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