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Anticipatory Guidance During Pregnancy. By Catherine Ramos Marin, MSN/ Ed(c ), WHCNP, RN. First Trimester (1-13 weeks). Discomforts of pregnancy (N/V, frequent urination) Increase sleep needs (8 hrs./day) Exercise (fine as long as the client is able to converse easily whle exercising)

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anticipatory guidance during pregnancy

Anticipatory Guidance During Pregnancy

By

Catherine Ramos Marin, MSN/Ed(c), WHCNP, RN

first trimester 1 13 weeks
First Trimester (1-13 weeks)
  • Discomforts of pregnancy (N/V, frequent urination)
  • Increase sleep needs (8 hrs./day)
  • Exercise (fine as long as the client is able to converse easily whle exercising)
  • Work: no exposure to hazardous chemicals or toxins
  • Ingest no medication, no alcohol/drugs and to stop smoking
second trimester 14 26 weeks
Second Trimester (14-26 weeks)
  • Sexual needs and desire: encourage communication b/w husband and wife
  • Regular dental check-up: maintain dental hygiene, delay radiographs and major dental work if possible (gum hypertrophy is common)
third trimester 27 weeks to 40 weeks
Third Trimester (27 weeks to 40 weeks)
  • Schedule childbirth classes
  • Increase urinary frequency and dyspnea
  • Review interventions on leg cramps, nasal stuffiness, varicose veins, and constipation
  • Breastfeeding teachings
  • Choosing pediatrician and clinic
  • Nutritional needs: period of rapid fetal growth
  • Teach s/s of preterm labor
  • Teach danger signs of pre-eclampsia and eclampsia
nutritional teachings
Nutritional Teachings
  • Increase intake by 300 calories above basal and activity needs
  • Increase protein by 30 gm/day
  • Increase intake of Iron (30+ mg) and folic acid (800 to 1000 mcg) through diet and supplements
  • Increase intake of Vitamin A, Vit. C and calcium through diet
weight gain
Weight Gain
  • 2-4 lbs. in the 1st trimester is considered normal
  • 0.9 lb./week thereafter
  • Is normal (> 2 lbs/week may be related to pre-eclampsia: edema
  • Total weight gain during pregnancy: 25-35 lbs.
substance abuse during pregnancy
Substance Abuse During Pregnancy
  • Smoking: low birth weight infant
  • Alcohol: fetal alcohol syndrome
  • Cocaine: preterm labor and abruptio placenta
  • Teach that teratogenic fetal effects are highest in the first trimester
anemia during pregnancy
Anemia during Pregnancy
  • A decrease in the oxygen carrying capacity of blood
  • Often related to Iron deficiency and reduced dietary intake
  • Occurs in 20% of pregnant women
  • Associated with increase incidence of abortion, PTL, pre-eclampsia
anemia
Anemia
  • Hgb < 11 g/dl, Hct < 37 % during 1st trimester
  • Hgb <10.5 g/dl, Hct < 35% during 2nd trimester
  • Hgb <10 g/dl, Hct < 32% during 3rd trimester
nursing interventions
Nursing Interventions
  • 24 hr. dietary recall
  • Oral administration of Iron
  • Teach nutritional requirements
oral administration of iron
Oral Administration of Iron
  • Best absorbed on an empty stomach
  • Taken with Vit. C such as OJ to increase absorption
  • Take in the evening if problem exist w/ morning sickness
  • Stools will turn dark green to black
  • Lab values should be checked for increased reticulocytes and rising Hgb and Hct
teenage adolescent pregnancy
Teenage Adolescent Pregnancy
  • Pregnancy at age 19 or younger
  • Highly associated with anemia, pre-eclampsia, CPD, STDs, IUGR, and ineffective parenting
  • Assess: Nutritional status (24 hr. diet recall), attitude toward pregnancy and becoming a mother, social support system (family, spouse, BF, friends), domestic violence, peer activities (smoking, drugs, alcohol), economic status, educational status, access to prenatal care
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