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Maternity > Prenatal Care & Nutrition > Flashcards

Prenatal Care & Nutrition Flashcards

1
Q

Naegle’s Rule

A

First day of LMP + 1 year - 3 months + 7 days

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2
Q

Preparing for Pregnancy

A
  1. Begins with attitudes & Practices that value pregnant women
  2. factors influencing families in the community
  3. Social Determinants of Health, nutrition, adequate intake, food supply, availability, accessibility, cultural influence
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3
Q

Aspects of Prenantal Care

A

Health Status - physical, psychologic, emotional
Health Services - available, accessible, acceptable, affordable
Self-Care - wanted pregnancy, program adherence and compliance, active involvement, collaboration
Family - size, composition, stability, support available
Socioeconomic status - income meets needs for food, shelter, clothing, Health insurance, medicaid
Nutrition - dietary intake adequate, food supply: good quality, available, affordable
Personal - genetics, culture, race/ethnicity, language
Environment: home, community, exposure to teratogens
Education - knowledge, skills, comprehension, language, perinatal education

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4
Q

Maternal Adaptation to Pregnancy

A

Accepting -> identifying with mother role -> reordering relationships -> establishing relationship with fetus -> preparing for childbirth

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5
Q

Paternal Adaptation

A

Accepting -> identifying with the role -> reordering relationships -> establishing relationship with Fetus -> preparing for childbirth

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6
Q

The Experience of Pregnancy

A
  • Physical, Emotional & Psychological changes and discomforts of pregnancy
  • While all pregnant women experience physical changes associated with pregnancy, NOT ALL women experience physical discomforts or emotional/psychological concerns
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7
Q

Pre-Conceptual Health & Nursing Management

A
  • Teaching role for nurses to promote pre-conceptual health of women & men of childbearing age before conception (prenatal health, iron stores, folic acid)
  • Many women never really know the exact time when they become pregnant (fertilization, implantation, zygote formation)
  • the first trimester is critical because it is the time of increased developmental risk
  • assessment: diet history, obstetrical & gynecological effects of nutrition, health history, usual maternal diet, physical examination, laboratory testing
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8
Q

Initial Visit - at 8 weeks

A
  1. Prenatal Interview
  2. Physical examination (Pap-Smear up to 24 weeks)
  3. Laboratory tests (urine C&S, and R&M (routine and microscopy) blood samples, (TSH, G&S, CBC, rubella titre
  4. scheduling of dating U/S
  5. Offer Genetic Testing (screen for Down’s syndrome, Trisomy 18 & Neural tube defects, aminiocentresis. Additional blood work, U/S after 20 weeks)
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9
Q

Each Visit

A
  1. Symphysis Fundal Height (14 weeks palpable) > 18 wks GA = SFU
  2. Fetal heart tone (12 weeks approx) (fetal pull at 6 weeks)
  3. Blood Pressure
  4. Urine dipstick (protein, ketones looking at metabolism and gestational diabetes)
  5. Maternal weight
  6. Leopolds Maneuver
  7. Specific Topics or Tests (GBS, GD, Ultrasound for anatomy)
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10
Q

Group B Streptococcus

A

35-37 weeks, expires after 5 weeks

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11
Q

Gestational Diabetes Screen

A

24-28 weeks

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12
Q

Ultrasound for anatomy

A

18-20 weeks
- do not reveal gender before 20 weeks. Not allowed to know gender before then in the event that you would want to know the gender to determine an abortion

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13
Q

Nursing Interventions: Education of Self-Management

A

Expected maternal and fetal changes
- morning sickness, general fetal development and size
Nutrition
- quality, cravings, tolerance, iron-rich
Personal Hygiene
- pH changes in mucosal linings increase risk vaginal infections (yeast) and oral cavities (gingivitis)
Prevention of UTI
Kegel exercises for perineal strengthening
- not only for childbearing but for support of pelvic structures
Preparation for breastfeeding
- nipple type, hand expression, nutritional needs
Dental health
Physical activity
Sexual activity

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14
Q

Weight in Pregnancy - what is the significance?

A
  • inadequate nutrition can lead to:
    Low-birth-weight infants <2500 gms (preterm)
  • 1st trimester: organogenesis
  • adequate nutrients for fetus
  • Folic acid protects against neural tube defects
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15
Q

Weight Gain by BMI: Underweight

A

BMI 18.5 & less
1st Trimester: 100kcal/day
- 12.5-18 kg weight gain

2nd + 3rd Trimester: 300kcal/day
- 0.5 kg/wk

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16
Q

Weight Gain by BMI: Normal

A

BMI: 18.5-24.9
1st Trimester wt gain: 11.5-15kg
2nd & 3rd: 0:4 kg/wk

17
Q

Weight Gain by BMI: Overweight

A

BMI: 25-29.9
1st Trimester wt gain: 7-11 kg
2nd & 3rd: 0.3kg/wk

18
Q

Weight Gain by BMI: Obese

A

BMI 30 and Up
1st Trimester wt gain: 5-9 kg
2nd & 3rd: 0.2 kg/wk

19
Q

Obesity in Pregnancy

A
  • Pregnant obese women at increased risk for C/S birth
  • hypertension, osteoarthritis, certain cancers including breast, endometrial & colon, numerous hormonal & inflammatory effects, lifetime heart disease, gestational diabetes & DM
    After birth obese women are at increased risk for:
  • DVT, PPH, wound infections, UTI’s & prolonged hospitalizations
20
Q

Obesity in Pregnancy: Adverse Fetal Outcomes

A
  • Fetal macrosomia - assoc. birth injuries
  • low birthwt is with increased risk of childhood & adult obesity & CV disease
  • preterm birth
  • Very low birthweight
  • Neural tube defects
  • women with a normal BMI who gain > 50 lbs has same risk as a woman who is obese
21
Q

Those at Risk for Poor Nutrition

A
  • adolescence or less than 2 years post menarch
  • frequent pregnancies: 3 within 2 years
  • poor fetal outcome in previous pregnancy
  • poverty-food insecurity
  • poor diet habits with resistance to change
  • use of tobacco, alcohol, or substances
  • weight at conception under or over normal weight
  • problems with weight gain
  • multifetal pregnancies
  • low hemoglobin (anemia)
  • diabetes
  • Chronic illness (related to absorption)
22
Q

Nutrient Needs in Pregnancy

A
  • Adolescents: education & prenatal care
  • fluids
  • omega 3 Fatty acids (preferably not fish-origin)
  • protein
    Minerals, Vitamins, Electrolytes
  • iron
  • calcium
  • magnesium
  • Sodium
  • Potassium
  • Zinc
  • Flouride
    Fat-Soluble Vitamins: A, D, E, K
    Water-Soluble Vitamins: C, B12, B6, folate, pyridoxine
  • Multivitamins
23
Q

Folic Acid Deficiency - Neural Tubal Defects

A
  • incomplete closure of the neural tube
  • varying degrees of closure 1 mg/day - 5 mg/day
24
Q

Coping with nutrition-related discomforts of pregnancy

A
  • Nausea and vomiting
  • Constipation
  • Pyrosis (heartburn) 50-80% of pregnancies, not just in the morning
  • Resolves by 20 weeks, usually
  • Etiology not well understood - increase hormones disrupts normal GI function
  • Hyperemesis Gravidarum - enough to cause weight loss, electrolyte imbalance, nutritional deficiencies and ketonuria
25
Q

Interventions for N&V

A
  • ginger ale, sniff lemons or ginger
  • eat soda crackers or potato chips before getting up
  • eat small meals often
  • drink fluids 30 mins before or after meal
  • eat whatever you feel like eating
  • get up and move slowly
  • do not skip meals
  • avoid cooking
  • get plenty of rest
26
Q

Assessments for Higher Risk Moms

A
  • mental health
  • intimate partner violence
  • prenatal screening: (U/S, growth, age, mov’t, fluid, HR)
  • Serum Screening, fetal mov’t, non-stress tests
  • High risk: polyhydramnios, IUGR, fetoplacental causes
  • Oligohyraminios - chromosomal abnormalities

Maternity (16 decks)

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