Downloaded 229 times
Uploaded byShrooti Shah
Minor disorders of pregnancy
The document discusses various minor disorders experienced by pregnant women, which can affect multiple body systems due to hormonal and physiological changes. Common issues include nausea, constipation, heartburn, urinary frequency, and musculoskeletal pain, along with their causes, preventative measures, and management strategies. It emphasizes that while these disorders may seem minor, they can significantly impact the woman's quality of life during pregnancy.
More Related Content
Similar to Minor disorders of pregnancy
Minor disorders of pregnancy
- 1.
- 2. Introduction • Many womenexperience some minor disorders during pregnancy. • Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman. • Most of the disorder of pregnancy is a result of the minor disorder that may occur due to hormonal changes, accomodation changes , metabolic changes and postural changes and are fairly specific to each of the three trimester.
- 3. Common disorders or discomfortsduring pregnancy • Digestive system disorders – Nausea/vomiting (morning sickness) – Heartburn – Excessive salivation/ptyalism – Pica eating – Constipation – Hemorrhoid
- 4. Common disorders or discomfortsduring pregnancy • Musculoskeletal system – Backache – Cramping legs • Genitourinary system – Frequency of micturation – Stress incontinence – Leucorrhoea
- 5. Common disorders or discomfortsduring pregnancy • Circulatory system disorders – Postural hypotension – Fainting – Varicosity • Nervous system disorders – Carpal Tunnel syndromes – Insomnia
- 6. Common disorders or discomfortsduring pregnancy • Integumentary system disorders – Skin changes – Itching • Respiratory system – Shortness of breath – Nasal stiffness and epistaxis
- 7. Morning sickness • Commonsymotms of nausea and vomiting usually during the first trimester of pregnancy. • It may occur usually in the morning but may occur at any time during the day. • It occurs in over 50 to 85% of the pregnancies.
- 8. • For 80%of sufferers, this condition stops around t he time of the 12th- 14th week • • However, 20% will suffer from nausea and vomiting for a loner period.
- 9. Causes • Sudden riseof HCG and estrogen in the blood stream, which stimulate the chemoreceptor (trigger zone in the brain and initiate nausea and vomiting • Increased sensitivity to smell • Smooth muscle relaxation • Emotional factors • Slower emptying of the stomach during labour • fatigue
- 10. Risk factors • Twinpregnancy • Previous history of nausea and vomiting • History of Motion sickness • Genetic predisposition to nausea during pregnancy • History of migraine
- 11. Diagnosis • Medical history •Physical examination
- 12. Prevention • Medication: well-knownover-the-counter drugs should be administered only when absolutely indicated and prescribed. • Drink water or other fluids between meals to avoid dehydration and acidosis • Avoid: Disagreeable odors and rich, spicy, or greasy foods • Explanation, reassurance, and symptomatic relief are sufficient.
- 13. Prevention • Eat drycrackers biscuits or dry bread 15 minutes before arising in the morning. • Avoid personal triggering factors (including smelling and cooking). • Avoid overeating fried food, spicy, fried and and fatty food. • Eat small, frequent meals • Avoid lying down immediately after eating • Avoid brushing teeth after meal
- 14. Prevention • When gettingup from the bed, get up slowly and avoid sudden movements. • Keep room well ventilated • Avoid warm places. • Hospitalization may be necessary to correct fluid and electrolyte imbalance • Behavior modification • Dietary changes
- 15. Constipation • Constipation isa condition of infrequent, irregular and difficulty in passing stool or the passing of hard stool. • It is quite common during pregnancy • Most commonly occurs during the 2nd -3rd trimester
- 17. Cause • Atonicity ofthe gut due to the effect of progesterone • Diminished physical activity and pressure of the gravid uterus on the pelvic colon • Sluggish bowel function are the possible explanations. • Lack of physical activity and exercise • Decreased fluid intake
- 18. Management • Mineral oilis contraindicated because it absorbs fat-soluble vitamins from the bowel and leaks from the anus. • Exercise and good bowel habits are helpful • Eat high fiber foods • Get regular daily exercise • Increased fluid intake at least 2000-3000 ml per day
- 19. Management • Chew foodthoroughly • Avoid iron pills. • Purgatives should be avoided because of the possibility of inducing labor. • Emphasize ample fluids and laxative foods and prescribe a stool softener • Regular bowel habit may be restored
- 20. Acidity and heartburn •Heartburn is a burning or painful sensation in the upper part in the middle of the chest and radiates upwards, often accompanied by bad tests in the mouth. • Common in all trimesters, with increasing severity in last trimester.
- 21. Acidity and heartburn •Due to relaxation of the esophageal sphincter • Most likely to occur when the patient is lying down or bending over • In late pregnancy, this may be aggravated by displacement of the stomach and duodenum by the uterine fundus • Heartburn (pyrosis, acid indigestion) results from gastroesophageal reflux disease (GERD) in almost 10% of all gravidas hiatus hernia
- 22. Management • Advice ondiet and lifestyle to prevent and relieve heartburn in pregnancy • Eat a balanced diet • Eat small frequent meals • Identifying foods, which causes heartburn and avoid foods known to cause gastric upset • Not to go to bed immediately after the meal. Keep her head higher than her stomach when lying down or sleeping (propped up position).
- 23. • Avoid overeating,eating and drinking at the same time to reduce stomach volume. • Chewing food • Drink milk and 6-8 glasses of water daily • Loose clothing • Eating fruits such as apple, pineapple and papaya with meals as they have digestive enzymes that speed up
- 24. Pharmacological intervention • Antacidpreparation • Calcium and magnesium based antacid
- 25. Pica • This isthe term used when a mother craves certain foods or unnatural substances such as coal. • Most commonly occurs during the 1st-3rd trimester, and most in 1st trimester. • Pica is the craving and intentional consumption of substances not culturally defined as food.
- 26. • The diagnosisof pica is based on an individual’s report of craving and intentional consumption of substances not culturally defined as food.
- 27. Causes • Unknown • Possiblyinfluenced by tradition • Change in the sense of test mouth • Hormones and changes in metabolism
- 28. diagnosis • History taking:questions asked in nonjudgmental manner
- 29. Prevention and relief measures •Explaining the possible harmful effects on pica on the fetus and suggesting the alternative behaviors may help. • If the substance craved is harmful to the unborn baby, the mother must be helped to seek medical advice. • Eat a balanced diet
- 30. Indigestion • Indigestion oftenoccurs after eating too much of heavy or greasy food or drinking too much alcohol • Discomfort or a burning feeling in the midchest characterizes it
- 31. Causes • Eating toomuch of heavy or greasy food or drinking too much alcohol
- 32. Prevention and relief measures •Eat digestible food • Avoid overeating fatty, greasy and spicy food • Eat small frequent meals • Avoid alcohol, coffee and cigarette • Eat boiled food
- 33. Excessive salivation • Increasedsecretion of salivation is observed during pregnancy. • Some women experience ptyalism or excessive salivation that is unpleasant and embarrassing. • Most commonly occurs during the 1st-3rd trimester
- 34. Cause • Unknown • Excessivesalivation appears to the stimulation of the salivary gland by eating an increased intake of starch
- 35. Preventive and reliefmeasure • Use astringent mouthwashes • Chew gum or suck hard candy • Limit intake of foods containing starch
- 36. Musculoskeletal system Cramping leg •Cramp is spasm that occurs when a muscle contracts too hard. • A muscle cramp is acute and painful • They usually occur in the leg, calf muscles • Mostly occurs at night • Mostly common in the second and third trimester and during labour
- 37. Causes • Unknown • Contributingfactors: – Inadequate calcium intake – Altered balance in calcium and phosphorous ratio in the body – Fatigue, chilling or tense body posture – Poor circulation to lower extremities due to pressure to the enlarged uterus on the pelvic vessels leading to the legs. – The pressure on the enlarged uterus on the pelvic nerve leading to the legs
- 38. Preventive and relief measures •Take enough calcium, eat balanced dier, make sure include plenty of magnesium, potassium, folate and vitamin rich well in diet and supplementary calcium therapy. • Take frequent breaks from sitting or standing for long periods • Take warm bath at bed time
- 39. Preventive and relief measures •Rest frequently during the day • Apply a warm cloth or heating pad to the painful area • Regular exercises especially walking • Avoid fatigue and cols • Change positions frequently during labour
- 40. Preventive and relief measures •If cramp: straighten the leg, point or pull toes upward toward the knees. • Gently massage the cramped muscle. Walk around when able
- 41. Backache • Many women(45-50%) experience pregnancy related low back or pelvic girdle pain, with more than 80% of these women experiencing difficulties in daily living and upto 30% requiring bed rest.
- 42. • Pelvic girdlepain refers to pain in the symphysis pubis and/or pain in the region of one or both of the sacroiliac joints,and pain in the gluteal region • Common in second and third trimester • Pain may be in the lower back and radiate in legs
- 43. Causes • Physiological changes –Relaxation of the sacroiliac joint when it is due to increased hormones (progesterone) resulting in relaxed the ligaments and joints in the lower back and pelvis. – Shifting of the center of gravity or increased curvature of the lumbosacral verterbra caused by enlarged uterus
- 44. Causes • Faulty postureand high heel shoes, muscle spasm, urinary infection or constipation • Fatigue, muscle spasm or postural back strain most often is responsible • Too much standing in one place or leaning forward,or hard physical work can cause pain
- 45. Causes • Pain isaggravated during standing, walking, sitting , twisting, climbing of stairs and turning while in bed • Lifting heavy objects • Poor sitting position
- 46. Diagnosis • History ofback pain • Physical examination
- 47. Prevention and relief measures •Improvement in posture is often achieved by the wearing of low-heeled shoes. • To achieve proper posture, the abdomen should be flattened, the pelvis tilted forward, and the buttocks tucked under to straighten the back. • Improvement of posture, well-fitted pelvic girdle belt which corrects the lumbar lordosis during walking and rest in hard
- 48. Prevention and relief measures •Rest with elevation of the legs to flex the hips may be helpful. • Excessive weight gain should be avoided.
- 49. Management • Apply localheat and light massage to relax tense, taut back muscles. • Recommend sleep on a firm mattress. • Back exercises under the supervision of a rehabilitation physician, an orthopedist, or a physical therapist. • Massaging the back muscles, analgesics and rest
- 50. Management • Maintain correctpostures and good body mechanisms. • The women should lie in the lateral recumbent position, with her knees and hips bent. A pillow can be used to support the weight of the uterus. • Encourage the woman’s family members or friends to massage the woman’s back
- 51. Management • Excessive weightgain should be avoided, • Avoid excessive twisting, bending stretching and standing over a long period of time. • Avoid situations that aggravate the conditions
- 52. Management • Obtain orthopedicconsultation if disability results. • Note neurological signs and symptoms indicative of prolapsed intervertebral disk syndrome, radiculitis. • Give acetaminophen 0.3–0.6 g orally or equivalent.
- 53. Urinary frequency • Urinaryfrequency is a common complaint throughout pregnancy, especially in the first and last months because of increased bladder sensitivity and pressure of the enlarging uterus on the bladder. • The condition subsides for a while when the uterus moves out of the pelvic area into the abdominal cavity around the 12th week. Frequency reoccurs in the last trimester as the enlarging uterus begins to press on the bladder again.
- 54. Causes • Increased intravascularvolume, elevated GFR and an increase in water exertion by the kidneys in early pregnancy. • Enlargement of the uterus in pelvis causing pressure on the bladder. • Pressure from the fetal presenting part on the bladder during the third trimester.
- 55. Prevention and relief measures •Void when urge is felt • Increased fluid intake • Perform kegel exercise • Lean forward when voiding to help empty the bladder completely • Limit intake of fluids containing natural diuretics
- 56. Stress incontinence • Leakingof urine when sneezing, coughing or laughing. • Cause – During pregnancy pelvic floor is stretched and sometimes damaged. This can lead to stress incontinence. – Enlarging uterus and pressure on the presenting part on the bladder
- 57. Prevention and relief measures •Do pelvic floor exercises or kegel exercise • Encourage the mother to wear perineal pads • Lean forward when voiding to help empty the bladder completely
- 58. Leukorrhoea • White mucoidnonirritant discharge with a faint musty odor. This copious mucoid fluid occurs in response to cervical stimulation by estrogen and progesterone. • High level of estrogen in pregnancy result in increased thick, white vaginal discharge from marked shedding of superficial mucosal cells in the vagina.
- 59. Leukorrhoea • With thehigher levels of estrogen, the normal bacteria (lactobacillus acidophilus) in the vagina increased activity, lactic acid byproducts and vaginal acidity, which provides some protection against pathogens, but increases the risk for candida albicans and Trichomonas vaginalis.
- 60. Causes • Hypertrophy andthickening of vaginal mucosa and increase production of mucus by the endocervical gland due to the increase in estrogen levels and effect of progesterone.
- 61. Prevention and relief measures •Women should be informed that an increase in vaginal discharge is a common physiological change that occurs during pregnancy. • Tell the patient to use a perineal pad and change them frequently • Using proper clean and hygiene techniques • Wear cotton underwear and avoid tights • Avoid douching • Clean vulva atleast once a day
- 62. Alert signs • Ifit is associate with itching, soreness, offensive , smell or pain on passing urine there may be an infective cause and investigation should be considered.
- 63. Supine hypotension • Whenthe pregnant woman is in the supine position, particularly in the second and third trimesters, the weight of the gravid uterus partially occludes the venacava and the descending aorta. • The occlusion impedes the return of blood from the lower extremities and therefore reduces cardiac return, cardiac output and blood pressure. This supine hypotension syndrome is also called venacaval syndrome.
- 64.
- 65. Causes • During latepregnancy, the gravid uterus produces a effect on the inferior venacava and part of descending aorta when the patient is in the supine position. • Therefore reduced circulating blood flow to the right side of the heart.
- 66. • The reducedblood flow causes reduced oxygenation to the brain and therefore can lead to a faint.
- 67. Prevention and relief measures •Turning to a lateral recumbent position if supine hypotension. • Rest in a side lying position to prevent supine hypotension (preferably on the left side). • Get up slowly from resting position • Avoid prolonged standing in a warm environment
- 68. Dizziness or fainting •When fainting arises early in pregnancy, it is probably caused by the progesterone induced, general vasodilatation of pregnancy. • fainting may occur in late pregnancy as a result of pressure on the aorta and the inferior venacava by enlarged uterus.
- 69. Causes • Drop inblood pressure caused by changes in position • Blood pools in vessels in lower legs and feet • Other possible causes include: – Stress – Hunger – Lack of sleep – Fatigue – Overexertion – hyperventilation
- 70. Prevention and relief measures •Get up slowly from a sitting or lying position • When lying down, lie on the left side • Eat smaller, more frequent meals • Avoid standing in warm places • Lie down or sit down if she starts to feel dizzy.
- 71. Varicose veins • Dilatedveins that appear in the legs are called varicosities or varicose veins. • The varicose veins are defined as elongated, dilated and turtuous superficial veins.
- 72. Causes • The exactcause is unknown • The increase in blood volume during pregnancy and the effect of progesterone relaxing the muscular walls of the veins caused increased pressure on the veins. • The condition is aggravated during pregnancy due to the enlarging uterus, causing pressure on the great abdominal vein, which interfered with return blood flow from the lower extremities, statis of the blood exerts pressure that gradually weakens the walls of the veins.
- 73. Clinical features • Asymptomatic •Symptomatic: – Leg pain – Discomfort especially after prolonged standing, itching
- 74. Prevention and reliefmeasures • Avoid sitting and standing for a prolonged period. • Elevate the legs when sitting. • Avoid wearing high heels. • Regular exercise improves the calf muscle pump. • Encourage the use of compression stockings
- 75. Prevention and relief measures •Avoid crossing legs at the knees. • Avoid tight clothes around the legs • Wear supportive bandage during the day but remove when at rest and at night • If vulval varicosities: wear sanitary pads • During delivery: gentle care
- 76. Hemorrhoids • Dilated veinsaround the anus, resulting from an impaired venous return, straining associated with constipation. • They may burn, hurt or itch. • Usually, it occurs in the second and third trimester.
- 77. Causes • The etiologyof hemorrhoids is similar to varicose veins (increased venous pressure and constipation) with veins becoming distended as the walls stretch, from increased blood volume, gravid uterus and reduced venous return , resulting in hemorrhoids. • Progesterone and gravid uterus decrease intestinal motility, further affects hemorrhoid formation.
- 78. Prevention and relief measures •Eat plenty of high fibrous food and fluids • Avoid standing for long periods • Take regular exercise • Sleep with the foot of the bed slightly raised • Prevent constipation and straining • Stool softeners • Warm baths
- 79.
- 80. Edema • Edema ofthe feet and ankles is a common condition in late pregnancy, occuring in about 40% of pregnant women. • It occurs during the second and third trimesters • Increasing venous return from the lower extremities • Standing for prolonged periods aggravate the condition
- 81. Causes • Reduced bloodcirculation in the lower extremities as the gravid uterus puts pressure on the large vessel • Leads to increase in hydrostatic pressure in the lower extremities • Increased levels of sodium due to hormonal influences and antidiuretic hormone release and the osmotic threshold for thirst decrease in parallel resulting in water retention.
- 82. Causes • High estrogenlevel may make blood vessels more fragile and leaky • Increased blood volume together with the distension of the veins • Prolonged standing, sitting and warm weather increase edema.
- 83. Prevention and relief measures •Elevate legs two or three times daily for 20 minutes when sitting or resting • Lying down is even better than standing • Avoid standing for longer time • Don’t cross leg while sitting • Don’t stay for long time in hot temp. • Increase intake of fluids 2-3 litres a day
- 84. Alert signs • Edemacomplicated with signs of preeclampsia and severe eclampsia needs treatment. • Localized pain over a vein swelling of the affected limb, which may indicate superficial thrombophlebitis. • Calf muscle tenderness, swelling of the affected limb, may indicate DVT
- 85. Nervous system Carpal tunnelsyndrome • Carpal tunnel syndrome refers to the complex symptoms and signs brought on by compression of the median nerve as it travels through the carpal tunnel. • When compression of the median nerve occurs, ischemia and mechanical disruption of the nerve follows.
- 86. Carpal tunnel syndrome •Usually presents in the second or third trimester and is caused by excess fluid compressing the median nerve in the wrist.
- 87. Causes • Alteration influid balance • It is caused by fluid retention • Aggravated by repetitive hand movement
- 88. Clinical features • Numbness,tingling, pain or burning in the fleshy part of the palm near the thumb and finger. • Mild hand weakness, this usually happens in the morning, but, it may occur at any time during the day. • Commonly bilateral, but may be pronounced in the dominant hand.
- 89. Prevention and reliefmeasures • Avoid extreme flexion and extension • Avoid prolonged exposure to repetitive actions • Physiotherapy • Wrist splinting • Corticosteroid therapy or surgical decompression is rarely needed. • Inform CTS normally resolves within 2 weeks of birth
- 90.
- 91. Headache • Headache iscommon in pregnancy but are usually harmless. • Causes – Changes in blood pressure – Bad posture and stress – Dehydration, low blood sugar, fatigue, stress
- 92. Prevention and reliefmeasures • Eat a balanced diet • Gentle exercise reduces stress, balances sugar and improves breathing • Correct posture • Deep breathing relaxation exercises • Going for short walk in the fresh air • Massaging
- 93. Alert signs • Ifheadache complicated with signs of preeclampsia and impending eclampsia needs treatment
- 94. Insomnia • Sleep andrest are essential during pregnancy • But, there are many conditions both physical and psychological, which may cause disruption in sleep pattern • Common in third trimester • Up to 90% report sleep problems.
- 95. Causes • Anxiety, hormonalchanges and physical discomfort. • Common in late pregnancy owing to the discomfort caused by fetal movements, frequency of micturation and difficulty in finding a comfortable position. • Discomfort caused by enlarged uterus
- 96. Causes • Nocturnal gastroesophagealreflux • Leg cramps • Low back pain
- 97. Prevention and reliefmeasures • Warm bath at bed time • Mild physical exercise before sleep may help • Drink a glass of warm milk at bedtime • Placing pillows between the knees, under the abdomen, and behind the back to take pressure off the lower back • Talk about fear and anxiety
- 98. Prevention and reliefmeasures • Do not eat a large meal within 2-3 hours of bedtime • Avoid caffeine after noon • Decrease noise, low stimuli environment and lights • Keep a regular sleep schedule • Use bed only for sleep • Use relaxation techniques and avoid naps late in the day, massage, heat and support for lower back pain
- 99. Fatigue • Most womenhave some fatigue during pregnancy, especially during first and third trimester. • Pregnancy puts a lot of strain on the body causing a sharp drop in energy level during early stages of pregnancy • Later in pregnancy growing fetus and loss of sleep
- 100. Causes • Lower bloodpressure • Lower blood sugar level • Hormonal changes due to effect of progesterone • Physiological anemia • Emotional stress • Imsomnia
- 101. Prevention and reliefmeasures • Proper rest and sleep • Eat a well balanced diet • Perform muscle relaxation and strengthening for the legs and hips joint exercise regularly • Do not take extra activities and responsibilities
- 102. Integumentary system disorder itchiness •It is quite common complaint in pregnancy to have generalized itching which is not due to systemic disease or skin lesion • Very frustrating and it may lead to disturb sleep • Most common during first and third trimester
- 103. Causes • Enlarged uteruscauses stretching and tightening of the skin across the abdomen • Familial tendency
- 104. Prevention and reliefmeasures • Wear loose clothing • Washing with mild soap • Good hygiene • Well balanced diet • Use cotton underwear • Use topical antipruritics and mosturizing creams. • If no relief , antihistamines
- 105. Alert signs • Skinlesions such as papules, macules or pustules which may indicate dermatitis. • Loss of appetite, nausea or vomiting, intolerance to fatty foods, which may indicate gall bladder disease.
- 106. Perspiration increased • Mostcommonly occurs during the 2nd-3rd trimester, increasing throughout pregnancy. • Causes : – Hormonal changes – Increase in thyroid activity – Increase in body weight and metabolic activity
- 107. Prevention and reliefmeasures • Wear light, loose fitting clothing • Increase the intake of fluids 2-3 litres a day • Bath more frequently
- 108. Alert signs • Rapidheartbeat, tremor, hyperactivity, weight loss and/or heat intolerance which may indicate hyperthyroidism. • Palpitations, nervousness, tightness in the chest, dry mouth : anxiety
- 109. Stretch marks (striaegravidarum) • Reddish or whitish streaks on breast, abdomen or upper thighs. • Initially these are pinkish but after delivery, scar tissue contract and obliterate the capillaries and they become glistening white in appearance and are called striae albicans. • Commonly occurs during 2nd-3rd trimester.
- 110. Causes • Hormonal changes •Production of steroid hormones by the adrenal glands • Familial tendency
- 111. Prevention and reliefmeasures • Wear well fitting, supportive garments for breasts and abdomen. • If itching is severe, use topical emollients or antipruritics.
- 112. Increased pigmentation • Increasedpigmentation may begin as early as the second month when levels of melanocyte stimulating hormone become elevated because of the effect of the estrogen and progesterone. • Most of these skin changes disappear on their own after childbirth.
- 113. Chloasma and lineanigra • Areas of pigmentation include brownish patches called chloasma, which usually involve the forehead cheeks and bridge of the nose. • A dark line of pigmentation may also extend from the umbilicus to the symphysis pubis.
- 114. Prevention and reliefmeasures • Reassurance • To avoid skin darkening, cover the skin or use nonallergenic sun blocking cream when in the sun.
- 115. Respiratory system shortness ofbreath • Shortness of breath is actually very common during pregnancy in last trimester. • Causes – Gravid uterus pressing upwards on the diaphragm and decreased vital capacity of lungs – Hormonal changes cause lower levels of carbon dioxide and higher levels of oxygen . Hyperventilation help maintain normal levels.
- 116. Prevention and reliefmeasures • Eat a balance diet • Eat a diet rich in iron and vitamin . • Gentle exercise • Get some fresh air • Sleep on additional pillows for relief if a problem occurs at night • Avoid overeating
- 117. Alert signs • Severebreathlessness, chest pain, palpitations, rapid pulse. • Cough, production of sputum, wheezing, which may indicate a respiratory disorder e.g. asthma • Shortness of breath that worsens on exertion, chest pain, palpitations may indicate heart disease.
- 118. Nasal stuffiness andepistaxis • Common during pregnancy, secondary to vascular congestion caused by increased estrogen and progesterone levels. • Bleeding may be spontaneous or may be brought about by overheating or forceful nose bleeding
- 119. Causes • Elevated estrogenand progesterone causes increase in blood flow to the capillaries and dilatation of the veins. • Increased blood flow to mucous membranes. • Nasal bleeding may result from local trauma or nasal polyps.
- 120. Prevention and reliefmeasures • If blowing a nose: do gently and try to avoid large sneezes. • to stop a nosebleed • For nasal stuffiness: use normal saline drops
- 121. Alert signs • Highblood pressure, if bleeding not stopped after 20 minutes. • Pain over the sinuses with purulent nasal discharge, headache which may indicate acute sinusitis. • Stuffiness with headache, watery eyes, may indicate allergies.