emotional aspects of pregnancy nutritional needs in pregnancy educational needs in pregnancy
TRANSCRIPT
Emotional Aspects of Pregnancy
Nutritional Needs in PregnancyEducational Needs in
Pregnancy
Psychological Responses
• Ambivalence• Acceptance• Introversion• Mood swings• Changes in body image
Reva Rubin’s Maternal Tasks
• Safe passage• Seeking acceptance• Binding in to the child• Giving of oneself
Expectant 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, baby’s health
• Couvade- unintentional development of physical sx: nausea, aches and pains, etc
Fathering steps
• Accepting the pregnancy
• Identifying with father role
• Reordering personal relationships
• Establishing relationship with fetus
Extended Family Preparation
• Siblings• Preparation:
• Inclusion:
• Grandparents• Preparation:
• Inclusion
Nursing Care in Pregnancy
What happens throughout the pregnancy
Initial 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
• 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.
Nagele’s Rule for EDC
• Begin with LMP• Subtract 3 months• Add 7 days
Let’s try it!!!• EDC• EDC• EDC
• LMP 1-05-13• LMP 3-25-13• LMP 10-10-13
GTPAL vs Gravida - Para
• Gravida= # of pregnancies
• Term deliveries= > 37 weeks-42 weeks
• Preterm deliveries= < 37 weeks(also Pt)
• Abortions= < 20 weeks
• Living children
• Gravida/Para = Pregnancy/Delivery
Gravida 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). • Can view 10th edition on page 244
Lab Tests• UA and culture• Blood: CBC, Type/Rh• VDRL/RPR/Serology• Toxoplasmosis• Rubella• Hepatitis B• HIV• Antibody Screening
• 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 culture
Website 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.
Other diagnostic testing...
• Pap test (hold her over until postpartum)
• Ultrasound for dates/anomalies
Educational Needs~begins at 1st prenatal visit but continues throughout pregnancy
• rest and sleep• exercise• employment• recreation• travel• use of
drugs &alcohol
• immunizations• skin and breast care• clothing• Dental health• nutrition
Prenatal Exercises & Sexual Activity during Pregnancy• Website on prenatal exercises• Refer to pp. 293-295 (10th ed) for
suggested exercises• Be open to discussion during
prenatal visits re: sexual activity.See Teaching Plan p. 296; 10th ed.
• 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
WARNING SIGNS~assessed 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
Subsequent prenatal visits
• Generally recommend monthly visits for low-risk mothers through 32 weeks gestation• Assess weight, BP, urine, sx of complications,
FHR, McDonald’s Rule
• 32-36 weeks~ bi-monthly• 36 weeks-delivery~ weekly
Maternal and Fetal Nutrition
Why 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.296 (10th ed)
Choose My Plate http://www.choosemyplate.gov
Weight 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
Recommended Weight Gain Throughout Pregnancy~ know this!
• 1st Trimester~ 3.5-5 lbs (1.6-2.3kg)
• 2nd & 3rd trimesters~1 lb/week (0.5 kg/wk)
PROTEIN~60g/day
• Fetal growth• Placental growth• Amniotic fluid production• Uterine muscle growth• Blood production
IRON (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
WATER
• 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
SODIUM
• Needed due to expanding circulating fluid volume
• Need to balance ECF concentration due to GFR
• Don’t restrict because Sodium is essential to fluid & electrolyte balance
• Don’t overdue as it may lead to excessive fluid retention (edema of face & hands)
CALCIUM(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 of
Calcium as green leafy vegetables, and Ca+++ fortified foods
FAT-SOLUBLE VITAMINS• A D E K• In excess amounts, they are toxic• Necessary for tooth budding and bone growth• Excellent source of Vitamin D:fortified milk
& sunlight which produces D on our skin• May be taken in water-miscible form if not
able to metabolize properly
ZINC
• Contained in enzymes of metabolic pathways
• Best resources~ meats, shellfish, poultry, OR whole grains and legumes
• Iron and folic acid inhibit absorption
LACTATION
• 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!
FOLIC 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.
Factors affecting nutrition
• Eating disorders
• Lactase deficiency (lactose intolerance)
• Pica~Pica 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.
Cultural 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.
Vegetarians~ websiteTypes• Lacto-ovovegetarians~mild, dairy products, &
eggs• Lactovegetarians~ include dairy, but no eggs• Vegans~strict 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.
Psychosocial factors~role 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.
Common Discomforts of Pregnancy
• Refer to pp.282-288 (10th ed) 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.
Feeling GREEN(nauseated)GREEN(nauseated)?
• eat dry foods(CHO’s)• small amts frequently• don’t get hungry!• fresh air helps• limit fried/fatty foods
• eat cold foods• foods with little or no
smell• don’t brush teeth right
after eating
Feeling STUCK(constipated)?STUCK(constipated)?!?
• eat high fiber• increase fluids• exercise to increase
bowel motility• Avoid laxatives
PLOP PLOP FIZZ FIZZ(heartburn)
• small frequent meals• avoid spicy foods• no tight clothes across tummy• don’t lie down after meals• may need to sleep in recliner in last weeks
WIC• 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
There you have it!!