HEALTH PROMOTION DURING PREGNANCY Flashcards
Nursing Diagnoses
- Imbalanced nutrition, less than body requirements
r/t increased physiologic needs - Imbalanced nutrition, less than body requirements
r/t nausea every morning - Health-seeking behaviors r/t determining best food
choices in pregnancy - Imbalanced nutrition, more than body requirements
r/t overeating or poor food choices - Deficient knowledge r/t need for increased intake of
nutrients and calories during pregnancy
Fetal growth occurs by:
*Hyperplasia - increased in the number of cells which
occurs in fetal growth early in pregnancy
*Hypertrophy - enlargement of existing cells in fetal
growth happens late in pregnancy
*SGA or Small for gestational age - means fetus
deprived of adequate nutrition early in pregnancy
Hyperplasia
increased in the number of cells which
occurs in fetal growth early in pregnancy
Hypertrophy
enlargement of existing cells in fetal
growth happens late in pregnancy
SGA or Small for gestational age
means fetus
deprived of adequate nutrition early in pregnancy
REMEMBER!
In the time before a woman recognizes she is
pregnant (about 6 weeks) her poor diet and lack
of important nutrient stores could already have
seriously impaired fetal growth (Arta et al., 2016)
Weight Gain in Pregnancy
*occurs from both fetal growth and an
accumulation of maternal stores
*increases by approximately 0.8 kg (1.5 lb) per
month during the first trimester
*0.4kg (1 lb) per week during the last two
trimesters
Recommended Weight Gain during
Pregnancy
*As a rule, an average woman should gain 11.3 to 15.8 kg (25 to
35 lb) during pregnancy
*Calculate a woman’s Body Mass Index or the ratio of body fat to
height and weight
Weight Gain in a Normal Pregnancy
1st Trimester
1 lb/month (3 lbs)
Weight Gain in a Normal Pregnancy
2nd Trimester
1 lb/week (12 lbs)
Weight Gain in a Normal Pregnancy
3rd Trimester
0.8 - 0.9 lbs/week (8-11 lbs)
Total Weight Gain of a Pregnant Woman during trimesters
25-35 lbs
imperial BMI formula
Weight (LBS) x 703 ÷ Height (Inches²)
metric BMI formula
Weight (KG) ÷ Height (Meters²)
Normal BMI
should aim to gain 25
to 35 lb
Underweight women or those
whose BMI s less than 18.5
should gain 28 to 40 lb
Overweight
should gain 15 to 25 lb
Obese
should gain 11 to 20 lb
To ensure adequate fetal nutrition
Advise women not to diet to lose
weight during pregnancy
A woman who reaches the midpoint of pregnancy and has gained less
than 10 lb
needs to have her daily nutrition intake reevaluated as low
weight gain is associated with fetal growth restrictions
obese women
need to gain a minimum of 0.5 lb per week or 11-15
lb total to help ensure adequate fetal growth
Weight gain
will be higher for a multiple pregnancy than for a single
pregnancy. You can encourage women who are pregnant with multiple
fetuses to gain at least 1 lb per week for a total of 37-54 lb
Energy (Calorie) Needs
RDA for women of childbearing age
2200
Energy (Calorie) Needs
RDA for pregnant
2,500 (additional of 300)
Energy (Calorie) Needs
Increase in calorie provides sustenance in metabolic rate in
the mother because of increase thyroid function and her
increase workload from the extra weight she carries
Energy (Calorie) Needs
Obtain their carbohydrate calories from Complex
Carbohydrates (cereals and grains) because they are more
slowly digested
Protein Needs
RDA for women
34 to 46 grams
Protein Needs
RDA for pregnant
71 grams daily
Protein Needs
If protein intake is inadequate, iron, B vitamins, calcium and phosphorus
will probably be inadequate as well
Vit B12
found almost exclusively in animal protein
Sources of complete protein
Meat, poultry, fish, yogurt, eggs and milk
Incomplete protein sources
are most plant-based sources, including nuts,
seeds, beans, legumes, whole grains, tofu, rice and vegetables
Complementary proteins
proteins that are cooked together provide all
essential amino acids such as beans and rice, legumes and rice or beans
and wheat
Milk
another rich source of protein
Protein Needs
Some women resist drinking it because it can be high in calories and
fat
Nonfat milk supplies same amount of protein as regular milk but half
the calories of regular milk
Yogurt, cheese, cream soup custards are other good
Substitutes for milk
Pregnant Woman with Hypercholesterolemia
*also called high cholesterol, is the presence of high levels of cholesterol in the blood.
*should not eat more than two or three eggs per week
*monitor intake of red meat because of high cholesterol content
*encourage women to eat lean meat, cook with olive oil instead of lard or butter and to remove the skin from poultry to reduce its fat content
*should not eat lunch meats such as bologna or salami as food staples because they may be a source of Listeria a bacteria harmful to fetal growth
Fat Needs
*Omega-3 fatty acids particularly linoleic acid are fats that are essential
for new cell growth but that cannot be manufactured by the body
*Pregnant women should take 200 and 300 mg of Omega-3 fatty acids
daily
*Use vegetable oils rather than animal based oils
*Sources of Omega-3 fatty acids: vegetable oils, olive oil, peanuts,
cottonseed, corn and fatty fish
*Fish to avoid because they are rich in Mercury: Marlin, orange roughy,
tilefish, swordfish, shark, king mackerel, bigeye/yellowfin tuna
Vitamin Needs
*requirements for both fat and water-soluble vitamins increase to
support the growth of new fetal cells
*Vitamin D - found in fortified milk, cheese, eggs and salmon is
essential for calcium absorption, formation of bones and teeth and
possibly for immune system functioning
*Lack of Vitamin D may lead to speech and language delays in newborn
*Can also lead to decreased fetal and maternal bone density
*RDA Vitamin D supplementation - 600 IU daily for pregnant women
Vitamin Needs
*Vitamin A - a substance necessary for new cell growth, healthy
skin, oral health and vision in dim light
*found in dark green and yellow vegetables and fruits and in animal
sources such as liver, milk, butter, cheese and eggs
*deficiency results in tender gums or tongues, cracks at the corner of
the mouth and poor night vision
Vitamin Needs
*Vitamin C - an antioxidant vitamin needed for the formation of collagen
in both mother and fetus
*also improves iron absorption from the woman’s stomach and increases her
resistance to infection
*It is found in many fresh vegetables and fruits such as:
✔ Beans and lentils
✔Tofu
✔Baked potatoes
✔Cashews
✔Dark green leafy vegetables such
as spinach
✔Fortified breakfast cereals
✔Whole-grain and enriched breads
✔Lean beef
✔Oysters
✔Chicken
✔Turkey
Vitamin Needs
*Folic Acid - folate or folacin
*belongs to the B vitamin groups
*found predominantly in fresh fruits and vegetables
*necessary for red blood cell formation and to prevent neural tube
defects
*deficiency results to megaloblastic anemia (large but ineffective red
blood cells)
*RDA of Folic Acid 0.4 to 0.6 mg daily for pregnant women
Women who were taking oral contraceptives before
they become pregnant
should take Vitamin A, B, and
folic acid in early pregnancy because contraceptives
may deplete stores of these vitamins in the body
If constipated
counsel women not to use mineral oil as
laxative because it can prevent absorption of fat-soluble
vitamins such as vitamins D and A from the
gastrointestinal tract, thus limiting their availability to
the body
What to avoid in vitamin needs
Avoid megadoses
Mineral Needs
necessary for building new cells in a fetus
*a cup of milk contains 300 mg of Calcium so drinking 4 glasses of milk
daily supplies enough calcium
* Can be found in milk, cheese, yogurts, leafy greens, almonds
CALCIUM AND PHOSPHORUS
are both necessary for the
calcification of fetal bones beginning at about 12 weeks of pregnancy
Mineral Needs
RDA of Calcium
1,300 mg in adolescent pregnant
Mineral Needs
RDA of Calcium
1,000 mg in pregnant women older than 18 years
Mineral Needs
*deficiency results in hypothyroidism (poorly functioning thyroid
gland) and goiter (thyroid enlargement)
*encouraged to use iodized salt and be certain to include a serving of
seafood in their diet at least once per week
IODINE
essential for the thyroid gland to be able to produce
thyroxine which is necessary for overall body metabolism
encouraged to use iodized salt and be certain to include a serving of
seafood in their diet at least once per week
Mineral Needs
IRON
after week 20, a fetus needs even more iron as he or she
begins to store enough iron in the liver to last through the first 3
months of life
*necessary for woman to build increased red cell volume for herself
and to protect against iron lost in blood at birth
*RDA of Iron- 27 mg in pregnant women
*Dietary iron (iron in food) 6 mg per 1000 calories
*caution women that iron compounds will turn stools black, can be
irritating to the stomach and can cause constipation
* Organ meats, eggs, leafy greens, dried fruit, whole grains
Mineral Needs
FLOURIDE
*aids in the formation of strong teeth
*a pregnant woman should drink fluoridated water
*in large amount can cause brown-stained teeth
*RDA of fluoride - 3 mg for pregnant and lactating women
Mineral Needs
*SODIUM
the major electrolyte that acts to maintain fluid in the body
*when sodium is retained rather than excreted by the kidneys, an equal or balancing amount of fluid is also retained
*Retaining enough fluid in the maternal circulation this way during pregnancy is important to ensure a pressure gradient to allow optimal exchange of nutrients across the placenta
*moderate foods that are salty to avoid hypertension
*too much salt could result in retention of excessive fluid putting a strain on her heart as blood volumes doubles
Mineral Needs
*ZINC
necessary for the synthesis of DNA and RNA and so is
important for fetal growth
*RDA of zinc - 12 mg in pregnant women
*found in foods such as meat, liver, eggs and seafood such as oysters,
nuts, whole grains and dairy products
Fiber Needs
*Constipation can occur during pregnancy because bowel peristalsis
slows due to the effect of progesterone and pressure of the uterus on
the intestines
*Eating fiber-rich foods is a natural way to prevent constipation,
because the bulk of the fiber left in the intestine aids evacuation
*also lowers cholesterol levels nd my remove carcinogenic agents from
the intestines
*found mainly in fruits and vegetables
Fluid Needs
eight glasses of fluid daily
Raw eggs and undercooked chicken
(danger of Salmonella)
Soft unpasteurized cheese
(can harbor Listeria bacteria)
Raw seafood and sushi
(can harbor hepatitis A virus )
Cold cuts
(deli meats should be heated until steaming could kill any bacteria)
Alcoholic beverages
(known to cause fetal alcohol spectrum disorder)
Saccharin
(has a long half-life and so can reach toxic levels in a fetus)
Foods to Avoid or Limit in Pregnancy
Raw milk
Fish with high mercury contents such as mackerel and swordfish
Weight loss diets and supplements
Caffeine
Foods with Caffeine
*Caffeine - central nervous system stimulant capable of increasing heart
rate, urine production in the kidneys and secretion of acid in the stomach
*A daily intake of over three cups of coffee per day may interfere with
fertility
*Women should also limit other sources of caffeine such as chocolates, soft
drinks and tea
*Tea varies in caffeine content, the longer the brewing the greater the
caffeine
*Green and oolong tea should both be avoided not because of their caffeine
content but because they tend to lower folic acid level in women
Artificial Sweeteners
*Reduce intake of these because they need the glucose of
regular sugar to help supply daily energy
*Recommended are: sucralose (Splenda), aspartame
(NutraSweet), acesulfame-K (ace-K), neotame, stevia and
advantame
*Use of saccharin is not recommended during pregnancy
because it is eliminated so slowly i the fetal bloodstream that it
could rise to toxic amount
Health promotion during Pregnancy
I. Self-Care Needs
- helping them separate fact
from fictions when it comes to
different warnings about what
they should or should not do
during pregnancy - enabling the woman to
enjoy pregnancy unhampered
by unnecessary restrictions
I. Self-Care Needs
- Bathing
- daily tub baths or showers are recommended d/t increase
sweating because the woman excretes waste products for herself
and the fetus
- women should not soak for long periods in extremely hot water or
in hot tubs
- extreme heat exposure could lead to:
hyperthermia in the fetus and birth defects
- tub baths are contraindicated if membranes rupture early and
vaginal bleeding is present to avoid contaminating uterine contents
Self-Care Needs
- Breast Care
- as breast size increases, a woman should be certain to wear a firm,
supportive bra with wide straps to spread breast weight across
shoulders
- evidence shows that a woman’s breast enlarge more if the fetus is
female than if the fetus is male
-2. Breast Care
- when planning for
breastfeeding,
recommend that she
should choose bras
suitable for
breastfeeding
Colostrum
at about 16th week
of pregnancy secretion begins in
the breast
- is the first form of milk
produced by the mammary glands
of mammals (including many
humans) immediately following
delivery of the newborn
- contains antibodies to
protect the newborn against
disease
I. Self-Care Needs
- Breast Care
- teach woman to wash her breasts with clear tap water daily to
remove the colostrum and reduce the risk of infection
- after washing, she should dry her nipples well by patting them
with a soft towel
- no soap, because that could be drying and can cause her
nipples to crack
- if colostrum secretion is profuse, place a gauze squares or
breast pads inside her bra, changing them frequently to maintain
dryness
I. Self-Care Needs
- Dental Care
- maintaining good oral health during pregnancy is important
- without adequate brushing, gingival tissue tends to hypertrophy and
unless a pregnant woman brushes her teeth well, pockets of plaque
form readily between the swollen gum line and teeth, possibly leading
to periodontal diseases
- encourage pregnant women to see their dentist regularly for routine
examination and cleaning
- encourage women to snack on nutritious foods such as fresh fruits
and vegetables rather than sugar-rich snacks to reduce the amount of
sugar in contact with their teeth
I. Self-Care Needs
- Perineal Hygiene
- maintaining a good perineal hygiene because there is increased
vaginal discharge during pregnancy
- caution them to always wipe from front to back after voiding to
prevent bringing contamination forward from the rectum
- douching is contraindicated because the force of the irrigating
fluid could cause the solution to enter the cervix, leading to a
uterine infection and douching also alters the pH of the vagina,
leading to an increased risk of vaginal bacterial growth
I. Self-Care Needs
- Clothing
- maternity clothing should be comfortable
- women should be cautioned to avoid garters, extremely firm girdles with panty legs, and knee-high stockings during pregnancy because these may impede lower extremity circulation
- shoes with moderate to low heel to minimize pelvic tilting and possible backache as well as to reduce the risk of falling
I. Self-Care Needs
- Sexual Activity
- some women feel lessened
sexual desire in early
pregnancy de to increased
estrogen
- breast tenderness may limit a
usual pattern of sexual arousal
- there is increased clitoral
sensation
- Sexual Activity
- Replace myths with facts, such as:
1. Coitus on the expected date of her period does not
initiate labor
2. Orgasm does not initiate preterm labor
3. Coitus during the fertile days of a cycle will not cause
a second pregnancy or twins
4. Coitus does not cause rupture of the membranes
Contraindications of Coitus during Pregnancy:
1.Hx of previous preterm birth
2. Early rupture of membranes
- Caution about oral-female genital contact because it can cause air
embolism from air entering open or fragile uterine arteries
I. Self-Care Needs
- Exercise
- moderate exercise is healthy because it offers general sense
of well being
- it helps prevent circulatory stasis in the lower extremities
- as a rule, average, well nourished women should exercise during
pregnancy about three times weekly for 30 consecutive minutes
- the exercise program should be: 5 minutes of warm-up exercises, an
active stimulus phase of 20 minutes and then 5 minutes of cool-down
exercises
- Long term benefits of exercise:
- Lowering Cholesterol levels
- Reducing the risk of Osteoporosis
- Increasing energy levels
- Maintaining a healthy body weight
- Decreasing the risk of heart disease
- Increasing self esteem and well being
I. Self-Care Needs
- Sleep
- pregnant women require an
increased amount of sleep or
at least need rest to build
new body cells during
pregnancy
- left side lying or Sims
position, with the top leg
forward
I. Self-Care Needs
- Sleep
- avoid flat on bed or resting
flat on her back because of
tendency of Supine
Hypotension (faintness,
diaphoresis, and hypotension
from the pressure of
expanding uterus on inferior
vena cava)
I. Self-Care Needs
8.Travel
- Early in a normal
pregnancy, there are no
restrictions unless a woman
needs to travel to a
malaria-prone or other at-risk
region
- Do not take medication for
motion sickness
