Chapter_8 revised.pptx

Chapter 8 Nutrition for Childbearing 1  Weight Gain During Pregnancy  Recommendation for total weight gain  Weight gain recommendations based on the woman’s prepregnancy body mass index (BMI)  Recommended weight gain is 11.5 to 1...

Chapter 8 Nutrition for Childbearing 1  Weight Gain During Pregnancy  Recommendation for total weight gain  Weight gain recommendations based on the woman’s prepregnancy body mass index (BMI)  Recommended weight gain is 11.5 to 16 kg (25 to 35 lb) for women who begin pregnancy at normal BMI.  Recommended weight gain is 6.8 to 11.3 kg (15 to 25 lb) for women who begin pregnancy overweight.  Recommended weight gain is 5 to 9.1 kg (11 to 20 lb) for women who begin pregnancy obese. 2 Weight Gain During Pregnancy (2 of 2)  Pattern of weight gain  The general recommendation is an increment of about 0.5 to 2 kg (1.1 to 4.4 lb) during the first trimester.  Maternal and fetal distribution  Factors that influence weight gain 3  Case Study You are the nurse working with prenatal clients at the health department. You meet Ms. Brooks, a 29- year-old G1P1 at 28 weeks of gestation. Ms. Brooks began prenatal care at 12 weeks. Her fetal screening ultrasound at 18 weeks revealed normal anatomy, and all of her prenatal labs have been normal or negative. The pregnancy was not planned, but she and her partner are “delighted” and plan to be married in 2 weeks. 4  Case Study (2 of 2) Ms. Brooks had a prepregnancy BMI of 32 and has a history of borderline chronic hypertension. She has been counseled by the physician to gain no more than 15 lb. during her pregnancy. As you check her in for her visit, you note that her total weight gain during pregnancy is 12 lb. Her blood pressure is 138/86. Her urine is negative for protein and glucose. When Ms. Brooks looks at the scale, she says, “What am I going to do? I have three more months to go.” She begins to cry.  What should you do and say? 5  Nutritional Requirements  Dietary reference intakes (DRIs) used to estimate nutrient needs; four categories  Recommended dietary allowance (RDA)  Adequate intake (AI)  Tolerable upper intake level (UL)  Estimated average requirements (EAR) 6  Nutritional Requirements: Energy  Measured in kilocalories (calories)  Carbohydrates  Simple or complex  Fats  Provide energy and fat-soluble vitamins  Calories  Most pregnant women need 2200 to 2900 calories daily.  Nutrient density  The quantity and quality of various nutrients in each 100 calories of food 7  Nutritional Requirements: Protein  Necessary for metabolism, tissue synthesis, and tissue repair  Daily protein RDA is 46 g for nonpregnant females.  Daily recommended protein intake of 71 g during pregnancy  Expansion of blood volume  Growth of maternal and fetal tissues 8 Nutritional Requirements: Vitamins  Fat-soluble  A, D, E, and K  Stored in liver  Excessive intake of these vitamins can be toxic.  Water-soluble  B6, B12, and C; folic acid; thiamine; riboflavin; and niacin  Should be included in the daily diet  Folic acid (also called folate)  Can decrease the occurrence of neural tube defects 9  Nutritional Requirements: Minerals  Iron  Important in the formation of hemoglobin  During pregnancy approximately 1000 mg of absorbed iron above maternal iron stores are needed.  Calcium  Important for mineralization of fetal bones and teeth  Calcium absorption and retention increase during pregnancy.  Sodium  Sodium needs are increased during pregnancy to provide for an expanded blood volume and the needs of the fetus. 10  Nutritional Requirements: Nutritional Supplementation  Purpose  Food is the best source of nutrients.  Health care providers usually prescribe prenatal vitamin-mineral supplements.  Women with adequate diets may not need supplements except for iron and folic acid.  Assessment of each woman’s individualized needs determines whether supplementation is appropriate. 11  Nutritional Requirements: Nutritional Supplementation (2 of 2)  Disadvantages and dangers  No standardization or regulation of the amounts of ingredients  Excessive amounts of some vitamins and minerals may be toxic to the fetus.  Supplements are not food substitutes and do not contain all the nutrients needed during pregnancy. 12  Nutritional Requirements: Water  Water is important during pregnancy.  For the expanded blood volume  As part of the increased maternal and fetal tissues  Women should drink approximately 8 to 10 cups of fluids that are mostly water each day. 13 Nutritional Requirements: Food Plan  USDA MyPlate provides a guide for healthy eating  Whole grains  Vegetables and fruits  Dairy group  Protein group  Other elements  Food precautions 14  Factors Influencing Nutrition  Age  Nutritional knowledge  Exercise  Culture  Southeast Asian dietary practices Effect of culture on diet during childbearing Increasing nutrients with traditional foods  Hispanic dietary practices 15  Nutritional Risk Factors  Socioeconomic status  Poverty  Food supplement programs; www.fns.usda.gov/wic  Vegetarianism  Meeting the nutritional requirements for the pregnant vegetarian Energy, protein, calcium, iron, zinc, vitamin B12, and vitamin A  Bariatric surgery considerations  Nausea and vomiting of pregnancy  Anemia 16  Nutritional Risk Factors (2 of 3)  Abnormal prepregnancy weight  Eating disorders  Anorexia  Bulimia  Food cravings and aversions  PICA  Multiparity and multifetal pregnancy 17  Nutritional Risk Factors (3 of 3)  Substance abuse  Smoking  Caffeine  Alcohol  Drugs  Adolescence  Nutrient needs  Common problems  Teaching the adolescent  Other risk factors 18  Nutrition After Birth  Nutrition for the lactating mother  Energy First 6 months of lactation, the estimated energy requirement (EER) is 330 additional calories. Second 6 months require 400 additional calories.  Protein  Fats  Vitamins and minerals 19  Nutrition After Birth (2 of 4)  Fluid  Alcohol  Caffeine  Other Avoid fish with high mercury levels Avoid herbal teas and remedies Avoid illicit drugs and tobacco 20  Nutrition After Birth (3 of 4)  Specific nutritional concerns  Dieting  Adolescence  Vegan diet  Avoidance of dairy products  Bariatric surgery  Inadequate diet 21  Nutrition After Birth (4 of 4)  Nutrition for the nonlactating mother  Can return to her prepregnancy diet  The nurse should assess the mother’s understanding of the amount of food she needs from each food group.  Weight loss 22 Application of the Nursing Process: Nutrition for Childbearing  Assessment  Interview  Appetite  Eating habits  Food preferences  Identification of potential problems  Psychosocial influences  Diet history  Food intake records  Hour diet history 23 Application of the Nursing Process: Nutrition for Childbearing (2 of 3)  Identification of potential problems (Cont.)  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 24 Application of the Nursing Process: Nutrition for Childbearing (3 of 3)  Planning: Expected outcomes  Interventions  Identifying problems  Explaining nutrient needs  Providing reinforcement  Evaluating weight gain  Encouraging supplement intake  Making referrals  Evaluation 25  Question A pregnant woman with a BMI of 22 asks the nurse how much weight she should be gaining during pregnancy. Which is the nurse's best response ? a. 1 lb per week throughout the pregnancy. b. 3.5 lb during the first trimester, then 1 lb each week until the end of the pregnancy. c. 1 lb a week during the first two trimesters, then 2 lb per week during the third trimester. d. a total of 25 to 35 lb. 26