Prenatal Care & Nutrition

Question 1

What is health promotion?

Answer 1

process that enables & empowers individuals to improve & increase control over their health.

Question 2

What is health promotion & Illness prevention?

Answer 2

emphasis community-based health promotion = collaborative efforts of community network to achieve public-health goals.

Important to maternal–newborn health, which is affected by multiple public-health issues (i.e. Maternal smoking, substance abuse, obesity)

Question 3

List 4 reasons why should women enter the HC system?

Answer 3

1. Well-woman care
2. Fertility control & infertility
3. Preconception counseling and care
   4 Pregnancy

Question 4

What does Well-women Care Provide within the HC system?

Answer 4

Provides HC needs for lifetime

Within primary health care delivery system

Provides contraception / Pap

Needs vary by age, culture, religion, and personal differences

Question 5

What does Fertility control and infertility offer within the HC system?

Answer 5

40% of all pregnancies are unplanned.

Education for family-planning/ choices.

Health promo applied to contraception, STI’s

Infertility and emotional pain, stress

Question 6

What does Preconception counseling and care provide within the HC system?

Answer 6

Promotes healthy behaviours to optimize normal fetal growth

Preconception Care Should Include:

 - Health promotion
 - Risk assessment
 - Interventions

Question 7

Why is it important for pregnant women to enter into the HC system?

Answer 7

Prenatal care in first 12 weeks identifies women at risk and initiates preventive/ treatment measures.

Goals of Care:
-Health stat. of mom/fetus 
-Gestational age of fetus 
  and monitor fetal 
  development.
-Identify women at risk for 
 complications and 
 min. risk
-Assess for social support 
 and previous loss.
-Assess learning needs.
-Provide appropriate education and counseling.

Question 8

What factors affect health in theChild-bearing Years?

Answer 8

1. Socioeconomic difference
2. Cultural factors
3. Substance Use
4. Poor Nutrition
5. Lack of physical fitness
6. Stress
7. Psychological Health
8. Violence against woman

Question 9

Preconception Care includes?

Answer 9

***PRENATAL CARE SHOULD BEGIN BEFORE A WOMAN BECOMES PREGNANT

Identify the risks/educate, help to access services if necessary.

Address psychological, social, & cultural concerns early

Remind her to keep appointments – develop relationship with care provider and catch any problems early

Question 10

Gravida

Answer 10

Women who is pregant

Question 11

Gravidity

Answer 11

pregnancy

Question 12

Multigravida

Answer 12

woman who has had two or more pregnancies

Question 13

Multipara

Answer 13

woman who has completed two or more pregnancies to 20 weeks gestation or more

Question 14

Nulligravida

Answer 14

woman who has never been pregnant

Question 15

Nullipara

Answer 15

woman who has not completed a pregnancy with fetus or fetuses beyond 20 weeks of gestation

Question 16

Parity

Answer 16

number of pregnancies in which fetus or fetuses have reached 20 weeks of gestation, not number of fetuses (e.g., twins) born. Parity is not affected by whether the fetus is born alive or is stillborn (i.e., showing no signs of life at birth).

Question 17

Postdate or postterm

Answer 17

pregnancy that goes beyond 41 weeks of gestation

Question 18

Preterm

Answer 18

pregnancy that has reached 20 weeks of gestation but before completion of 36 weeks of gestation

Question 19

Primigravida

Answer 19

woman who is pregnant for the first time

Question 20

Primipara

Answer 20

woman who has completed one pregnancy with fetus or fetuses who have reached 20 weeks of gestation

Question 21

Term

Answer 21

pregnancy from beginning of week 37 of gestation to end of week 40 plus 6 days of gestation

Question 22

Viability

Answer 22

capacity to live outside the uterus; about 22 to 25 weeks of gestation

Question 23

GTPALS SYSTEM

Answer 23

G: Gravida - # times uterus gravid 
T: Term – after 37 completed weeks
P: Preterm – before 37 completed weeks
A: Abortion – therapeutic or spontaneous prior to 20 weeks
L: number of living children

Example: 5th pregnancy, two miscarriages, one set of twins at 32 weeks, one full term child: G_T_P_A_L_

Question 24

NAGALES RULE

Answer 24

Nagele’s rule – 1st day LMP subtract 3 months, add 7 days,

Eg. LMP: January 10.
Subtract 3 months (October 10) and add 7 days. Therefore due date is: Oct 17
Assumes 28-day menstrual cycle
Only 5% of women deliver on due date

Question 25

Fetal Development

Answer 25

``` -Influenced by genetics, exposure to teratogens, maternal nutrition -Most susceptible – days 15-60 greatest/fastest cell differentiation -Teratogens may be: *Drugs or chemicals (thalidomide, alcohol) *Infections *Exposure to radiation *Maternal conditions (diabetes) ```

Question 26

Drug Classifications

Answer 26

Classified by effect on fetal development: A – proven to be ok - controlled human studies B – proven ok - animal studies only C – probably ok - no studies to prove otherwise animal or human D – causes some harm – benefit outweighs risk X – definitely not used – risk outweighs benefits Herbs are meds – not regulated or tested

Question 27

Placenta: Structure

Answer 27

``` -Starts forming at implantation -Consists of 15-20 cotyledons -Each is a functional unit -Maternal-placental- embryonic circulation in place day 17 (embryonic heart starts to beat) -Structure complete by 12th week but continues to grow until 20th week -Ends up covering half of uterine surface -Only one cell width b/w maternal and fetal blood ```

Question 28

Placenta Endocrine Function (protein hormones)

Answer 28

``` 1. hCG human chorionic gonadotropin – preserves corpus luteum to produce progesterone and estrogen to maintain pregnancy 2. hCS- human somatomammotropin / hPL/human placental lactogen: *helps maternal metabolism supply nutrients for fetal growth *increases insulin resistance *facilitates glucose transport across placenta- *breast development for lactation ```

Question 29

Placenta Endocrine Function (steroid hormones)

Answer 29

``` Progesterone – (decreases near end) *maintains endometrium *Reduces uterine contractility *Stimulate development of breast alveoli and maternal metabolism ``` ``` Estrogen (Estriol)- (peaks at end of pregnancy) *Stimulates uterine growth and uteroplacental blood flow *Increase in breast gland tissue *Increases uterine contractility ```

Question 30

Placenta: Metabolic Function

Answer 30

``` Respiration (lung): -O2 diffuses from maternal across placental membrane into fetal blood, CO2 opposite direction ``` ``` Nutrition: -Water, inorganic salts, carbs, proteins, fats, vitamins pass across placental membrane -Nutrition passes in different ways depending upon molecular weight – hydrostatic and osmotic pressures, facilitated and active transport, pinocytosis ```

Question 31

Placenta: Metabolic Function

Answer 31

``` Respiration (lung): -O2 diffuses from maternal across placental membrane into fetal blood, CO2 opposite direction ``` ``` Nutrition: -Water, inorganic salts, carbs, proteins, fats, vitamins pass across placental membrane -Nutrition passes in different ways depending upon molecular weight – hydrostatic and osmotic pressures, facilitated and active transport, pinocytosis ``` ``` Excretion: -Waste crosses from fetal to maternal blood across the membrane -Maternal kidneys then excrete it -Viruses/some bacteria and protozoa can infect fetus -Drugs can cross membrane ``` Storage: -Carbohydrates, proteins, calcium and iron stored for fetus

Question 32

What is involved in the First trimester- initial visit for physical exam and lab testing?

Answer 32

``` Physical Exam: -Provides a baseline for future changes. -Vital Signs (incl ht/ wt.) -Physical Assess-risks, screen, confirm pregnancy, urine, blood test for hCG. -note fundal ht after 1st tri. -Immunizations (No live viruses) -Pelvic Exam ``` ``` Lab tests: -Provides baseline -Hct, hgb, glucose test, blood group antibody screen, rubella titre, Hep B, VDRL -Controversial Screenings: Chlamydia, gestation diabetes, U/S, HIV/AIDS, maternal serum marker screening. ```

Question 33

What is involved in the First trimester- initial visit for interview/ assessments?

Answer 33

``` Interview: -Overview role of HCP -Standardized record used by all HCP’s -History (family hx, previous pregnancy, social, emotional concerns) -EDB - Nagle’s rule -Establish GTPALS ``` Psychosocial assessment – ALPHA tool- # risk factors indicate poor family outcome – woman abuse, child abuse, PPD, couple dysfunction, increased chance of illness Assess – adjustment to pregnancy, support or lack of it (child abuse, PPD), stress and anxiety – life events, death, move, job change, father receiving support

Question 34

Subsequent Assessment -

Answer 34

``` Frequency of visits: *Every 4 weeks until 30 weeks then *Every 3 weeks until 36 then *Every week till delivery Assess for: -BP /edema -Urine for proteinuria, glucose (GTT between 24-28 weeks) -Weight gain: 25-35 pds -Fundal height above symphysis pubis at 12 weeks, @ umbilical at 20 weeks then 1 centimeter per week after ```

Question 35

Subsequent Assessment CONT:

Answer 35

-Fetal tones – 120-160 bpm -Health teaching – emotional assessment -Pelvic assessment 3-4 weeks from EDB - Evaluate cervix -Lab tests to redo – Hct & 16-18 weeks triple marker – hCg, estriols, and Alpha feto protein – is elevated for neuraltube, decreased for Down’s syndrome -Culture GBS at 35-37 weeks -Antibody titre Coombs Test: Rh negative at 22 weeks & 28 weeks

Question 36

What are some warning signs during pregnancy?

Answer 36

-Severe vomiting -Epigastric pain (severe stomach ache) -Sudden swelling in face, hands, arms -Headaches -Blurred Vision -Vaginal bleeding -A fall, accident -Sudden sharp abdominal pain -Chills or fever -Burning on urination -Abdominal cramping -Change in fetal movement

Question 37

Role of the Nurse

Answer 37

ADVOCATE: Political, economic, social cultural, environmental, behavioural & biological factors can all favour health or be harmful to it. Health promotion action aims at making these conditions favourable through advocacy for health. ENABLE: Health promotion action aims at reducing differences in current health status & ensuring equal opportunities & resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills & opportunities for making healthy choices. Must apply equally to both men & women.

Question 38

What are some important nutritional requirements during pregnancy?

Answer 38

``` Fluids Protein Vitamins & Minerals Iron Calcium Folate Vit A Calcium Omega-3 Fatty Acids ```

Question 39

Nutrition / Weight gain

Answer 39

``` -Consider pre-pregnancy weight -Calculate BMI = weight/height² -18.5.8-24.9 BMI normal for single fetus -16-20 for twin -Normal weight gain 11.5- 16kg (25-35lbs) -Underweight: gain 12.5 – 18kg (28-40lbs) -Overweight: gain 7-11.5 kg (15-25lbs) -Obese: gain 5-9 kg (11-20lbs) ```

Question 40

What are some nutritional risks during pregnancy?

Answer 40

``` Adolescents Frequent pregnancies Poverty Poor diet habits Weight at conception: obesity Food choices & cravings: Pica, lactose intolerance, vegetarians ```

Question 41

Role transition includes the ways in which parents respond to the birth of their child are influenced by various factors including:

Answer 41

-Age -Social networks -Culture -Socioeconomic conditions -Personal aspirations for the future.

Question 42

How is the transition into parenthood viewed?

Answer 42

Historically seen as a life crisis ``` Current perspective: -Developmental transition -Viewed as an opportunity to try new roles, new coping strategies, reach new developmental stages ``` -

Question 43

First-time parents tend to perceive the first 4 to 10 weeks of parenthood in much the same way.Viewed as a period characterized by:

Answer 43

-Uncertainty - Increased responsibility - Disruption of sleep - Inability to control the time needed to care for the infant and reestablish the marital dyad

Question 44

BARRIERS TO EFFECTIVE TRANSITION

Answer 44

Some parents have limited knowledge of what being a parent entails. New parents often require information about: - Infant care - Relationship changes - Views on parenting Women generally have more support systems (i.e. Female relatives, postnatal groups, friends) than men Need to reconcile the actual child with the fantasy and dream child (i.e. coming to terms with the infant's physical appearance, sex, innate temperament, & physical status)