Nutrition (class 6)

Maternal & fetal nutrition during pregnancy

-good nutrition is very important

-follow recommendations of food guide plus 2-3 extra servings from any food group

-Supplements: take between meals with water or liquids other than milk or caffeinated beverages

Trimester 1 calories

same as pre preg level (1900)

trimester 2 calories

pre preg (1900) plus 340

trimester 3 calories

pre preg (1900) plus 452

lactation calories

pre preg (1900) plus 330-400

weight gain during pregnancy for a normal weight woman

25-35 lbs

weight gain during pregnancy for underweight woman

28-40 lbs

weight gain during pregnancy for overweight woman

15-25 lbs

weight gain during pregnancy for obese woman

11-20 lbs

pica

craving for and eating of non food substances.

must consider nutritional deficiencies

remedies to try to relieve N&V include:

-get lots of rest

-dry crackers or few potato chips

-eat small meals and eat frequently

-sip small amounts of fluid to avoid dehydration

-get up slowly and do not lie down too soon after eating

-sniff lemons or ginger

-acupressure

Hyperemesis gravidarum

Nausea and vomiting of pregnancy

hyperemesis gravidarum

• Characterized by extreme unrelenting nausea, protracted vomiting, retching, severe dehydration and weight loss

• Most commonly occurs between 4 and 9 weeks of gestation; lessens by 16 weeks but may persist past trimester and remain throughout pregnancy (HG)

• Potentially Life threatening condition affecting 0.5 to 2% of pregnancies

• Often requires hospitalization

risk factors for hyperemesis gravidarum

• Nulliparity

• Increased body weight

• Hx of migraines

• Pregnant with twins or hydatidiform mole

• High levels of stress, anxiety, and ambivalance towards pregnancy

goals of care for hyperemesis gravidarum

1. maintain hydration

2. support nutrition

3. treatment of nausea and vomiting

nursing care for hyperemesis gravidarum

-Often requires hospitalization and treatment with IV fluids

-Complete physical assessment for S&S of dehydration and malnutrition

-Vital signs \n
-Lab tests to rule out fluid and electrolyte imbalance \n
-Urine for ketonuria

-Psychosocial assessment

postpartum nutrition needs

protein -helps tissue repair and rebuilding

iron - may have anemia , low hemoglobin

calcium for lactation

breastfed infants need vitamin __ supplement

D

breast milk is

easier to digest.

it boosts immune system

canada recommends exclusive breast feeding for ___ months

6

benefits of breastfeeding

• 1. Health and Immunologic Benefits to newborns – IgM, IgA, IgD, IgG, IgE

** Allergy Prevention** - mothers / Omega 3 consumption research

• 2. Developmental benefits

• 3. Nutritional benefits to infant

• 4. Health benefits to mothers

• 5. Psychological benefits

for the production of milk:

Anterior Pituitary -→ release of ________ in response to stimulation of afferent nerves in nipple when infant sucks

prolactin

for the production of milk: Suckling -→ release of ________ from posterior pituitary which stimulates cells in the alveoli to contract and eject milk through ducts

oxytocin

foremilk is high in

CHO

hindmilk is high in

fat

lactogenesis

the phase in which breasts prepare to produce milk

contraindications to breastfeeding

• Medical Contraindications – ie) HIV, CMV, Active herpes, measles, varicella zoster virus

• Nutrition and drug related contraindications ie.) infantile disorders of metabolism, selective maternal medications, chemotherapy

how much vitamin d supplement should breast fed babbies get

400 international units per day.

women with a bmi of over 30

obese

women with a bmi of 25-29.9

overweight

1. Which is true about women who experience hyperemesis gravidarum?

1. Seventy percent of all pregnant women suffer from it at some point in pregnancy.

2. Such women have vomiting severe and persistent enough to cause weight loss,

   dehydration, and electrolyte imbalance.

3. They need intravenous (IV) fluid and nutrition for most of their pregnancy.

4. They often inspire similar, milder symptoms in their male partners and mothers.

ANS: 2 \n Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases. Although 70% of pregnant women experience nausea and vomiting, about 0.5 to 2% proceed to this severe level. IV administration may be used at first to restore fluid levels, but it is seldom needed for very long. Women suffering from this condition want sympathy, because some authorities believe that difficult relationships with mothers or partners may be the cause.

Infants should be breastfed as soon as possible after birth and at least __ to ? times per day thereafter.

8

The football or clutch-hold position is often preferred after

Caesarean birth

Milk should be stored in serving sizes of ? to prevent waste.

60 to120 mL

Underweight women should gain 12.5 to 18 kg.

Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale.

Normal-weight women should gain 11.5 to 16 kg.

A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 11.5 to 16 kg, or about 1 to 2.25 kg in the first trimester and about 500 g/week during the second and third trimesters,

Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with

intrauterine growth restriction (is when a baby in the womb (a fetus) does not grow as expected. The baby is not as big as would be expected for the stage of the mother's pregnancy.)

1. Which of the following should the nurse recommend for sore nipples?

   1. Wash nipples with an antimicrobial soap to prevent infection.

   2. Position infant so that the end of the nipple is grasped.

   3. Express milk manually and bottle-feed infant until nipples heal.

   4. Vary infant’s position at breast; for example, use the “football hold” at times.

d

Let down reflex

The let-down reflex is what makes breastmilk flow. When your baby sucks at the breast, tiny nerves are stimulated.

mother says sometimes it is difficult to stimulate the let-down reflex. Which of the following is the most appropriate recommendation?

1. Apply warm compresses before feedings.

2. Avoid touching breasts or nipples before feedings.

3. Wear a well-fitting nursing bra 24 hours a day.

4. Feed Lauren in a quiet place, using the same feeding position every time.

1

folic acid is important because it prevents

neural tube defects

for N&V they should eat something like crackers or a high carbohydrate snack before ?

before getting out of bed

a late hunger sign is

crying

baby hunger signs

-opening mouth

-hand to mouth motion

-sucking / routing

after 6 months, a breastfed baby needs

iron

how do a parent whos breast feeding assess to make sure their child is getting enough milk

6-8 wet diapers a day