Aclient in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. which suggestion for sleeping should the nurse prioritize for this client?

Women are being advised to sleep on their side in the last three months of pregnancy, women in their third trimester are encouraged not to sleep on their backs. When they sleep on their back, the chances of the heavy uterus can reduce blood flow to the uterus and fetus, which can result in a stillbirth. Also, women are encouraged to sleep on their left side, as this is considered the best choice because the uterus naturally alternates to the right during pregnancy and left-sided lying will bring it more to the center and improve blood flow.

To help her sleep, a pillow can be placed between her legs or a long body pillow to support the back are often helpful. When a pillow is placed direct at her back and front, it helps support her body, resulting in a more comfortable position for sleep.

The major reason why she is having lightheadedness and dizziness when she lies on her back is that the weight of her uterus can compress a major blood vessel, called the vena cava, this then disrupts blood flow to the baby, leaving her nauseated, dizzy, and short of breath.

synovial joints are characterized by the presence of a joint cavity. the walls of this space are formed by the articular capsule, a fibrous connective tissue structure that is attached to each bone just outside the area of the bone’s articulating surface. the bones of the joint articulate with each other within the joint cavity.

friction between the bones at a synovial joint is prevented by the presence of the articular cartilage, a thin layer of hyaline cartilage that covers the entire articulating surface of each bone. however, unlike at a cartilaginous joint, the articular cartilages of each bone are not continuous with each other. instead, the articular cartilage acts like a teflon® coating over the bone surface, allowing the articulating bones to move smoothly against each other without damaging the underlying bone tissue. lining the inner surface of the articular capsule is a thin synovial membrane. the cells of this membrane secrete synovial fluid (synovia = “a thick fluid”), a thick, slimy fluid that provides lubrication to further reduce friction between the bones of the joint. this fluid also provides nourishment to the articular cartilage, which does not contain blood vessels. the ability of the bones to move smoothly against each other within the joint cavity, and the freedom of joint movement this provides, means that each synovial joint is functionally classified as a diarthrosis.

outside of their articulating surfaces, the bones are connected together by ligaments, which are strong bands of fibrous connective tissue. these strengthen and support the joint by anchoring the bones together and preventing their separation. ligaments allow for normal movements at a joint, but limit the range of these motions, thus preventing excessive or abnormal joint movements. ligaments are classified based on their relationship to the fibrous articular capsule. an extrinsic ligament is located outside of the articular capsule, an intrinsic ligament is fused to or incorporated into the wall of the articular capsule, and an intracapsular ligament is located inside of the articular capsule.

at many synovial joints, additional support is provided by the muscles and their tendons that act across the joint. a tendon is the dense connective tissue structure that attaches a muscle to bone. as forces acting on a joint increase, the body will automatically increase the overall strength of contraction of the muscles crossing that joint, thus allowing the muscle and its tendon to serve as a “dynamic ligament” to resist forces and support the joint. this type of indirect support by muscles is very important at the shoulder joint, for example, where the ligaments are relatively weak.

additional structures associated with synovial joints

a few synovial joints of the body have a fibrocartilage structure located between the articulating bones. this is called an articular disc, which is generally small and oval-shaped, or a meniscus, which is larger and c-shaped. these structures can serve several functions, depending on the specific joint. in some places, an articular disc may act to strongly unite the bones of the joint to each other. examples of this include the articular discs found at the sternoclavicular joint or between the distal ends of the radius and ulna bones. at other synovial joints, the disc can provide shock absorption and cushioning between the bones, which is the function of each meniscus within the knee joint. finally, an articular disc can serve to smooth the movements between the articulating bones, as seen at the temporomandibular joint. some synovial joints also have a fat pad, which can serve as a cushion between the bones.

desert perennials often survive by remaining dormant during dry periods of the year, then springing to life when water becomes available. most annual desert plants germinate only after heavy seasonal rain, then complete their reproductive cycle very quickly.