Chapter 5 Week 1

Nutritional Requirements: Food Plan

• USDA MyPlate provides a guide for healthy eating, emphasizing:
  • Whole grains
  • Vegetables and fruits
  • Dairy group
  • Protein group
  • Other essential elements

Factors Influencing Nutrition

• Age
• Nutritional knowledge
• Exercise
• Culture, including:
  • Southeast Asian dietary practices and their impact on diet during childbearing
  • Increasing nutrients with traditional foods
  • Hispanic dietary practices

Nutritional Risk Factors

• Socioeconomic status, including:
  • Poverty
  • Food supplement programs (e.g., www.fns.usda.gov/wic)
• Vegetarianism, considering:
  • Meeting nutritional requirements for pregnant vegetarians
  • Energy, protein, calcium, iron, zinc, vitamin B12, and vitamin A needs
• Bariatric surgery considerations
• Nausea and vomiting of pregnancy
• Anemia
• Abnormal prepregnancy weight
• Eating disorders, including:
  • Anorexia
  • Bulimia
• Food cravings and aversions
• PICA
• Multiparity and multifetal pregnancy
• Substance abuse, including:
  • Smoking
  • Caffeine
  • Alcohol
  • Drugs
• Adolescence, considering:
  • Nutrient needs
  • Common problems
  • Teaching the adolescent

Nutrition After Birth

• Nutrition for the lactating mother, including:
  • Energy needs (330 additional calories in the first 6 months, 400 in the second 6 months)
  • Protein needs
  • Fats needs
  • Vitamins and minerals needs
• Fluid intake, considering:
  • Avoiding fish with high mercury levels
  • Avoiding herbal teas and remedies
  • Avoiding illicit drugs and tobacco
• Specific nutritional concerns, including:
  • Dieting
  • Adolescence
  • Vegan diet
  • Avoidance of dairy products
  • Bariatric surgery
  • Inadequate diet
• Nutrition for the nonlactating mother, considering:
  • Returning to prepregnancy diet
  • Assessing understanding of food needs from each group
  • Weight loss

Application of the Nursing Process: Nutrition for Childbearing

• Assessment, including:
  • Interview
  • Appetite
  • Eating habits
  • Food preferences
  • Psychosocial influences
  • Diet history
  • Food intake records
  • Hour diet history
• Identification of potential problems, including:
  • Food frequency questionnaires
  • Physical assessment
  • Weight and height at initial visit
  • Weight at subsequent visits
  • Signs of nutrient deficiency
  • Laboratory tests
  • Ongoing nutritional status
  • Identification of client problems
• Planning: Expected outcomes
• Interventions, including:
  • Identifying problems
  • Explaining nutrient needs
  • Providing reinforcement
  • Evaluating weight gain
  • Encouraging supplement intake
  • Making referrals
• Evaluation

Nutritional Requirements

• Dietary reference intakes (DRIs) used to estimate nutrient needs, including:
  • Recommended dietary allowance (RDA)
  • Adequate intake (AI)
  • Tolerable upper intake level (UL)
  • Estimated average requirements (EAR)
• Energy needs, including:
  • Measured in kilocalories (calories)
  • Carbohydrates (simple or complex)
  • Fats (providing energy and fat-soluble vitamins)
  • Calories (2200-2900 daily for most pregnant women)
  • Nutrient density
• Protein needs, including:
  • Necessary for metabolism, tissue synthesis, and tissue repair
  • Daily protein RDA (46 g for nonpregnant females, 71 g during pregnancy)
  • Expansion of blood volume and growth of maternal and fetal tissues
• Vitamin needs, including:
  • Fat-soluble (A, D, E, and K) and water-soluble (B6, B12, and C, folic acid, thiamine, riboflavin, and niacin) vitamins
  • Folic acid (decreasing the occurrence of neural tube defects)
• Mineral needs, including:
  • Iron (important for hemoglobin formation, 1000 mg above maternal iron stores needed during pregnancy)
  • Calcium (important for mineralization of fetal bones and teeth, calcium absorption and retention increase during pregnancy)
  • Sodium (needed for expanded blood volume and fetal needs)
• Nutritional supplementation, including:
  • Purpose (food is the best source of nutrients, but supplements may be necessary)
  • Health care providers usually prescribe prenatal vitamin-mineral supplements
  • Assessment of individualized needs determines supplementation
  • Disadvantages and dangers (no standardization, excessive amounts may be toxic)
• Water intake, including:
  • Importance during pregnancy
  • Need for expanded blood volume and maternal and fetal tissues
  • Recommendation of 8-10 cups of fluids (mostly water) daily

Weight Gain During Pregnancy

• Recommended weight gain during pregnancy is based on prepregnancy BMI (body mass index)
• For women with normal BMI, recommended weight gain is 11.5 to 16 kg (25 to 35 lb)
• For women who are overweight, recommended weight gain is 6.8 to 11.3 kg (15 to 25 lb)
• For women who are obese, recommended weight gain is 5 to 9.1 kg (11 to 20 lb)
• Pattern of weight gain: 0.5 to 2 kg (1.1 to 4.4 lb) during the first trimester
• Maternal and fetal distribution of weight gain is important to consider

Case Study

• Ms. Brooks, a 29-year-old pregnant woman, has a prepregnancy BMI of 32 and a history of borderline chronic hypertension
• She has been counseled to gain no more than 15 lb during pregnancy
• Her total weight gain during pregnancy is 12 lb, and her blood pressure is 138/86

Nutritional Requirements

• Dietary reference intakes (DRIs) are used to estimate nutrient needs
• Four categories of DRIs: Recommended Dietary Allowance (RDA), Adequate Intake (AI), Tolerable Upper Intake Level (UL), and Estimated Average Requirements (EAR)
• Energy requirements: most pregnant women need 2200 to 2900 calories daily
• Nutrient density: the quantity and quality of various nutrients in each 100 calories of food
• Protein requirements: 46 g daily for nonpregnant women, 71 g daily during pregnancy
• Vitamins: fat-soluble (A, D, E, and K) and water-soluble (B6, B12, and C, folic acid, thiamine, riboflavin, and niacin)
• Minerals: iron, calcium, and sodium

Nutritional Supplementation

• Purpose: to supplement the diet, not replace it
• Health care providers usually prescribe prenatal vitamin-mineral supplements
• Women with adequate diets may not need supplements except for iron and folic acid
• Disadvantages and dangers: no standardization or regulation of ingredients, excessive amounts of some vitamins and minerals can be toxic to the fetus

Nutrition After Birth

• Nutrition for the lactating mother: energy, protein, fats, vitamins, and minerals
• Fluid intake: avoid fish with high mercury levels, herbal teas, and illicit drugs
• Nutrition for the nonlactating mother: can return to prepregnancy diet, weight loss

Application of the Nursing Process

• Assessment: interview, appetite, eating habits, food preferences, diet history, and physical assessment
• Identification of potential problems: psychosocial influences, food intake records, laboratory tests, and ongoing nutritional status
• Planning: expected outcomes, interventions, and evaluation

This quiz covers the basics of nutrition, including healthy eating guidelines, factors that influence nutrition, and risk factors. Topics include the USDA's MyPlate, nutritional requirements, and cultural dietary practices.