Emotional%20Aspects%20of%20Pregnancy%20Nutritional%20Needs%20in%20Pregnancy%20Educational%20Needs%20in%20Pregnancy - PowerPoint PPT Presentation

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Emotional%20Aspects%20of%20Pregnancy%20Nutritional%20Needs%20in%20Pregnancy%20Educational%20Needs%20in%20Pregnancy

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Title: Emotional%20Aspects%20of%20Pregnancy%20Nutritional%20Needs%20in%20Pregnancy%20Educational%20Needs%20in%20Pregnancy


1
Emotional Aspects of PregnancyNutritional Needs
in PregnancyEducational Needs in Pregnancy
Ambivalence
Couvade
Calories
Folic Acid
Lamaze
2
Psychological Responses
  • Ambivalence
  • Acceptance
  • Introversion
  • Mood swings
  • Changes in body image

3
Reva Rubins Maternal Tasks
  • Safe passage
  • Seeking acceptance
  • Binding in to the child
  • Giving of oneself

4
Expectant Father
  • First trimester- confused, baby
    seems unreal
  • Second trimester- Proud, ?acceptance and
    attachment, financial concerns
  • Third trimester- anticipating the birth, some
    fears about labor process, babys health
  • Couvade- unintentional development of physical
    sx nausea, aches and pains, etc

5
Fathering steps
  • Accepting the pregnancy
  • Identifying with father role
  • Reordering personal relationships
  • Establishing relationship with fetus 

6
Extended Family Preparation
  • Siblings
  • Preparation
  • Inclusion
  • Grandparents
  • Preparation
  • Inclusion

7
Nursing Care in Pregnancy
  • What happens throughout the pregnancy

8
Initial Prenatal Visit
  • Generally recommended after 2nd missed period
  • Begin with thorough history
  • Chronic illnesses
  • Social history
  • Psychological needs
  • Determine Estimated Due Date (EDD) or Estimated
    Date of Confinement (EDC)
  • Present pregnancy LMP, presumptive signs, GTPAL

9
  • Complete physical examination
  • Assess pelvis for diagonal conjugate, and
    adequacy of pelvis for vaginal delivery of
    average-sized baby
  • Draw all prenatal labs
  • Begin all the prenatal education books, videos,
    etc.

10
Nageles Rule for EDC
  • Begin with LMP
  • Subtract 3 months
  • Add 7 days

11
Lets try it!!!
  • EDC
  • EDC
  • EDC
  • LMP 1-05-13
  • LMP 3-25-13
  • LMP 10-10-13

12
GTPAL vs Gravida - Para
  • Gravida of pregnancies
  • Term deliveries gt 37 weeks-42 weeks
  • Preterm deliveries lt 37 weeks(also Pt)
  • Abortions lt 20 weeks
  • Living children
  • Gravida/Para Pregnancy/Delivery

13
Gravida and Para vs GTPAL
  • Gravida any pregnancy regardless of duration
  • Para Birth after 20 weeks gestation, regardless
    of whether the infant is born alive or dead
  • When using the detailed system, GTPAL, GRAVIDA
    keeps the same meaning, but the meaning of PARA
    changes because the detailed system counts each
    infant born rather than the number of pregnancies
    carried to viability (Davidson et al, p.318,
    2012).

14
Lab Tests
  • UA and culture
  • Blood CBC, Type/Rh
  • VDRL/RPR/Serology
  • Toxoplasmosis
  • Rubella
  • Hepatitis B
  • HIV
  • Antibody Screening

15
  • 10-12 wks Chorionic Villi Sampling
  • 14-16 wks Amniocentesis
  • 15-20 wks MSAFP (see Fetal Assessment Wksht)
  • 24-28 wks Blood sugar 3 hr GTT
  • 36 wks Beta strep vaginal cultureWebsite for
    Group B Beta Strep CDC pamphlet
  • Hgb Hct repeated prn throughout pg.
  • Urine ? glucose and protein at every prenatal
    visit. Should be 1st morning specimen collected
    and refrigerated, but can also be fresh sample
    upon arrival at office.

16
Other diagnostic testing...
  • Pap test (hold her over until postpartum)
  • Ultrasound for dates/anomalies

17
Educational Needsbegins at 1st prenatal visit
but continues throughout pregnancy
  • rest and sleep
  • exercise
  • employment
  • recreation
  • travel
  • use ofdrugs alcohol
  • immunizations
  • skin and breast care
  • clothing
  • Dental health
  • nutrition

18
Prenatal Exercises Sexual Activity during
Pregnancy
  • Website on prenatal exercises
  • Refer to pp. 364-366 for suggested exercises
  • Be open to discussion during prenatal visits re
    sexual activity.See Teaching Plan p. 367-368.
  • Changes in desire r/t nausea, fatigue in 1st
    trimester, ? desire in 2nd trimester, ? desire in
    3rd trimester r/t backache, size of baby
  • Suggest alternative methods to express intimacy
  • Stress importance of open communication between
    partners

19
WARNING SIGNSassessed at each prenatal visit
  • vaginal bleeding
  • edema of face and in fingers
  • severe continuous headache
  • dim or blurred vision/spots/flashes
  • abdominal pain/persistant vomiting
  • fever and chills
  • gush of fluid from vagina
  • dysuria, backache, flank pain

20
Subsequent prenatal visits
  • Generally recommend monthly visits for low-risk
    mothers through 32 weeks gestation
  • Assess weight, BP, urine, sx of complications,
    FHR, McDonalds Rule
  • 32-36 weeks bi-monthly
  • 36 weeks-delivery weekly

21
Maternal and Fetal Nutrition
22
Why Pregnancy more need for nutrients?
  • Uterine-placental-fetal unit
  • Maternal blood volume ?
  • Mammary changes
  • RDA 300 kcal more / day than prepregnant
    dietary needs
  • Look at Teaching plan on p.399 Davidson et al

23
Choose My Plate http//www.choosemyplate.gov
24
Weight Gain over entire pregnancy
  • Underweight - 28 40 lbs.
  • Normal weight - 25 35 lbs.
  • Overweight - 15 25 lbs.
  • Obese - 15 lbs.
  • Adolescents - high end of range
  • Short women low end of range
  • Twins - 44 lbs. Has best outcome

25
Recommended Weight Gain Throughout Pregnancy
know this!
  • 1st Trimester 3.5-5 lbs (1.6-2.3kg)
  • 2nd 3rd trimesters1 lb/week (0.5 kg/wk)

26
PROTEIN60g/day
  • Fetal growth
  • Placental growth
  • Amniotic fluid production
  • Uterine muscle growth
  • Blood production

27
IRON (27 mg/day)
  • Facilitates blood cell production
  • If mom is anemic, there is ? risk of lethargy in
    mom, preterm births, intolerance to blood loss at
    delivery
  • Guidelines for taking Iron (e.g.. Ferrous Sulfate
    FeSO4 , FerroSequels, Ferrous Fumarate)-- Take
    on an empty stomach with OJ-- Do NOT take with
    milk, coffee, tea-- Keep away from CHILDREN-- ?
    risk of toxic ingestion-- Instruct mom on
    possible stool changes black and tarry, ?
    risk of constipation

28
WATER
  • Necessary for expansion of blood volume to ?
    risk of constipation
  • Need to drink 6 8 glasses/day
  • Limit caffeine intake
  • Avoid artificial sweeteners in beverages

29
SODIUM
  • Needed due to expanding circulating fluid volume
  • Need to balance ECF concentration due to ? GFR
  • Dont restrict because Sodium is essential to
    fluid electrolyte balance
  • Dont overdue as it may lead to excessive fluid
    retention (edema of face hands)

30
CALCIUM(1000mg)
  • Fosters fetal calcification of bones
  • If intake not adequate, demineralization of
    maternal bones occurs
  • 4 cups of milk or its equivalent
  • Assess cultural diet as some cultures do not
    advocate milk dairy products
  • Review alternative resources ofCalcium as green
    leafy vegetables, and Ca fortified foods

31
FAT-SOLUBLE VITAMINS
  • A D E K
  • In excess amounts, they are toxic
  • Necessary for tooth budding and bone growth
  • Excellent source of Vitamin Dfortified milk
    sunlight which produces D on our skin
  • May be taken in water-miscible form if not able
    to metabolize properly

32
ZINC
  • Contained in enzymes of metabolic pathways
  • Best resources meats, shellfish, poultry, OR
    whole grains and legumes
  • Iron and folic acid inhibit absorption

33
LACTATION
  • RDA 500 kcal more than non-pregnant woman
  • Minimum of 1800 kcal/day
  • ? Calcium and Iron intake
  • Smoking impairs milk production
  • Alcohol in excess impairs milk ejection reflex
  • Caffeine accumulated in infant through
    breastmilk will be manifested as a wakeful and
    active baby!

34
FOLIC ACID
  • Low levels correlate with neural tube defects.
  • Critical to begin increasing Folic Acid intake at
    least 3 months before conception!
  • Supplemental Folic Acid only begun in 1992, Now a
    big March of Dimes initiative
  • Acceptable Folic Acid levels are most critical in
    the 1st 6 wks of pregnancy and should be
    continued throughout pregnancy.

35
Factors affecting nutrition
  • Eating disorders
  • Lactase deficiency (lactose intolerance)
  • PicaPica is the practice of eating non-edible
    substances(clay, dirt, laundry starch, etc.).
  • It is especially important for the nurse to
    assess the pregnant patient who has lower
    hemoglobin levels as she may be replacing
    low-nutrient products for nutritious foods.

36
Cultural Spiritual influences
  • MANY cultures have hot/cold theories on
    nutrition and pregnancy is often viewed as a
    hot time that requires foods that fall under
    the cold categories. These foods generally
    include dairy foods. Be sure to assess
    carefully.
  • Vegetarians still need adequate proteins and need
    to be taught of good resources.

37
Vegetarians website
  • Types
  • Lacto-ovovegetariansmild, dairy products, eggs
  • Lactovegetarians include dairy, but no eggs
  • Vegansstrict vegetarians who eat no food from
    any animal sources. These persons need to plan
    how to get adequate complete proteins and
    sufficient calories.
  • Examples of complete proteins beans rice, or
    peanut butter on whole grain bread, whole grain
    cereal with soy milk.

38
Psychosocial factorsrole of food and serving
food as a maternal role
  • Socioeconomic factors (see slide on WIC)
  • Education it is essential for nurses to
    integrate teaching on healthy eating in pregnancy
    from the first prenatal visit.
  • Psychological Factors food may be used as a
    substitute for emotions OR may be avoided if
    patient is depressed.

39
Common Discomforts of Pregnancy
  • Refer to pp.349-359 in Davidson et al for
    discussion of many general discomforts of
    pregnancy and how to alleviate them.
  • The following discussion focuses on those related
    to nutrition in pregnancy and discomforts
    associated with it.

40
Feeling GREEN(nauseated)?
  • eat dry foods(CHOs)
  • small amts frequently
  • dont get hungry!
  • fresh air helps
  • limit fried/fatty foods
  • eat cold foods
  • foods with little or no smell
  • dont brush teeth right after eating

41
Feeling STUCK(constipated)?!?
  • eat high fiber
  • increase fluids
  • ? exercise to increase bowel motility
  • Avoid laxatives

42
PLOP PLOP FIZZ FIZZ(heartburn)
  • small frequent meals
  • avoid spicy foods
  • no tight clothes across tummy
  • dont lie down after meals
  • may need to sleep in recliner in last weeks

43
WIC
  • Women Infants Children(federally funded
    program provided by Health Dept.)
  • Supplemental nutrition program for moms babies
  • Income eligible
  • Food coupons for pregnant lactating women
  • Formula available for bottlefed babies
  • Must go to nutrition class taught by dietician
  • Children have regular developmental assessments
    by nurses

44
There you have it!!
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