Sg 2 antepartum prof unn hidle updated spring 2010
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SG #2: ANTEPARTUM Prof. Unn Hidle Updated Spring 2010. Review of Nagele’s Rule. EDD, EDC, EDB ADD 7 days (to the date of 1 st day of LMP) SUBTRACT 3 months ADD 1 year. PREGNANCY TESTS. URINE vs. SERUM WHICH ONE WOULD YOU DO?. PREGNANCY TESTS cont. URINE

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Sg 2 antepartum prof unn hidle updated spring 2010

SG #2: ANTEPARTUMProf. Unn HidleUpdated Spring 2010


Review of nagele s rule
Review of Nagele’s Rule

  • EDD, EDC, EDB

  • ADD 7 days (to the date of 1st day of LMP)

  • SUBTRACT 3 months

  • ADD 1 year


Pregnancy tests
PREGNANCY TESTS

  • URINE vs. SERUM

  • WHICH ONE WOULD YOU DO?


Pregnancy tests cont
PREGNANCY TESTS cont.

  • URINE

    • Detection of hCG (human chorionic gonadotrophin) released by the placenta early in pregnancy

    • Always have a follow-up serum pregnancy test to confirm results

    • OTC (over-the-counter) pregnancy tests are 95-99% accurate if done according to instructions

    • Much more sensitive today. May detect pregnancy 1-2 days after first missed period (some newer versions even sooner)

    • Some test results within 1 minute

  • SERUM

    • More accurate than urine

    • May be as sensitive as detecting pregnancy (positive) as early as 1-2 days after implantation



Signs of pregnancy

SIGNS OF PREGNANCY

PRESUMPTIVE SIGNS

PROBABLE SIGNSPOSITIVE SIGNS


Presumptive signs
PRESUMPTIVE SIGNS

  • SUBJECTIVE = Key!

  • S/S the woman experiences

  • May have other causes than pregnancy

    • Amenorrhea

    • N/V

    • Weight gain

    • Fatigue

    • Breast fullness, tenderness; pronounced nipples with increased pigmentation of areola

    • Urinary frequency

    • “Quickening” (16-18 weeks)

    • Chadwick’s sign and thickening of vaginal mucosa

      • Chadwick’s sign also considered probable


Probable signs
PROBABLE SIGNS

  • OBJECTIVE = Key!

  • Objective changes perceived by examiner

  • May be causes other than pregnancy:

    • Abdominal/uterine enlargement

    • Hegar’s sign (softening of uterine wall – 6th week)

    • Goodell’s sign (softening of cervix – 8th week)

    • Chadwick’s sign (discoloration)

    • Ballottement

    • Fetal outline by palpation (NOT ultrasound)

    • Braxton Hicks contractions

    • Positive pregnancy test (hCG)




Positive signs
POSITIVE SIGNS

  • CONCLUSIVE of pregnancy:

    • FHR by Doppler/US at 8-12 weeks

    • FHR by Fetoscope at 18-20 weeks

    • Active fetal movement palpable by examiner AFTER 18 weeks

    • Outline of fetal skeleton via X-ray or US transvaginally as early as 10 days after implantation



Uterus
UTERUS

  • Weight

    • Increases from 70 grams to 900-1200 grams

  • Volume

    • Increases from 10ml to 2-10 liters

  • Position

    • Dextro rotates = moves to the right

    • Pressure on ureter and on vena cava and aorta in 3rd trimester = hypotensive or inferior vena cava syndrome (hypotension, lower extremity edema)

    • Location of uerus

      • 12 weeks: “Lifts” into the pelvis = palpable

      • 3 months: At symphysis pubis

      • 5 months: At umbilicus

      • 9 months: At xyphoid


Uterus cont
UTERUS cont.

  • Endometrium

    • Proliferates – estrogen necessary to prepare for implantation

    • Insufficient progesterone – prevents successful implantation

    • Storage of glycogen – nourishment

  • Cervix

    • Chadwick’s sign = Increased vascularity

    • Goodell’s sign = edematous and muscles soften

    • “Mucus plug” forms from endocervical gland secretions

    • Glandular hyperactivity = significant increase in discharge

  • Braxton Hicks Contractions

    • Irregular, sporadic non-rhythmic contractions throughout pregnancy (stretching of uterus and estrogen)

    • “False labor” – in 3rd trimester


Ovaries
OVARIES

  • After ovulation, ovaries stop producing ova

  • Corpus luteum is formed – produces progesterone:

    • Secures implantation

    • Development of placenta

  • Corpus luteum supplies nutrition + hormones

  • It regresses and is almost gone by mid-pregnancy

  • 10-12 weeks of pregnancy, placenta takes over

  • hCG is released and remains in circulation until 3 day in PP period


Vagina
VAGINA

  • Vascular and congested (Chadwick’s sign)

  • Walls thicken

  • Leukorrhea:

    • Caused by increased circulation & hormones

    • Thick & white

    • Acidic: pH 3.5-6.0

      • Lactic acid produced by lactobacilli

      • Controls growth of pathogenic bacteria (tends to grow in moist environment)

      • Favors yeast organisms such as Candidiasis-monilia


Breasts
BREASTS

  • Increased size – glands - (preparation for lactation)

  • Nodularity

  • Sensitivity

  • Superficial veins more prominent due to increased circulation and hormones (estrogen and progesteron), however, no major discoloration

  • Nipples erect & areolas darken

  • Montgomery’s follicles: enlarged sebacious glands

  • Stria

  • Secretory stage: mid-pregnancy

    • Colostrum expressed

  • Stimulation of breasts in last trimester may induce contractions (oxytocin release)



Cardiovascular
CARDIOVASCULAR

  • Cardiac output:

    • INCREASES 30-50% first trimester

    • INCREASES 10% last two trimesters

  • Change in blood distribution

  • Increased heart size; displaced up and to the left

  • Pulse rate increase 10-15 beats/min

  • Kidney filtration and O2 transport increase

  • Uterine blood flow:

    • Factors decreasing uterine blood flow

      • Contractions, hypertonus, hypertension or hypotension, streneous exercise, smoking, pathologic conditions (anemia, placental abnormalities, etc)

    • Factors increasing uterine blood flow

      • Bedrest

      • (Left) lateral recumbent position


Cardiovascular cont
CARDIOVASCULAR cont.

  • Plasma volume

    • INCREASES by 50% and at a quicker rate than RBC volume

    • Result: hemodilution = “physiologic anemia” or “pseudoanemia”

    • Decreased Hgb and Hct due to increased but diluted blood volume

    • Abnormal value: Hct <29% in 2nd trimester

    • Volume expansion does not maintain iron stores = increase iron supplementation

    • Vessel walls increase in permeability

    • Approx. 500ml of blood is lost in vaginal delivery (1000ml is acceptable in C-section)


Cardiovascular cont1
CARDIOVASCULAR cont.

  • Peripheral circulatory changes

    • Peripheral vascular resistance DECREASES due to:

      • Progesterone causing smooth muscle relaxation in vessel walls

      • Increased circulation due to addition of uteroplacental unit

      • Fetal heat production causing vasodilation

      • Increased synthesis of prostaglandins which causes resistance to circulating vasoconstrictors (angiotensin II and norepinephrine)

    • This will cause INCREASED venous return to the heart and MAINTAIN STABLE BP

    • However, factors such as prolonged standing, crossing legs, excessive weight gain may cause decrease venous return due to “pooling”/”stagnation” of blood.


Cardiovascular cont2
CARDIOVASCULAR cont.

  • Compression of pelvic - & femoral vessels:

    • Stagnation of blood, varicosites, dependent edema in pelvis and lower extremities

  • Pressure on vena cava in supine position

    • Supine hypotensive syndrome = vena cava syndrome

  • BP (systolic and diastolic) decreases in first 20 weeks by 5-10mmHg, then rise back to “normal”

  • Any rise of 30mmHg SBP or 15mmHg DBP is ABNORMAL (…… 140/90……..)


Respiratory
RESPIRATORY

  • Low CO2 levels in the mother

    • Due to sensitivity to progesterone

    • Fetal plasma CO2 is higher and therefore passes easily from fetal to maternal circulation (“getting rid of the waste”)

  • Increased progesterone

    • Increased in vocal cord size

    • Deeper voice


Urinary tract
URINARY TRACT

  • Compression of bladder

    • Frequency of urination

    • Stagnation urine

      • Risk of reflux and infection

  • Increased renal blood flow

    • Glomerular filtration increases by 50%

    • Result: decrease threshold for glucose and spillage of glucose (glucosuria)

  • “Nutritious urine”

    • Excretion of folates, glucose, lactose, amino acids, vitamin B12 and ascorbic acid


Hormones
HORMONES

  • Increased water retention (physiologic edema) due to:

    • Estrogen from placenta

    • Aldosterone secretion from the adrenals

  • Na and other electrolyte loss in urine

  • Progesterone increases kidney size


Posture
POSTURE

  • Key word: GRAVITY!

  • Pooling in pelvis and lower extremities (sitting and standing) = DEPENDENT EDEMA

  • Lateral recumbent position:

    • Increases kidney filtration

    • Redistribution of fluid to the body; may cause nocturia



Gastrointestinal
GASTROINTESTINAL

  • Displaced stomach and intestine

    • Constipation, pyrosis (heartburn), indigestion

    • Hemorrhoids & varicosites (vessel dilitation and “pooling”)

  • Hormonal changes

    • Decreases tone and motility of GI tract

    • Decreases emptying time causing

      • Constipation (also from decrease motility and more time for reabsorption of H2O from bowel content)

      • Reflux

      • nausea


Gastrointestinal1
GASTROINTESTINAL

  • Cholestasis

    • Supression of bile flow (due to progesterone causing gallbladder to hypotonic and have prolonged emptying time)

    • Retention of bile salt

    • SEVERE pruritis (itching)

  • Indigestion

    • DECREASED secretion of HCL acid and pepsin secondary to estrogen

  • PICA

  • Saliva production increases


Musculoskeletal
MUSCULOSKELETAL

  • Postural changes

    • Shift in center of gravity

    • Backache

    • Lordosis

  • Diastasis recti

    • Herniation of the uterus

    • From pressure of enlarging uterus

  • Protein

    • Increased daily requirement due to fetal growth

    • Maternal muscle mass may decrease


SKIN

  • Increased pigmentation due to estrogen:

    • Chloasma

    • Linea negra

    • Striae

    • Spider angiomas

    • Palmar erythema







Discomforts of pregnancy

Discomforts of Pregnancy

in order of

REASON



Fatigue
FATIGUE

  • Increased hormonal production

  • Increased demands of cardiopulmonary system

  • Increased metabolic rate

  • Inadequate nutrition

  • Anemia

  • Lack of exercise or excessive!

  • Excessive weight gain; incorrect posture

  • Infection or other illness

  • Psychological factors (depression)


Fatigue nursing
Fatigue: Nursing

  • ALWAYS rule out underlying physiologic causes & also psychological factors

  • Reassurance (“normal”)

  • Teaching


Insomnia
INSOMNIA

  • Anxiety

  • Comfort – position

  • Nocturia

  • Eating habits (large meals, spices = heart burn & ingestion)

  • Fetal activity

  • Leg cramps

  • Dyspnea


Insomnia nursing
INSOMNIA: Nursing

  • Assessment:

    • Sleep patterns and habits

    • Nutritional status

    • Psychological state

  • Reassurance

  • Intervention

    • Based on assessment, i.e. correction of comfort issues, support, etc.



Urinary frequency
URINARY FREQUENCY

  • When?

  • Stretching of the base of the bladder by the enlarging uterus (1st trimester) = reduced bladder capacity.

  • Compression of bladder (3rd trimester)


Urinary frequency nursing
URINARY FREQUENCY: Nursing

  • Rule out any physiologic cause (check s/s):

    • UTI

    • (Gestational) Diabetes

  • Advise woman to:

    • Decrease Caffeine

    • Hydration: adequate during the day, decrease towards the night

    • Voiding when having the urge

    • Kegal exercises

  • Teaching


Flatulence
FLATULENCE

  • Causes:

    • Ingestion of gas-forming foods

    • Aerophagia (air swallowing)

    • Ptylaism (increased saliva)

    • Nausea

    • Decreased GI motility

    • Decreased exercise

    • Uterine compression of GI tract

    • Constipation (fecal impaction


Flatulence nursing
FLATULENCE: Nursing

  • Assessment

  • Reassurance

  • Teaching:

    • Avoid gas producing foods

    • Avoid large meals

    • Proper chewing

    • NO gum (?????)

    • No smoking

    • Regular bowel habits and exercise


Constipation
CONSTIPATION

  • Progesterone causes:

    • Decreased peristalsis

    • Relaxation of muscle tone

  • Uterine pressure

  • Personal factors:

    • Alteration in nutritional habits

      • Decreased fiber

      • Iron intake

      • Decreased fluid intake

    • Decreased physical activity


Constipation nursing
CONSTIPATION: Nursing

  • Assessment

    • Underlying factors

    • Habits

  • Teaching:

    • Increase fluid intake (6-8 glasses/day: warm)

    • Fiber / bulk: Metamucil

    • Stool softener / laxative

  • Reassurance


Hemorrhoids
HEMORRHOIDS

  • Increased blood volume = pressure on venous circulation

  • Enlarging uterus = restricting venous return to perineum

  • Constipation

  • Straining

  • Inactivity / poor muscle tone (of bowel)

  • Obesity


Hemorrhoids nursing
HEMORRHOIDS: Nursing

  • Assessment:

    • Nutrition: fiber, fluid and iron

    • Exercise

    • Bowel habits

  • Reassurance / prevention (KEY!)

  • Teaching:

    • Preventative: avoid constipation + straining

    • Sitz bath (slightly warm &/or cool)

    • Petrolium jelly after BM

    • Astringent witch hazel pads (TUCKS) = decrease inflammation

  • Other medications as prescribed

    • Lie in knee-chest position 15min/day

    • Kegal exercises (strengthen perineal muscles)



  • Altered self esteem

    • Changes of pregnancy

    • Ambivalence vs. acceptance

  • Altered sexuality of couple

    • Ambivalence to increased labido to decreased labido (secondary to discomfort)

    • Change in body image

    • Discomfort

  • Nursing = EDUCATION


Mood changes
MOOD CHANGES

  • Depressant effects of progesterone

  • Emotional changes

  • Physical discomforts

  • Lack of support system (or too much??)

  • Nursing:

    • Assess for need of counseling

    • Reassurance



Breast
BREAST

  • Influence of progesterone and increased vascular supply:

    • Fullness and tingling

    • Tissue development for breastfeeding

  • Nursing:

    • Assessment

    • Teaching: BREASTCARE!


Leukorrhea
LEUKORRHEA

  • Increased production of cervical mucous

  • Cause:

    • Estrogen

    • Increased cervical vascularity

    • Desquamation

  • Nursing:

    • Assessment: r/o STD or candida albicans

    • Reassurance = NORMAL

    • Teach:

      • Good hygiene

      • External vinegar and water (NO DOUCHING)

      • Cotton underwear (loose)

      • No pantyhose

      • Peripads – NO tampons


Headache
HEADACHE

  • Dilitation of cerebral arteries due to:

    • Increased circulatory volume and heart rate

    • Vascular congestion (nasal turbinates)

    • Spasms of neck muscles (tension)

    • Slight decreased BP (2nd trimester)


Headache nursing
HEADACHE: Nursing

  • Assessment:

    • R/O neurological causes

    • R/O PIH

    • R/O sinusitis

  • Teach/Advise:

    • Warning signs of the above – REPORT!

    • Increase rest/relaxation

    • Comfort measures: cool cloths, massage, etc.

    • Tylenol (???)


Backache
BACKACHE

  • Lordosis

  • Increased weight of uterus

  • Relaxation of pelvic ligaments

  • Hormonal influence: estrogen and relaxin

  • Respiratory changes: thoracic pressure

  • Nursing:

    • Body mechanics / posture

    • Exercises: pelvic tilt

    • Relaxation and elevation of legs whenever possible


Leg cramps
LEG CRAMPS

  • Phosphorus and Calcium ratio:

    • Too little Ca (decreased dairy intake)

    • Too much Ca

    • Too much phosphorus (i.e. carbonated soft drinks)

  • Fatigue / muscle strain in lower extremity

  • Nursing:

    • Assess for other causes: phlebitis (Homan’s sign)

    • Depending on the cause: limit Ca intake or take Ca supplements; decrease PO4 intake

    • PO4/Ca binding antiacids with aluminum hydroxide (Amphogel)

    • Antacids WITHOUT phosphorus (Amphojel, Maalox, Mylanta)

    • Antacids WITH Calcium carbonate (Tums)


SKIN

  • Assessment

  • Reassurance about “normal” pregnancy changes and also how skin changes will appear post-partum

  • Teaching:

    • Good hygiene

    • Increase elasticity of the skin with:

      • Mosturizing lotion (aloa lanolin)

      • Oils






Bleeding
“BLEEDING”

  • Bleeding gums = gigivitis gravidarum

  • Bleeding nose = epistaxis

  • Due to hypertrophy and hyperemia secondary to estrogen levels.

  • Nursing:

    • R/O hypertension

    • Teach regarding oral hygiene:

      • Dental visit before pregnancy

      • Soft toothbrush

      • Floss gently

      • Good nutrition


Edema
EDEMA

  • Sodium and water retention

  • Capillary permeability

  • Vascular changes: increased blood volume

  • Varicose congestion: varicosites

  • Dietary: increased sodium intake


Edema nursing
EDEMA: Nursing

  • R/O PIH

    • Proteinuria

    • Hypertension

    • Rapid weight gain

    • Oliguria

    • Hyperreflexia

  • Teaching:

    • Increase rest periods: L-lateral position

    • Elevate legs

    • Supportive hose

    • Increase protein (will decrease fluid retention)

    • Nutrition: decrease sodium, simple carbs and fat


Braxton hicks contractions
BRAXTON HICKS CONTRACTIONS

  • Irregular, sporadic non-rhythmic contractions throughout pregnancy (stretching of uterus and estrogen)

  • Mostly in multiparas

  • “False labor” – in 3rd trimester


What do you assess

What do you assess?

(regarding contractions)


Assessment of contractions
Assessment of Contractions

  • Frequency, intensity and duration of contractions

  • Preterm labor (true labor) versus “false labor”

  • Rest in L-lateral recumbent position

  • Walking will usually relieve Braxton-Hicks contractions versus true labor, they will only get more intense.



Dyspnea
DYSPNEA

  • Compression of vena cava

  • Possibly hypotension from decreased blood return to the heart

  • Enlarged uterus = pressure on diaphragm

  • Nursing:

    • R/O anomalies: anemia, underlying respiratory issues

    • Advice: good posture, rest, L-lateral recumbent position


Vena cava syndrome supine hypotensive syndrome
VENA CAVA SYNDROME (SUPINE HYPOTENSIVE SYNDROME)


Dizziness and fainting
DIZZINESS AND FAINTING

  • Increased blood volume

  • Decreased O2 carrying ability of RBCs (pseudo-anemia)

  • Vena cava syndrome: decreased O2 to brain secondary to hypotension

  • Nursing:

    • R/O underlying causes

    • Advise: rise slowly (orthostatic hypotension); prevent hypoglycemia; nutrition; rest


Varicosites
VARICOSITES

  • Restriction of venous circulation to legs and perineum caused by:

  • Pressure from increased blood volume and enlarging uterus

  • Inactivity

  • Poor muscle tone

  • Prolonged standing leading to pooling of blood


Varicositis nursing
VARICOSITIS: Nursing

  • Thorough assessment of legs:

    • Pain

    • Venous stasis; pitting edema

    • Skin pigmentation: pale vs. red

    • Temperature: cool vs. warm

    • Dilated veins

  • Teaching:

    • Rest with legs elevated

    • Move around every hour

    • Supportive hose

    • Loose clothing

    • Avoid knee-highs

    • Flat shoes

    • No crossing of legs



Pyrosis heartburn
PYROSIS = Heartburn

  • Progesterone causes:

    • Gastric reflux from relaxation of smooth GI muscle and cardiac sphincter of the stomach

  • Displacement of stomach/duodenum secondary to enlarged uterus

  • Decreased HCL acid & pepsin in the stomach due to estrogen

  • Emotional factors


Pyrosis nursing
PYROSIS: Nursing

  • R/O anomalies:

    • Psychological issues

    • GI illnesses

  • Nutritional teaching:

    • Small, frequent meals

    • Proper chewing

    • NO, NO! greasy, spicy foods

    • Chew gum (?)

    • Avoid caffeine and cigarettes

    • Plenty of fluids (water, hot decaf. Tea)

    • Avoid sodium bicarbonate

    • Milk, cream, yogurt = all good!

    • Antacids WITHOUT phosphorus (Amphojel, Maalox, Mylanta)

    • Antacids WITH Calcium carbonate (Tums)

    • Avoid medications with ASA (acetylcalecylic acid = Aspirin)–alka Seltzer

    • Avoid medications with sodium (Rolaids)


Food cravings
FOOD CRAVINGS

  • Unknown etiology

  • PICA = craving of “non-food” sources:

    • Ice; soap; detergent; clay; plaster; tooth paste; sand

  • Nursing:

    • Assessment of nutritional status

    • Assess for appropriate weight gain (including semesters)

    • Cultural and socioeconomic status

    • Anemia r/t PICA

    • Emotional and psychological factors

    • Iron and vitamin supplements

    • Counseling if needed


Nausea vomiting
NAUSEA & VOMITING

  • Progesterone and increased hCG causes:

    • Decreased emptying time

  • Estrogen causes:

    • Decreased HCL acid and pepsin secretion

  • Dehydration

  • Pytalism (increased saliva)

  • Hypoglycemia

  • Acute infections/illness


Nausea vomiting nursing
NAUSEA & VOMITING: Nursing

  • Assess for underlying issues

  • Assess overall nutrition status

  • Usually resolves SPONTANEOUSLY after the first trimester (hormonal changes)

  • Teaching:

    • Avoid strong odors as much as possible

    • Small, frequent meals – increase carbohydrates

    • Snacks: unsalted dry crackers, esp. before rising in the AM

    • NO, NO! greasy, spicy foods

    • Avoid caffeine and cigarettes

    • Plenty of fluids (water, hot decaf. Tea: Peppermint, spearmint) – sip carbonated water

    • Milk, cream, yogurt = all good!

    • Vitamin B6 has been found to decrease nausea

    • Walks, fresh air


Hyperemesis gravidarum
HYPEREMESIS GRAVIDARUM

  • Cause:

    • Rapidly rising levels of hCG in early pregnancy

    • Psychological factors (feelings of pregnancy)

  • S/S:

    • Excessive vomiting

    • Triggered by all 5 senses

  • Intervention:

    • Fluid and electrolyte balance: IV/PO

    • Rest / hospitalization / quiet environment

    • Psychological support


Iron deficiency anemia
IRON DEFICIENCY ANEMIA

  • Cause:

    • Reduced Hgb / Hct due to depletion of iron stores

    • Inadequate dietary intake

    • Blood loss / hemolysis

  • Assessment:

    • s/s of anemia

    • Lab data

  • Intervention:

    • Rx for iron supplements (FeSO4 325 mg PO TID WITH Vitamin C 500 mg PO QD)

    • Teaching: nutrition (foods high in iron)



4 stages
4 Stages

  • First stage:

    • Ensuring safe passage through pregnancy, labor and birth

      • Concern for both unborn and herself

      • Seeks health care advise (safety)

  • Second stage:

    • Seeking acceptance of this child by others (family)

      • Support from immediate family (preferably partner) helps mother to form maternal identity and accept antepartal changes

  • Third stage:

    • Seeking commitment and acceptance of self as mother to infant (“binding-in”)

      • Child becomes a “real person” (after quickening) = bonding

      • Commitment to protect the child

  • Fourth stage:

    • Learning to give of oneself on behalf of one’s child

      • A matter of GIVING infant and family members to each other

      • (Mother is unselfish – comes last)


Father s needs
Father’s Needs

  • Important to focus on his needs as well

  • Stress

  • Role confusion

  • Jealousy



Why are teenagers at risk
Why are teenagers at risk?

  • Poor nutritional status (even when not pregnant!)

    • Iron deficiency anemia

  • Lower pre-pregnancy weight

  • Complications:

    • Pre-term and SGA births

    • PIH

    • Preeclampsia, eclampsia

  • Denial or other factors: delay in seeking pre-natal care

  • Infection:

    • postpartal endometritis

    • neonatal septicemia

  • STDs

  • <14 years old has the greatest risk


Adolescent physiologic
Adolescent: Physiologic

  • Puberty: Capable of reproduction

    • TANNER STAGING

    • Menarche

    • Breast changes

    • Vascularity in perineum (labia majora)

    • Pubic hair

    • Hips – widen + adipose tissue

    • Growth spurts (height)

    • Sebacious glands of axilla and face = acne


Adolescent psychologic
Adolescent: Psychologic

  • Freedom: education, career, future

  • G&D: autonomy (friends/family)

  • Alteration in identity formation

  • Identity: loss of peers

  • Risk factors:

    • Single motherhood – lack of support

    • Father involved / uninvolved

    • Stress of childrearing

    • Family stress

    • Limited education / lack of work & income


Adolescent nutritional risks
Adolescent: Nutritional risks

  • Musculoskeletal growth

  • Nutritional needs of BOTH adolescent and fetus:

    • Increase calories up to 50kcal/kg

    • Iron deficiency: 30-50mg elemental iron

    • Ca (musculoskeletal growth) – 1200mg/day = 1 extra serving of dairy additionally

    • Folic acid – needed for adolescent growth

    • Protein >60grams/day

  • High activity levels (or very low)

  • Poor eating habits

  • Body image

    • Crash diets

    • Eating disorders


Adolescent nutritional risks nursing interventions
Adolescent: Nutritional risks Nursing interventions

  • Reinforce good eating habits

  • Educate regarding G&D needs

  • Younger adolescent at higher risk:

    • Need nutrition for their own growth

    • Need nutrition for the fetal growth



Serving needs in pregnancy
Serving needs in pregnancy

  • DAIRY GROUP (2-3 servings)

    • Pregnancy – 4 servings

    • ** Adolescent pregnancy – 5 servings

  • PROTEIN GROUP (2-3 servings)

    • Pregnancy – 3 servings

    • ** Adolescent pregnancy – 3-4 servings

  • GRAIN GROUP (6-11 servings)

    • Pregnancy & Adolescent pregnancy – >6 servings

  • VEGETABLE GROUP (3-5 servings)

    • Pregnancy & Adolescent pregnancy – 5 servings (including vegetables with folic acid & vitamin A, B, C and fiber)

  • FRUIT GROUP (2-4 servings)

    • Pregnancy & Adolescent pregnancy – >2 servings (with Vit. C)




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