Nutrition Session #11 PDF

Nutrition and Diet Therapy – Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR...

Nutrition and Diet Therapy – Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session # 11 LESSON TITLE: Nutrition through the Life Span: Materials: Pregnancy and Lactation Pen and notebook LEARNING OUTCOMES: At the end of the lesson, you can: 1. Explain the importance of a healthy diet and other lifestyle choices before and during a pregnancy; 2. Discuss nutrient needs of and recommended food choices for pregnant women; 3. Enumerate the recommended weight gain of pregnant women as per BMI; 4. Identify the common Nutrition-Related Concerns of Pregnancy; 5. Enumerate the common problems during pregnancy; 6. Identify the special nutritional needs of a pregnant Reference: teenager; and, DeBruyne, L.K., Pinna, K., & Whitney E., (2016). 7. Summarize the nutrient needs of women during lactation Nutrition and diet therapy: Principles and practice and contraindications to breastfeeding. (9th ed.). USA: Cengage Learning. LESSON PREVIEW/REVIEW Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the space provided. You may use the back page of this sheet, if necessary. Have fun! Instruction: List at least 5 benefits of fitness. 1. __________________________________________________________________________________ 2. __________________________________________________________________________________ 3. __________________________________________________________________________________ 4. __________________________________________________________________________________ 5. __________________________________________________________________________________ MAIN LESSON You will study and read their book, if available, about this lesson. Pregnancy: The Impact of Nutrition on the Future A. Nutrition Prior to Pregnancy A discussion on nutrition prior to pregnancy must, by its nature, focus mainly on women. A man’s nutrition may affect his fertility and possibly the genetic contributions he makes to his children, but nutrition exerts its primary influence through the woman. Her body provides the environment for the growth and development of a new human being. Full nutrient stores before pregnancy are essential both to conception and to healthy infant development during pregnancy. In the early weeks of pregnancy, before many women are even aware that they are pregnant, significant developmental changes occur that depend on a woman’s nutrient stores. In preparation for a healthy pregnancy, a woman can establish the following habits: ⎯ Achieve and maintain a healthy body weight. Both underweight and overweight women, and their newborns, face increased risks of complications. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 12  ⎯ Choose an adequate and balanced diet. Malnutrition reduces fertility and impairs the early development of an infant should a woman become pregnant. ⎯ Be physically active. A woman who wants to be physically active when she is pregnant needs to become physically active beforehand. ⎯ Receive regular medical care. Regular health care visits can help ensure a healthy start to pregnancy. ⎯ Avoid harmful influences. Both maternal and paternal ingestion of, or exposure to, harmful substances (such as cigarettes, alcohol, drugs, or environmental contaminants) can cause miscarriage or abnormalities, alter genes or their expression, and interfere with fertility.1 Young adult who nourish and protect their bodies do so not only for their own sakes but also for future generations B. Pre-pregnancy Weight Appropriate weight prior to pregnancy benefits pregnancy outcome. Being either underweight or overweight presents medical risks during pregnancy and childbirth. Underweight women are therefore advised to gain weight before becoming pregnant and overweight women to lose excess weight Underweight. Infant birth weight correlates with pre-pregnancy weight and weight gain during pregnancy and is the most potent single predictor of the infant’s future health and survival. An underweight woman has a high risk of having a low-birthweight infant, especially if she is unable to gain sufficient weight during pregnancy. Overweight and Obesity. Obese women are also urged to strive for healthy weights before pregnancy. Infants born to obese women are more likely to be large for gestational age, weighing more than 9 pounds. Problems associated with a high birth weight include increased likelihood of a difficult labor and delivery, birth trauma, and cesarean section. C. Healthy Support Tissues A major reason that the mother’s pre-pregnancy nutrition is so crucial is that it determines whether her uterus will be able to support the growth of a healthy placenta during the first month of gestation. The placenta is both a supply depot and a waste-removal system for the fetus. If the placenta works perfectly, the fetus wants for nothing; if it doesn’t, no alternative source of sustenance is available, and the fetus will fail to thrive. The fetus receives nutrients and oxygen across the placenta; the mother’s blood picks up carbon dioxide and other waste materials to be excreted via her lungs and kidneys. The umbilical cord is the pipeline from the placenta to the fetus. The amniotic sac surrounds and cradles the fetus, cushioning it with fluids. The placenta is an active metabolic organ with many responsibilities of its own. It actively gathers up hormones, nutrients, and protein molecules such as antibodies and transfers them into the fetal bloodstream. The placenta also produces a broad range of hormones that act in many ways to maintain pregnancy and prepare the mother’s breasts for lactation. A healthy placenta is essential for the developing fetus to attain its full potential. D. The Events of Pregnancy The newly fertilized ovum is called a zygote. It begins as a single cell and rapidly divides to become a blastocyst. During the first week, the blastocyst floats down into the uterus, where it will embed itself in the inner uterine wall—a process known as implantation. The Embryo and Fetus During the next 6 weeks of development, the embryo registers astonishing physical changes). At 8 weeks, the fetus has a complete central nervous system, a beating heart, a fully formed digestive system, well-defined fingers and toes, and the beginnings of facial features. In the last 7 months of pregnancy, the fetal period, the fetus grows 50 times heavier and 20 times longer. Critical periods of cell division and development occur in organ after organ. Most successful pregnancies last 38 to 42 weeks and produce a healthy infant weighing between 6.8 and 7.9 pounds. The 40 or so weeks of pregnancy are divided into thirds, each of which is called a trimester. A Note about Critical Periods Each organ and tissue type grows with its own characteristic pattern and timing. The development of each takes place only at a certain time—the critical period. Whatever nutrients and other environmental conditions are necessary during This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 12 this period must be supplied on time if the organ is to reach its full potential. If the development of an organ is limited during a critical period, recovery is impossible. For example, the fetus’s heart and brain are well developed at 14 weeks; the lungs, 10 weeks later. Therefore, early malnutrition impairs the heart and brain; later malnutrition impairs the lungs. The effects of malnutrition during critical periods of pregnancy are seen in defects of the nervous system of the embryo (explained later), in the child’s poor dental health, and in the adolescent’s and adult’s vulnerability to infections and possibly higher risks of diabetes, hypertension, stroke, or heart disease. The effects of malnutrition during critical periods are irreversible: abundant and nourishing food, consumed after the critical time, cannot remedy harm already done. High-Risk Pregnancy Factors ⎯ Pre-pregnancy BMI either 25 ⎯ Insufficient or excessive pregnancy weight gain ⎯ Nutrient deficiencies or toxicities; eating disorders ⎯ Poverty, lack of family support, low level of education, limited food available ⎯ Smoking, alcohol, or another drug use ⎯ Teens, especially 15 years or younger; women 35 years or older ⎯ Many previous pregnancies (three or more to mothers younger than age 20; four or more to mothers age 20 or older) ⎯ Short or long intervals between pregnancies (59 months) ⎯ Previous history of problems ⎯ Twins or triplets ⎯ Low- or high-birth weight infants ⎯ Development of gestational hypertension ⎯ Development of gestational diabetes ⎯ Diabetes; hypertension; heart, respiratory, and kidney disease; certain genetic disorders; special diets and medications E. Nutrient Needs during Pregnancy To meet the high nutrient demands of pregnancy, a woman must make careful food choices, but her body will also do its part by maximizing nutrient absorption and minimizing losses. Energy, Carbohydrate, Protein, and Fat Energy needs change as pregnancy progresses. In the first trimester, the pregnant woman needs no additional energy, but as pregnancy progresses, her energy needs rise. She requires an additional 340 kcalories daily during the second trimester and an extra 450 kcalories each day during the third trimester. Well-nourished pregnant women meet these demands for more energy in several ways: some eat more food, some reduce their activity, and some store less of their food energy as fat. A woman can easily meet the need for extra kcalories by selecting more nutrient-dense foods from the five food groups. If a woman chooses less nutritious options such as sugary soft drinks or fatty snack foods to meet her energy needs, she will undoubtedly come up short on nutrients. The increase in the need for nutrients is even greater than that for energy, so the mother-to-be should choose nutrient-dense foods such as whole-grain breads and cereals, legumes, dark green vegetables, citrus fruits, low-fat milk and milk products, and lean meats, fish, poultry, and eggs. Ample carbohydrate (ideally, 175 grams or more per day and certainly no less than 135 grams) is necessary to fuel the fetal brain and spare the protein needed for fetal growth. Fiber in carbohydrate-rich foods such as whole grains, vegetables, and fruit can help alleviate the constipation that many pregnant women experience. The protein RDA for pregnancy is 25 grams per day higher than for nonpregnant women. Pregnant women can easily meet their protein needs by selecting meats, seafood, poultry, low-fat milk and milk products, and protein-containing plant foods such as legumes, tofu, whole grains, nuts, and seeds. Some vegetarian women limit or omit protein-rich meats, eggs, and milk products from their diets. For them, meeting the recommendation for food energy each day and including generous servings of protein-containing plant foods are imperative. Because use of high-protein supplements during pregnancy may be harmful to the infant’s development, it is discouraged unless medically prescribed and carefully monitored to treat fetal growth problems. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 12 The high nutrient requirements of pregnancy leave little room in the diet for excess fat, especially solid fats such as fatty meats and butter. The essential fatty acids, however, are particularly important to the growth and development of the fetus.17 The brain contains a substantial amount of lipid material and depends heavily on long chain omega-3 and omega-6 fatty acids for its growth, function, and structure Folate and Vitamin B12 The vitamins famous for their roles in cell reproduction—folate and vitamin B12—are needed in large amounts during pregnancy. New cells are laid down at a tremendous pace as the fetus grows and develops. At the same time, because the mother’s blood volume increases, the number of her red blood cells must rise, requiring more cell division and therefore more vitamins. To accommodate these needs, the recommendation for folate during pregnancy increases from 400 to 600 micrograms a day. Folate plays an important role in preventing neural tube defects. To review, the early weeks of pregnancy are a critical period for the formation and closure of the neural tube that will later develop to form the brain and spinal cord. By the time a woman suspects she is pregnant, usually around the 6th week of pregnancy, the embryo’s neural tube normally has closed. To reduce the risk of neural tube defects, women who are capable of becoming pregnant are advised to obtain 400 micrograms of folic acid daily from supplements, fortified foods, or both, in addition to eating folate-rich foods The pregnant woman also needs a greater amount of vitamin B12 to assist folate in the manufacture of new cells. Because high intakes of folate complicate the diagnosis of a vitamin B12 deficiency quantities of 1 milligram or more require a prescription. Most over-the-counter multivitamin supplements contain 400 micrograms of folic acid; supplements for pregnant women usually contain at least 800 micrograms. People who eat meat, eggs, or dairy products receive all the vitamin B12 they need, even for pregnancy. Those who exclude all animal-derived foods from the diet, however, need vitamin B12–fortified foods or supplements. Vitamin D and Calcium for Bones Vitamin D and the minerals involved in building the skeleton—calcium, phosphorus, magnesium, and fluoride—are in great demand during pregnancy. Insufficient intakes may produce abnormal fetal bone growth and tooth development. Vitamin D plays a vital role in calcium absorption and utilization. Consequently, severe maternal vitamin D deficiency interferes with normal calcium metabolism, which, in rare cases, may cause rickets in the infant.22 Regular exposure to sunlight and consumption of vitamin D–fortified milk are usually sufficient to provide the recommended amount of vitamin D during pregnancy (15 μg/day), which is the same as for nonpregnant women All pregnant women, but especially those who are younger than 25 years of age, need to pay special attention to calcium to ensure adequate intakes. Iron The body conserves iron especially well during pregnancy: menstruation ceases, and absorption of iron increases up to threefold due to a rise in the blood’s iron absorbing and iron-carrying protein transferrin. Still, iron needs are so high that stores dwindle during pregnancy. To help improve the iron status of women before and during pregnancy, the Dietary Guidelines for Americans 2010 recommend that all women capable of becoming pregnant choose foods that supply heme iron (meat, seafood, and poultry), which is most readily absorbed; choose additional sources, such as iron rich eggs, vegetables, and legumes; and consume foods that enhance iron absorption, such as vitamin C-rich fruits and vegetables Zinc Zinc is required for protein synthesis and cell development during pregnancy. Typical zinc intakes of pregnant women are lower than recommendations but, fortunately, zinc absorption increases when intakes are low. Large doses of iron can interfere with zinc absorption and metabolism, but most prenatal supplements supply the right balance of these minerals for pregnancy. Zinc is abundant in protein-rich foods such as shellfish, meat, and nuts. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 12 Nutrient Supplements A healthy pregnancy and optimal infant development depend on the mother’s diet. Pregnant women who make wise food choices can meet most of their nutrient needs, with the possible exception of iron. Even so, physicians often recommend daily multivitamin-mineral supplements for pregnant women. These prenatal supplements typically provide more folic acid, iron, and calcium than regular supplements. Prenatal supplements are especially beneficial for women who do not eat adequately and for those in high-risk groups: women carrying twins or triplets, cigarette smokers, and alcohol or drug abusers. For these women, prenatal supplements may be of some help in reducing the risks of preterm delivery, low infant birth weights, and birth defects. Weight Gain Weight loss during pregnancy is not recommended. Even obese women are advised to gain between 11 and 20 pounds for the best chance of delivering a healthy infant. Ideally, overweight women will achieve a healthy body weight before becoming pregnant, avoid excessive weight gain during pregnancy, and postpone weight loss until after childbirth. Weight Loss after Pregnancy The pregnant woman loses some weight at delivery. In the following weeks, she loses more as her blood volume returns to normal and she gets rid of accumulated fluids. The typical woman does not, however, return to her pre-pregnancy weight. In general, the more weight a woman gains beyond the needs of pregnancy, the more she retains—mostly as body fat. Even with an average weight gain during pregnancy, most women tend to retain a few pounds with each pregnancy. When those few pounds become 7 or more and BMI increases by a unit or more, complications such as diabetes and hypertension in future pregnancies as well as chronic diseases later in life can increase—even for women who are not overweight. Women who achieve a healthy weight prior to the first pregnancy and maintain it between pregnancies best avoid the cumulative weight gain that threatens health later on Guidelines for Physical Activity during Pregnancy This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 12 Common Nutrition-Related Concerns of Pregnancy Food Cravings and Aversions. Some women develop cravings for, or aversions to, certain foods and beverages during pregnancy. Individual food cravings during pregnancy do not seem to reflect real physiological needs. In other words, a woman who craves pickles does not necessarily need salt. Similarly, cravings for ice cream are common during pregnancy but do not signify a calcium deficiency. Food aversions and cravings that arise during pregnancy are probably due to hormone-induced changes in taste and sensitivities to smells, and they quickly disappear after the birth Non Food Cravings. Some pregnant women develop cravings for and ingest nonfood items such as laundry starch, clay, soil, or ice—a practice known as pica.39 Pica may be practiced for cultural reasons that reflect a society’s folklore. Pica is often associated with iron deficiency, but whether iron deficiency leads to pica or pica leads to iron deficiency is unclear Morning Sickness. The nausea of “morning” (actually, anytime) sickness seems unavoidable and may even be a welcome sign of a healthy pregnancy because it arises from the hormonal changes of early pregnancy. The problem typically peaks at 9 weeks’ gestation and resolves within a month or two.41 Many women complain that odors, especially cooking smells, make them sick. Thus, minimizing odors may alleviate morning sickness for some women Heartburn. Heartburn, a burning sensation in the lower esophagus near the heart, is common during pregnancy and is also benign. As the growing fetus puts increasing pressure on the woman’s stomach, acid may back up and create a burning sensation in her throat. Constipation. As the hormones of pregnancy alter muscle tone and the thriving infant crowds’ intestinal organs, an expectant mother may complain of constipation, another harmless but annoying condition. A high-fiber diet, physical activity, and plentiful fluids will help relieve this condition. Also, responding promptly to the urge to defecate can help. Laxatives should be used only as prescribed by a physician. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 12 Problems in Pregnancy Preexisting Diabetes. Pregnancy presents special challenges for the management of diabetes. Insulin-induced hypoglycemia has a more rapid onset during pregnancy and is a danger to the mother, especially in those with type 1 diabetes. Women with type 2 diabetes often start pregnancy with insulin resistance and obesity, making optimal glycemic control difficult. Gestational Diabetes. Some women are prone to developing a pregnancy-related form of diabetes, gestational diabetes. Gestational diabetes usually resolves after the infant is born, but some women go on to develop type 2 diabetes later in life, especially if they are overweight. For this reason, health care professionals strongly advise against excessive weight gain during and after pregnancy. Weight gains after pregnancy increase the risk of gestational diabetes in the next pregnancy. Gestational diabetes can lead to fetal or infant sickness or death, though the risk of these outcomes falls dramatically when it is identified early and managed properly. Hypertension. Hypertension (blood pressure ≥140/90 mm Hg) complicates pregnancy and affects its outcome in different ways, depending on how severe it becomes. Hypertension during pregnancy is classified as chronic hypertension or gestational hypertension. Chronic hypertension can be a preexisting condition that develops before a woman becomes pregnant. In women whose pre-pregnancy blood pressure is unknown, diagnosis of chronic hypertension is based on the presence of sustained hypertension before 20 weeks of gestation. In contrast, gestational hypertension develops after the 20th week of gestation. In women with gestational hypertension, blood pressure usually returns to normal during the first few weeks after childbirth. Preeclampsia. Preeclampsia is a condition characterized not only by high blood pressure but also by protein in the urine. Preeclampsia usually occurs with first pregnancies and almost always appears after 20 weeks’ gestation. Symptoms typically regress within 48 hours of delivery. Because delivery is the only known cure, preeclampsia is a leading cause of indicated preterm delivery and accounts for about 15 percent of infants who are growth restricted. Preeclampsia affects almost all of the woman’s organs—the circulatory system, liver, kidneys, and brain. If it progresses, she may experience seizures; when this occurs, the condition is called eclampsia. Maternal mortality during pregnancy is rare in developed countries, but eclampsia is the most common cause. Practices to Avoid Cigarette Smoking Medicinal Drugs and Herbal Supplements taken during pregnancy can cause serious birth defects. Pregnant women should not take over-the counter drugs or any other medications without consulting their physicians, who must weigh the benefits against the risks. Drugs of Abuse Environmental Contaminants Foodborne Illness Large Doses of Vitamin-Mineral. Supplements Many vitamins and minerals are toxic when taken in excess. Excessive vitamin A is particularly infamous for its role in fetal malformations of the cranial nervous system. Intakes before the 7th week of pregnancy appear to be the most damaging. Restrictive Dieting Sugar Substitutes, Caffeine, and Alcohol Complications Associated with Smoking During Pregnancy Fetal growth restriction Low birthweight Preterm birth Premature separation of the placenta Miscarriage Stillbirth Sudden infant death syndrome Congenital malformations Adolescent Pregnancy A pregnant adolescent presents a special case of intense nutrient needs. Young teenage girls have a hard enough time meeting nutrient needs for their own rapid growth and development, let alone those of pregnancy. Many teens enter This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 12 pregnancy deficient in vitamins B12 and D, folate, calcium, and iron, which increases the risk of impaired fetal growth. Pregnant adolescents are less likely to receive early prenatal care and are more likely to smoke during pregnancy—two factors that predict low birthweight and infant death. The rates of stillbirths, preterm births, and low-birthweight infants are high for teenagers—both for teen moms and for teen dads. Their greatest risk, though, is death of the infant: mothers younger than 16 years of age bear more infants who die within the first year than do women in any other age group. These factors combine to make adolescent pregnancy a major public health problem. Adequate nutrition is an indispensable component of prenatal care for adolescents and can substantially improve the outlook for both mother and infant. To support the needs of both mother and fetus, a pregnant teenager with a BMI in the normal range is encouraged to gain about 35 pounds to reduce the likelihood of a low-birthweight infant. As mentioned earlier, however, compared with older mothers, the lifetime risk of postpartum weight retention in young adolescents may be far greater.73 Researchers agree that optimal weight gain recommendations for pregnant adolescents need focused attention. Meanwhile, pregnant and lactating adolescents would do well to form a kcalorie level that will support adequate, but not excessive, weight gain. Breastfeeding Exclusive breastfeeding for 6 months and breastfeeding with complementary foods for at least 12 months as an optimal feeding pattern for infants. Breast milk’s unique nutrient composition and protective factors promote optimal infant health and development. The only acceptable alternative to breast milk is iron-fortified formula. Adequate nutrition of the mother supports successful lactation, and without it, lactation is likely to falter or fail. Health care professionals play an important role in providing encouragement and accurate information on breastfeeding This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 12 Nutrition during Lactation Energy. A nursing woman produces about 25 ounces of milk a day, with considerable variation from woman to woman and in the same woman from time to time, depending primarily on the infant’s demand for milk. Producing this milk costs a woman almost 500 kcalories per day above her regular need during the first 6 months of lactation. To meet this energy need, the woman is advised to eat foods providing an extra 330 kcalories each day. The other 170 kcalories can be drawn from the fat stores she accumulated during pregnancy. During the second 6 months of lactation, an additional 400 kcalories each day are recommended Weight Loss. After the birth of the infant, many women actively try to lose the extra weight and body fat they accumulated during pregnancy. How much weight a woman retains after pregnancy depends on her gestational weight gain and the duration and intensity of breastfeeding Vitamins and Minerals. A question often raised is whether a mother’s milk may lack a nutrient if she fails to get enough in her diet. The answer differs from one nutrient to the next, but, in general, nutritional deprivation of the mother reduces the quantity, not the quality, of her milk. Women can produce milk with adequate protein, carbohydrate, fat, folate, and most minerals, even when their own supplies are limited Water. The volume of breast milk produced depends on how much milk the infant demands, not on how much fluid the mother drinks. The nursing mother is nevertheless advised to drink plenty of liquids each day (about 13 cups) to protect herself from dehydration. Particular Foods. Foods with strong or spicy flavors (such as onions or garlic) may alter the flavor of breast milk. A sudden change in the taste of the milk may annoy some infants, whereas familiar flavors may enhance enjoyment. Flavors imparted to breast milk by the mother’s diet can influence the infant’s later food preferences Contraindications to Breastfeeding Alcohol Tobacco and Caffeine Medications and Illicit Drugs Maternal Illness Alcohol, smoking, caffeine, and drugs may reduce milk production or enter breast milk and impair infant development. Some maternal illnesses are incompatible with breastfeeding CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed. 1. The most important single predictor of an infant’s future health and survival is: a. the infant’s birth weight. b. the infant’s iron status at birth. c. the mother’s weight at delivery. d. the mother’s prepregnancy weight. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. A mother’s pre pregnancy nutrition is important to a healthy pregnancy because it determines the development of: a. the largest baby possible. b. adequate maternal iron stores. c. an adequate fat supply for the mother. d. healthy support tissues—the placenta, amniotic sac, umbilical cord, and uterus. ANSWER: ________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 12 RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. A pregnant woman needs an extra 450 calories above the allowance for nonpregnant women during which trimester(s)? a. First b. Second c. Third d. First, second, and third ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. Two nutrients needed in large amounts during pregnancy for rapid cell proliferation are: a. vitamin B12 and vitamin C. b. calcium and vitamin B6 c. folate and vitamin B12. d. copper and zinc. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. For a woman who is at the appropriate weight for height and is carrying a single fetus, the recommended weight gain during pregnancy is: a. 40 to 60 pounds. b. 25 to 35 pounds. c. 10 to 20 pounds. d. 20 to 40 pounds. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. Rewards of physical activity during pregnancy may include: a. weight loss. b. decreased incidence of pica. c. relief from morning sickness. d. reduced stress and easier labor. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. During pregnancy, the combination of high blood pressure and protein in the urine signals: a. jaundice. b. preeclampsia. c. gestational diabetes. d. gestational hypertension. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. Which of the following preventative measures should pregnant women take to avoid contracting listeriosis? a. Choose soft rather than aged cheeses. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 10 of 12 b. Avoid pasteurized milk. c. Thoroughly heat hot dogs. d. Avoid raw fruits and vegetables. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. To facilitate lactation, a mother need: a. about 5000 kcalories a day. b. adequate nutrition and fluid intake. c. vitamin and mineral supplements. d. a glass of wine or beer before each feeding. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. A woman who breastfeeds her infant should drink plenty of water to: a. produce more milk. b. suppress lactation. c. prevent dehydration. d. dilute nutrient concentrations. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ RATIONALIZATION ACTIVITY The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 2. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 3. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 4. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 5. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 6. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 11 of 12 7. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 8. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 9. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 10. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ LESSON WRAP-UP You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL Activity: CAT 3-2-1 This strategy provides a structure for you to record your own comprehension and summarize your learning. Let us see your progress in this chapter! Three things you learned: 1. __________________________________________________________________________________________ 2. __________________________________________________________________________________________ 3. __________________________________________________________________________________________ Two things that you’d like to learn more about: 1. __________________________________________________________________________________________ __________________________________________________________________________________________ 2. __________________________________________________________________________________________ __________________________________________________________________________________________ One question you still have: 1. __________________________________________________________________________________________ __________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 12 of 12