Title: Emotional%20Aspects%20of%20Pregnancy%20Nutritional%20Needs%20in%20Pregnancy%20Educational%20Needs%20in%20Pregnancy
1Emotional Aspects of PregnancyNutritional Needs
in PregnancyEducational Needs in Pregnancy
Ambivalence
Couvade
Calories
Folic Acid
Lamaze
2Psychological Responses
- Ambivalence
- Acceptance
- Introversion
- Mood swings
- Changes in body image
3Reva Rubins Maternal Tasks
- Safe passage
- Seeking acceptance
- Binding in to the child
- Giving of oneself
4Expectant 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
5Fathering steps
- Accepting the pregnancy
- Identifying with father role
- Reordering personal relationships
- Establishing relationship with fetus
6Extended Family Preparation
- Siblings
- Preparation
- Inclusion
- Grandparents
- Preparation
- Inclusion
7Nursing Care in Pregnancy
- What happens throughout the pregnancy
8Initial 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.
10Nageles Rule for EDC
- Begin with LMP
- Subtract 3 months
- Add 7 days
11Lets try it!!!
- LMP 1-05-13
- LMP 3-25-13
- LMP 10-10-13
12GTPAL 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
13Gravida 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).
14Lab 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.
16Other diagnostic testing...
- Pap test (hold her over until postpartum)
- Ultrasound for dates/anomalies
17Educational 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
18Prenatal 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
19WARNING 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
20Subsequent 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
21Maternal and Fetal Nutrition
22Why 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
23Choose My Plate http//www.choosemyplate.gov
24Weight 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
25Recommended 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)
26PROTEIN60g/day
- Fetal growth
- Placental growth
- Amniotic fluid production
- Uterine muscle growth
- Blood production
27IRON (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
28WATER
- 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
29SODIUM
- 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)
30CALCIUM(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
31FAT-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
32ZINC
- Contained in enzymes of metabolic pathways
- Best resources meats, shellfish, poultry, OR
whole grains and legumes - Iron and folic acid inhibit absorption
33LACTATION
- 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!
34FOLIC 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.
35Factors 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.
36Cultural 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.
37Vegetarians 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.
38Psychosocial 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.
39Common 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.
40Feeling 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
41Feeling STUCK(constipated)?!?
- eat high fiber
- increase fluids
- ? exercise to increase bowel motility
- Avoid laxatives
42PLOP 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
43WIC
- 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
44There you have it!!