Prenatal Care & Nutrition Flashcards
Naegle’s Rule
First day of LMP + 1 year - 3 months + 7 days
Preparing for Pregnancy
- Begins with attitudes & Practices that value pregnant women
- factors influencing families in the community
- Social Determinants of Health, nutrition, adequate intake, food supply, availability, accessibility, cultural influence
Aspects of Prenantal Care
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
Maternal Adaptation to Pregnancy
Accepting -> identifying with mother role -> reordering relationships -> establishing relationship with fetus -> preparing for childbirth
Paternal Adaptation
Accepting -> identifying with the role -> reordering relationships -> establishing relationship with Fetus -> preparing for childbirth
The Experience of Pregnancy
- 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
Pre-Conceptual Health & Nursing Management
- 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
Initial Visit - at 8 weeks
- Prenatal Interview
- Physical examination (Pap-Smear up to 24 weeks)
- Laboratory tests (urine C&S, and R&M (routine and microscopy) blood samples, (TSH, G&S, CBC, rubella titre
- scheduling of dating U/S
- Offer Genetic Testing (screen for Down’s syndrome, Trisomy 18 & Neural tube defects, aminiocentresis. Additional blood work, U/S after 20 weeks)
Each Visit
- Symphysis Fundal Height (14 weeks palpable) > 18 wks GA = SFU
- Fetal heart tone (12 weeks approx) (fetal pull at 6 weeks)
- Blood Pressure
- Urine dipstick (protein, ketones looking at metabolism and gestational diabetes)
- Maternal weight
- Leopolds Maneuver
- Specific Topics or Tests (GBS, GD, Ultrasound for anatomy)
Group B Streptococcus
35-37 weeks, expires after 5 weeks
Gestational Diabetes Screen
24-28 weeks
Ultrasound for anatomy
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
Nursing Interventions: Education of Self-Management
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
Weight in Pregnancy - what is the significance?
- 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
Weight Gain by BMI: Underweight
BMI 18.5 & less
1st Trimester: 100kcal/day
- 12.5-18 kg weight gain
2nd + 3rd Trimester: 300kcal/day
- 0.5 kg/wk
Weight Gain by BMI: Normal
BMI: 18.5-24.9
1st Trimester wt gain: 11.5-15kg
2nd & 3rd: 0:4 kg/wk
Weight Gain by BMI: Overweight
BMI: 25-29.9
1st Trimester wt gain: 7-11 kg
2nd & 3rd: 0.3kg/wk
Weight Gain by BMI: Obese
BMI 30 and Up
1st Trimester wt gain: 5-9 kg
2nd & 3rd: 0.2 kg/wk
Obesity in Pregnancy
- 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
Obesity in Pregnancy: Adverse Fetal Outcomes
- 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
Those at Risk for Poor Nutrition
- 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)
Nutrient Needs in Pregnancy
- 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
Folic Acid Deficiency - Neural Tubal Defects
- incomplete closure of the neural tube
- varying degrees of closure 1 mg/day - 5 mg/day
Coping with nutrition-related discomforts of pregnancy
- 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
Interventions for N&V
- 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
Assessments for Higher Risk Moms
- 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
