a. Urinary Frequency and Urgency.

(1) This is caused by the vascular engorgement and altered bladder function. It is caused by an increase in hormones and by the reduction of bladder capacity. This is due to the enlarging uterus and fetal presenting part.

NOTE: The presenting part is that part of the fetus which lies closest to the internal os of the cervix.

(2) Nursing interventions consist of advising the patient:

(a) That this is normal.

(b) To limit fluid intake before bedtime to ensure rest.

(c) To wear perineal pads.

(d) Notify the physician if pain or burning is noted.

b. Stress Incontinence. This occurs later in pregnancy. The patient may actually void on herself. Stress incontinence is caused by the enlarging uterus and pressure on the presenting part on the bladder. Nursing interventions consist of:

(1) Teaching the mother how to do the Kegel exercise. The Kegel exercise is the alternate tightening and relaxing of the muscles of the perineum.

(2) Encouraging the mother to wear perineal pads.

(3) Informing the patient to notify the physician so that rupture of the membranes can be ruled out.