<p> Nutritional Health </p><p>Nutritional Health</p><p> Nutritional state before and during pregnancy have a direct bearing on the her health and on fetal growth and development.</p><p> Hyperplasia-early in pregnancy, fetal growth occurs by an increase in the number of cells formed.</p><p> Hypertrophy-late in pregnancy, occurs by enlargement of existing cells.</p><p> Nurses must educate their patients on the importance of good nutrition.</p><p> Recommended Weight Gain:</p><p> adequate nutrients to the fetus and her own nutrition.</p><p> adequate protein</p><p> weight gain of 11.2 to 16 kg (25 to 40 lbs)</p><p> 1 lb / month during the 1st trimester</p><p> 1 lb/ week during the last 2 trimesters (3-12-12)</p><p> excessive is > 6.6 lbs in the last 2 trimesters or < 2.2 lbs/ month</p><p> underweight women should gain 30 to 40 lbs</p><p> obese women should gain less 15 lbs</p><p> multiple pregnancy- 1 lb / wk for total of 40 to 45 lbs</p><p> sudden gains suggest fluid retention</p><p> Components of Health Nutrition:</p><p> Caloric Needs:</p><p> total 2500 calories/day  never less than 1500 calories/ day</p><p> Protein Needs:</p><p> 60 g/day</p><p> meat, poultry,fish, yogurt, eggs, milk, beans & rice, legumes & rice, or beans & wheat.</p><p> Fat Needs:</p><p> linoleic acid necessary for new cell growth</p><p> vegetable oils are a good source</p><p> Vitamin Needs:</p><p> folate deficiency>fetal neural tube defect</p><p> vitamin D deficiency>diminished bone density of fetus and mother </p><p> Prenatal Vitamins (Natalins)</p><p> Mineral Needs:</p><p> needed for new cell building</p><p> calcium - 1200 to 1500 mg</p><p> phosphorus - eat foods high in protein</p><p> iodine - 175 ug daily(seafood is best source)</p><p> iron - 30 mg dietary supplement of 30 mg / day</p><p> organ meats, eggs, green leafy vegetables, whole grain, enriched breads, dried fruits (OJ increases absorption)</p><p> black stools and constipation</p><p> may need a stool softener- Colace  Fluoride:</p><p> aids in formation of teeth</p><p> Sodium:</p><p> maintains fluid balance in body</p><p> to much salt results in retention of fluids</p><p> Zinc:</p><p> synthesis of DNA and RNA</p><p> 15 mg in meats, liver,eggs and seafood.</p><p> Fluid Needs:</p><p> increase water to promote kidney function</p><p> 2 glasses daily plus 1 quart of milk</p><p> Fiber Needs:</p><p> increase fiber-broccoli, asparagus, fruits and green leafy vegetables</p><p> Foods to Avoid:</p><p> caffeine</p><p> artificial sweeteners</p><p> weight loss diets</p><p> Ask for a 24 hour nutrition recall</p><p> Areas of assessment </p><p> Monitor H&H and UA</p><p> Promoting Nutritional Health</p><p> Set nutritional outcomes by looking at the woman’s lifestyle.  Family considerations</p><p> Financial considerations</p><p> Cultural considerations</p><p> Managing Common Problems:</p><p> Nausea and vomiting</p><p> once a day is common</p><p> acupressure, antimotion sickness wrist bands, avoiding fluids with meals, increasing carbohydrates, eat dry crackers or sourball candies</p><p> disappears by 4th month</p><p> Cravings</p><p> strange desires for foods</p><p> Pica</p><p> Pyrosis (heartburn) burning sensation along esophagus caused by regurgitation of gastric contents into lower esophagus.</p><p> due to decreased gastric motility that slows gastric emptying</p><p> relieved by small frequent meals and do not lie down immediately after eating</p><p> Maalox or Amphojel</p><p> Hypercholesterolemia:</p><p> elevated cholesterol</p><p> may be due to increased progesterone</p><p> gallstone formation and cardiovascular disease  eat moderate amounts of fat, oat bran, fish, butter substitutes, broil meats, minimum use of salad oils, exercise daily</p><p> Special Needs:</p><p> Adolescent:</p><p> they are continuing to grow also</p><p> high caloric intake (2500 calories / day); need calcium, iron, folic acid.</p><p> avoid foods that their parents see as important (milk, fruit, vegetables)</p><p> meal-cheese and sausage pizza, milk and apple</p><p> snack frequently need good snacks</p><p> Woman Over Age 40:</p><p> not studied a lot - decreased kidney function</p><p> high fluid intake</p><p> packed or fast-foods</p><p> Decreased Nutritional Stores:</p><p> high parity, short intervals between pregnancies or dieting depletes reserves</p><p> may have anemia, decreased K, folate, iron, thiamine</p><p> Underweight Women:</p><p> defined as 10% to 15% less than ideal body weight for her height or BMI </p><p>< 19.8</p><p> low birth weight infants</p><p> poverty, stress, depression, eating disorders  major reason - insufficient intake of food due to chronic poor nutritional habits</p><p> 24 hour nutrition recall</p><p> need 3500 calories; 500 calorie increase = additional 1 lb/week</p><p> Overweight Women:</p><p> 20% above her ideal body weight or BMI over 26.1</p><p> risks - diabetes, hypertension, excessive fetal growth, prolonged pregnancies, ambulating is difficult</p><p> dieting not recommended during pregnancy not below 1500 to 1800 calories/day</p><p> walk daily and decrease carbohydrates</p><p> Vegetarian Woman:</p><p> different types</p><p> lack of vitamin B12 (from meats), calcium (dark leafy vegetables), vitamin</p><p>D (milk and sunlight)</p><p> need a prenatal supplement</p><p> Phenylketonuria PKU:</p><p> inherited disorder-cannot convert amino acid phenylalanine into tyrosine; used for cell growth</p><p> Fetus can develop microcephaly, intrauterine growth restrictions, neurological damage.</p><p> Foods low in phenylalanine- OJ, bananas, squash, spinach, peas.  Proteins contain high levels</p><p> Begin low phenylalanine diet 3 months prior to pregnancy</p><p> Multiple Pregnancy:</p><p> gain more weight with greater speed</p><p> Smoking, Drugs or Alcohol:</p><p> general nutrition problems</p><p> Many Fast Food Meals:</p><p> 90% women work outside the home</p><p> prepare a good lunch the night before</p><p> Lactose Intolerance:</p><p> sugar in milk is lactose and people have difficulty digesting lactose</p><p> nausea, diarrhea, cramps, gas, bloatedness</p><p> can eat cheese, yogurt, soy milk</p><p> Hyperemesis Gravidarum:</p><p> nausea and vomiting prolonged past week 12 or so severe that dehydration, ketonuria, weight loss</p><p> may need to be hospitalized for IV RL</p>