmentation in the face, stomach, and/or areola

Positive signs of pregnancy — confirmation of pregnancy

 Fetal heartbeat

 Visualization of fetus (ultrasound)

 Positive hCG urine or blood

Vaginal bleeding

Vaginal bleeding occurs in 20 to 40% of pregnant people during their first trimester and can sometimes be confused with a light period (4,5).

Nausea
Nausea during the beginning of pregnancy is commonly referred to as morning sickness due to a change in stomach function at this time — it
usually, but not always, goes away in a few weeks (1). Even though it’s called “morning sickness,” nausea isn’t just confined to the morning.
Increase in urination
Increase in urination in early pregnancy can be due to hormonal changes influencing bladder function and urinary output (6). Additionally,
the cervix becomes softer by the sixth week of pregnancy — known as Hegar’s sign—and can be detected by a physician during a pelvic exam
(1).
Pregnancy tests detect the hormone human chorionic gonadotropin (hCG), which is present in the blood and urine of a pregnant person. hCG is
secreted by the placenta shortly after pregnancy begins (1). It’s best to take a pregnancy test to determine if you’re pregnant.
 Common Discomforts During Pregnancy

Symptoms of discomfort due to pregnancy vary from woman to woman. The following are some common discomforts. However, each mother-
to-be may experience symptoms differently or not at all:

 Nausea and vomiting. About half of all pregnant women experience nausea and sometimes vomiting in the first trimester. This is also
called morning sickness because symptoms are most severe in the morning. Some women may have nausea and vomiting throughout the
pregnancy. Morning sickness may be due to the changes in hormone levels during pregnancy.

Morning sickness seems to be made worse by stress, traveling, and certain foods, like spicy or fatty foods. Eating small meals several times a day
may help lessen the symptoms. A diet high in protein and complex carbohydrates (like whole-wheat bread, pasta, bananas, and green, leafy
vegetables) may also help reduce the severity of the nausea.

If vomiting is severe, causing a woman to lose fluids and weight, it may be a sign of a condition called hyperemesis gravidarum. Hyperemesis can
lead to dehydration and may need hospitalization for intravenous fluids and nutrition. Call your healthcare provider or midwife if you are having
constant or severe nausea and vomiting.

 Fatigue. As the body works overtime to provide a nourishing environment for the fetus, it is no wonder a pregnant woman often feels
tired. In the first trimester, her blood volume and other fluids increase as her body adjusts to the pregnancy. Sometimes anemia is the
underlying cause of the fatigue. Anemia is a reduction in the oxygen-carrying capability of red blood cells. It is usually due to low iron levels. A
simple blood test performed at a prenatal visit will check for anemia.

 Hemorrhoids. Because of increased pressure on the rectum and perineum, the increased blood volume, and the increased likelihood of
becoming constipated as the pregnancy progresses, hemorrhoids are common in late pregnancy. Avoiding constipation and straining may help
to prevent hemorrhoids. Always check with your healthcare provider or midwife before using any medicine to treat this condition.

 Varicose veins. Varicose veins—swollen, purple veins—are common in the legs and around the vaginal opening during late pregnancy. In
most cases, varicose veins are caused by the increased pressure on the legs and the pelvic veins. It is also caused by the increased blood volume.
 Heartburn and indigestion. Heartburn and indigestion, caused by pressure on the intestines and stomach (which, in turn, pushes
stomach contents back up into the esophagus). It can be prevented or reduced by eating smaller meals throughout the day and by avoiding lying
down shortly after eating.

 Bleeding gums. Gums may become more spongy as blood flow increases during pregnancy. This causes them to bleed easily. A pregnant
woman should continue to take care of her teeth and gums and go to the dentist for regular checkups. This symptom usually disappears after
pregnancy.

 Pica. Pica is a rare craving to eat substances other than food, like dirt, clay, or coal. The craving may indicate a nutritional deficiency.

 Swelling or fluid retention. Mild swelling is common during pregnancy, but severe swelling that lasts may be a sign of preeclampsia
(abnormal condition marked by high blood pressure). Lying on the left side, elevating the legs, and wearing support hose and comfortable shoes
may help to relieve the swelling. Be sure to notify your healthcare provider or midwife about sudden swelling, especially in the hands or face, or
rapid weight gain.

 Skin changes. Due to fluctuations in hormone levels, including hormones that stimulate pigmentation of the skin, brown, blotchy
patches may happen on the face, forehead, and/or cheeks. This is often called the mask of pregnancy, or chloasma. It often disappears soon
after delivery. Using sunscreen when outside can reduce the amount of darkening that happens. 

Pigmentation may also increase in the skin surrounding the nipples, called the areola. In addition, a dark line often appears down the middle of
the stomach. Freckles may darken, and moles may grow.

 Stretch marks. Pinkish stretch marks may appear on the stomach, breasts, thighs, or buttocks. Stretch marks are generally caused by a
rapid increase in weight. The marks usually fade after pregnancy.

 Yeast infections. Due to hormone changes and increased vaginal discharge, also called leukorrhea, a pregnant woman is more
susceptible to yeast infections. Yeast infections are characterized by a thick, whitish discharge from the vagina and itching. Yeast infections are
highly treatable. Always talk with your healthcare provider or midwife before taking any medicine for this condition. 

 Congested or bloody nose. During pregnancy, the lining of the respiratory tract receives more blood, often making it more congested.
This congestion can also cause stuffiness in the nose or nosebleeds. In addition, small blood vessels in the nose are easily damaged due to the
increased blood volume, causing nosebleeds.

 Constipation. Increased pressure from the pregnancy on the rectum and intestines can interfere with digestion and subsequent bowel
movements. In addition, hormone changes may slow down the food being processed by the body. Increasing fluids, regular exercise, and
 increasing the fiber in your diet are some of the ways to prevent constipation. Always check with your healthcare provider or midwife before
taking any medicine for this condition. 

 Backache. As a woman's weight increases, her balance changes, and her center of gravity is pulled forward, straining her back. Pelvic
joints that begin to loosen in preparation for childbirth also contribute to this back strain. Proper posture and proper lifting techniques
throughout the pregnancy can help reduce the strain on the back.

 Dizziness. Dizziness during pregnancy is a common symptom, which may be caused by:

o Low blood pressure due to the uterus compressing major arteries

o Low blood sugar

o Low iron

o Quickly moving from a sitting position to a standing position

o Dehydration

To prevent injury from falling during episodes of dizziness, a pregnant woman should stand up slowly and hold on to the walls and other stable
structures for support and balance.

 Headaches. Hormonal changes may be the cause of headaches during pregnancy, especially during the first trimester. Rest, proper
nutrition, and adequate fluid intake may help ease headache symptoms. Always talk with your healthcare provider or midwife before taking any
medicine for this condition. If you have a severe headache or a headache that does not resolve, call your healthcare provider. It may be a sign of
preeclampsia.
Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting, excessive pregnancy-
related nausea and/or vomiting that prevents adequate intake of food and fluids." Hyperemesis is considered a rare complication of pregnancy
but, because nausea and vomiting duringpregnancy exist on a continuum, there is often not a good diagnosis between common morning
sickness and hyperemesis. Estimates of the percentage of pregnant women afflicted range from 0.3% to 2.0%
Nursing Assessment for Hyperemesis Gravidarum

1. Activity / rest
Systolic blood pressure decreases, pulse rate increased by more than 100 times per minute.

2. Ego Integrity
Interpersonal family conflicts, economic difficulties, changes in perception about the conditions, unplanned pregnancies.

3. Elimination
Changes in consistency; defecation, increased frequency of urination
Urinalysis: increased concentration of urine.

4. Food / fluid
Excessive nausea and vomiting (4-8 weeks), epigastric pain, weight loss (5-10 kg), oral mucous membrane irritation and red, low hemoglobin and
hematocrit, breath smelled of acetone, reduced skin turgor, sunken eyes and dry tongue.
5. Breathing
Respiratory frequency increased.

6. Security
The temperature sometimes rises, weakness, icterus and may lapse into a coma.

7. Sexuality
Cessation of menstruation, when a state endangering the mother carried a therapeutic abortion.

8. Social Interaction
Changes in health status / stressors of pregnancy, changes in roles, the response of family members that can be varied to hospitalization and
illness, the less support system.

9. Learning and education

o Everything is eaten and drunk vomited, especially if lasts long.
o Weight loss of more than 1 / 10 of normal body berast
o Skin turgor, dry tongue
o The presence of acetone in the urine.

Nursing Diagnosis and Intervention : Imbalanced Nutrition - Less Than Body Requirements for Hyperemesis Gravidarum

Nursing Diagnosis for Hyperemesis Gravidarum

Imbalanced Nutrition: Less Than Body Requirements related to the frequency of excessive nausea and vomiting.

Nursing Intervention for Hyperemesis Gravidarum

1. Restrict oral intake until the vomiting stops.

Rationale: Maintaining a fluid electrolyte balance and prevent further vomiting.

2. Give the anti-emetic drugs are prescribed.

Rationale: Preventing vomiting and maintain fluid and electrolyte balance.

3. Maintain fluid therapy can be saved.

Rationale: Correction of hypovolemia and electrolyte balance.

4. Record intake and output.

Rationale: Determining hydration fluids, and spending through vomiting.

5. Encourage to eat small meals but often

Rational: Can adequate intake of nutrients your body needs.

6. Advise to avoid fatty foods

Rational: fatty foods can stimulate nausea and vomiting.

7. Encourage to eat a snack such as crackers, bread and tea (hot) warm before waking up at noon and before bed.
Rational: snack can reduce or prevent nausea, vomiting, excessive excitatory.

8. Record intake, if oral intake cannot be given within a certain period.

Rationale: To maintain a balance of nutrients.

9. Inspection of irritation or Iesi the mouth.

Rational: To know the integrity of the oral mucosa.

10. Review oral hygiene and personal hygiene and the use of oral cleaning fluid as often as possible.
Rationale: To maintain the integrity of the oral mucosa.

11. Monitor hemoglobin levels and Hematocrit

Rationale: To identify the potential presence of anemia and decreased oxygen-carrying capacity. Clients with Hb levels less than 12 mg / dl or
hematocrit levels are low, consider-trimester anemia I.

12. Urine Test against acetone, albumin and glucose ..

Rationale: Establish baseline data; done routinely to detect potential high-risk situations such as inadequate intake of carbohydrates.

13. Measure uterine enlargement

Rationale: Malnutrition mother affects fetal growth and aggravate the decrease in the complement of brain cells in the fetus, resulting in
deterioration of fetal development and the possibilities further.

Nursing Diagnosis and Intervention : Imbalanced Nutrition - Less Than Body Requirements for Hyperemesis Gravidarum
Nausea is a queasy sensation that may include or not include an urge to vomit. It is a common and distressing indication with multiple causes,
including chemical stimulation of the vomiting center by certain medications, chemotherapy, intracranial lesions, ingestion of toxins, inhalation
of anesthetic gases, mucosal diseases, gastrointestinal obstruction, or microorganisms in the gastrointestinal tract. Other physiological factors
include decreased motility, delayed gastric emptying time, and decreased peristalsis. It may also have psychogenic origins such as gastroparesis
in which the stomach cannot empty itself of food in a normal fashion. Carsickness or seasickness are also some factors for most causes of
nausea.

Nausea during pregnancy is commonly one of the most experienced and complained about symptoms that women report. Up to 70 percent of
expectant mothers experience this at some point during early pregnancy but this subsides by their second trimester although sometimes even
longer.

Nurses are responsible for assessing the causes of nausea and vomiting, administering appropriate antiemetic agents, evaluating the outcomes
of the agents, and communicating data and information to physicians when changes in treatment are indicated.

Causative Factors

Here are common reasons that can cause nausea: 

Treatment-related:

 Gastric distention
 Medications like analgesics, HIV treatment, aspirin, opioids, radiotherapy, or chemotherapy agents
 Postoperative
 Stomach upset due to alcohol, drugs, blood, or iron
 Tube feeding
Biophysical:

 Bowel obstruction
  Cardiac pain
 Cancer
 Cough
 Gastrointestinal diseases
 Increased ICP
 Infections
 Motion sickness
 Peritonitis
 Pregnancy
 Uremia
 Toxins
 Tumors
 Vestibular problems
Situational:

 A reaction to smells and odors

 Bulimia
 Fear
 Noxious stimuli
 Overeating
 Pain
Signs and Symptoms

The nausea is characterized by the following signs and symptoms. Look for these nursing assessment cues to help you diagnose: 

 Allergy to food
 Excessive salivation
 Gagging sensation
 Increased swallowing
 Reports of nausea
 Sour taste in the mouth

FrequentUrinationDuringPregnancy

When does frequent urination start during pregnancy?

Frequent urination is one of the most common early symptoms of pregnancy that starts in the first trimester, around week 4 (or the time you'd be
getting your period).

Most women find they have to pee with even more frequency late in pregnancy, from about week 35 on. Nighttime bathroom trips tend to increase
throughout the third trimester too. 

What causes frequent urination during pregnancy?

Blame excessive urination on the pregnancy hormone hCG, which increases the blood flow to your pelvic area.
While that blood flow can be good for increased sexual pleasure during pregnancy (if you're in the mood for it), it's not so good for long car rides: hCG
also increases blood flow to your kidneys, which become more efficient during pregnancy.

As your kidneys get better at their job, your body gets rid of waste more quickly (including baby's, since you'll be peeing for two).

Your growing uterus also bears some responsibility for your bathroom runs, since it puts pressure on your bladder, giving it less room to store urine.

Near the end of the third trimester, when your baby is preparing for childbirth, his or her head "drops" down into the pelvis and presses squarely on your
bladder — which means you’ll have that gotta-go urge more than ever.

For nighttime urination in particular, those swollen feet and ankles can also play a part. When your body absorbs the fluid in your legs while you’re
sleeping, those fluids are used to make urine.

What can I do about frequent urination when I'm pregnant?

Try to empty your bladder completely by leaning forward as you urinate, so that you'll hopefully need fewer trips to the toilet. 

Also, don't cut back on liquids thinking it'll keep you out of the bathroom. Your body and your baby need a steady supply of fluids during your
pregnancy — plus, dehydration can lead to urinary tract infections.

Can I prevent frequent urination during pregnancy? 

Besides fully emptying your bladder every time you go to the bathroom, try these tricks to reduce urinary frequency:

 Skip diuretics like caffeine. They’ll make you have to pee even more often.
 Don't drink before bed. If you find you have to get up often to go to the bathroom during the night, try limiting fluids right before bedtime.

When can I expect frequent urination to end while I'm pregnant?

Because the arrangement of internal organs varies slightly from woman to woman, the degree of urinary frequency in pregnancy may also vary: Some
women barely notice it, while others are bothered by it throughout their pregnancies. Frequent urination is generally likely to last through the ninth
month of pregnancy, until you give birth.
When should I talk to my doctor about urinary frequency during pregnancy?
If you're always feeling the urge to go to the bathroom (even after you've just peed), or if it seems like the issue is getting worse, talk to your practitioner.
He or she might want to run a test to see if you've contracted a UTI. Also keep an eye on the color of your urine to ensure you're staying hydrated: It
should be clear and pale yellow, not dark.

REFERENCES:

1. https://helloclue.com/articles/life-stages/most-common-symptoms-early-pregnancy
2. https://free-nursingcareplan.blogspot.com/2011/06/nursing-care-plan-for-hyperemesis.html
3. https://nurseslabs.com/nausea/
4. https://www.whattoexpect.com/pregnancy/symptoms-and-solutions/frequent-urination.aspx
5. https://nurseslabs.com/fatigue/?fbclid=IwAR0_8BXTAHQPZmhjnxyR4qyO385lErvS8wDHNAeTwPgDT0wKzkmO36kYYb0
6. https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/folic-acid-folate/
7. https://www.pediatriconcall.com/drugs/folic-acid/596#:~:text=An%20exogenous%20source%20of%20folate,suffering%20from
%20certain%20megaloblastic%20anemias.
8. rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_assessment/?fbclid=IwAR3jxj43jA5u0GnF88uJZxvHLQ-
vM587X9EVDMhw0c0qjhOsUeRLweXrhsw
9. https://www.slideshare.net/ShaellsJoshi/nursing-assessment-13173390
10. Jones RE, Lopez KH. Human reproductive biology. Academic Press; 2013 Sep 28.
11. TRETHOWAN WH, Conlon MF. The couvade syndrome. The British Journal of Psychiatry. 1965 Jan 1;111(470):57–66.
12. Foxcroft KF, Callaway LK, Byrne NM, Webster J. Development and validation of a pregnancy symptoms inventory. BMC
pregnancy and childbirth. 2013 Jan 16;13(1):3.
13. Harville EW, Wilcox AJ, Baird DD, Weinberg CR. Vaginal bleeding in very early pregnancy. Human Reproduction. 2003 Sep
1;18(9):1944–7.
14. OB Peds Women’s Health Notes by Brenda Holloway, CRNP, FNP, MSN; Cheryl Moredieh RNC, MH, WHNP; Kathie Aduddell,
Ed.D, MSN, RN-BC

4.) PHYSICAL ASSESSMENT

PATIENT DATA

Name: Marie Cutler

Age: 23-years old

Work: Aerobic instructor

PATIENT HISTORY

Date: December 28, 2020

Chief Complain:

Pregnant woman in first trimester complaining frequent nausea, urinary frequency and fatigue.

Laboratory results:

Her urine test is negative for ketones, albumin, leukocytes and sugar.

HISTORY OF PREGNANCY

G1P0A0L0

LMP: September 30, 2020

EDC: July 7, 2021

AOG: 12 weeks and 5 days

PHYSICAL ASSESSMENT (HEAD-TO-TOE ASSESSMENT)

General appearance: Patient looks well

Vital signs:
BP-108/60 mm Hg

temperature-97*F

pulse-68 bpm

respirations-12 cpm

weight-125 lbs

height-65 inches

Nutritional Status: Noted a decreased of 3 pounds from previous check-up.

Mobility and self care:

Patient have good posture.

Patient balance is good during functional activity.

Patient is able to mobilize.

Patient is able to perform daily living activity.

Head face and neck:

Chest:

Abdomen:
Skin, hair and nails

Genitalia:

Extremeties: