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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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
slide32
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)
slide55
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)
slide64
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
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)
ad