Transcript Psyphosocial of pregnancy/Nutirition

Emotional Aspects of Pregnancy
Nutritional Needs in Pregnancy
Educational Needs in Pregnancy
Psychological Responses
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Ambivalence
Acceptance
Introversion
Mood swings
Changes in body image
Reva Rubin’s Maternal Tasks
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Safe passage
Seeking acceptance
Binding in to the child
Giving of oneself
Expectant Father
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First trimester- confused,
baby seems “unreal”
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Second trimester- Proud,
acceptance and attachment,
financial concerns
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Third trimester- anticipating
the birth, some fears about
labor process, baby’s health
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Couvade- unintentional
development of physical sx:
nausea, aches and pains, etc
Fathering steps
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Accepting the
pregnancy
Identifying with
father role
Reordering personal
relationships
Establishing
relationship with
fetus
Extended Family Preparation
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Siblings
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Preparation:
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Inclusion:
Grandparents
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Preparation:
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Inclusion
Nursing Care in Pregnancy
What happens throughout the
pregnancy
Initial Prenatal Visit
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Generally recommended after 2nd missed
period
Begin with thorough history
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Chronic illnesses
Social history
Psychological needs
Determine Estimated Due Date (EDD) or
Estimated Date of Confinement (EDC)
Present pregnancy~ LMP, presumptive
signs, GTPAL
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Complete physical examination
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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
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Begin with LMP
Subtract 3 months
Add 7 days
Let’s try it!!!
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EDC
EDC
EDC
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LMP 1-05-13
LMP 3-25-13
LMP 10-10-13
GTPAL vs Gravida - Para
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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
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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).
Lab Tests
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UA and culture
Blood: CBC, Type/Rh
VDRL/RPR/Serology
Toxoplasmosis
Rubella
Hepatitis B
HIV
Antibody Screening
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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...
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Pap test (hold her over until
postpartum)
Ultrasound for dates/anomalies
Educational Needs~begins at 1
st
prenatal
visit but continues throughout pregnancy
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rest and sleep
exercise
employment
recreation
travel
use of
drugs &
alcohol
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immunizations
skin and breast care
clothing
Dental health
nutrition
Prenatal Exercises &
Sexual Activity during Pregnancy
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Website on prenatal exercises
Refer to pp. 364-366 for suggested
exercises
Be open to discussion during
prenatal visits re: sexual activity.
See Teaching Plan p. 367-368.
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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
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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
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Generally recommend monthly visits for
low-risk mothers through 32 weeks
gestation
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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?
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Uterine-placental-fetal unit
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Maternal blood volume 
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Mammary changes
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RDA = 300 kcal more / day than prepregnant
dietary needs
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Look at Teaching plan on p.399 Davidson et al
Choose My Plate http://www.choosemyplate.gov
Weight Gain over entire pregnancy
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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!
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1st Trimester~ 3.5-5 lbs (1.6-2.3kg)
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2nd & 3rd trimesters~1 lb/week (0.5 kg/wk)
PROTEIN~60g/day
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Fetal growth
Placental growth
Amniotic fluid production
Uterine muscle growth
Blood production
IRON (27 mg/day)
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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
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Necessary for expansion of blood volume
& to  risk of constipation
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Need to drink 6 – 8 glasses/day
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Limit caffeine intake
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Avoid artificial sweeteners in beverages
SODIUM
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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)
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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
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ADEK
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
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Contained in enzymes of metabolic
pathways
Best resources~ meats, shellfish, poultry,
OR whole grains and legumes
Iron and folic acid inhibit absorption
LACTATION
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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
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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
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Eating disorders
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Lactase deficiency (lactose intolerance)
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Pica~Pica is the practice of eating non-edible
substances(clay, dirt, laundry starch, etc.).
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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
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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~ website
Types
• 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.
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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
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Socioeconomic factors (see slide on WIC)
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Education~ it is essential for nurses to integrate
teaching on healthy eating in pregnancy from the
first prenatal visit.
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Psychological Factors~ food may be used as a
substitute for emotions OR may be avoided if
patient is depressed.
Common Discomforts of Pregnancy
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Refer to pp.349-359 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)?
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eat dry foods(CHO’s)
small amts frequently
don’t get hungry!
fresh air helps
limit fried/fatty foods
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eat cold foods
foods with little or no
smell
don’t brush teeth right
after eating
Feeling STUCK(constipated)?!?
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eat high fiber
increase fluids
 exercise to increase
bowel motility
Avoid laxatives
PLOP PLOP FIZZ FIZZ(heartburn)
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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
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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!!