Anticipatory Guidance During Pregnancy By Catherine Ramos Marin

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) p Increase sleep needs (8 hrs. /day) p Exercise (fine as long as the client is able to converse easily whle exercising) p Work: no exposure to hazardous chemicals or toxins p Ingest no medication, no alcohol/drugs and to stop smoking p

Second Trimester (14 -26 weeks) Sexual needs and desire: encourage communication b/w husband wife p Regular dental check-up: maintain dental hygiene, delay radiographs and major dental work if possible (gum hypertrophy is common) p

Third Trimester (27 weeks to 40 weeks) p p p p 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 1. 2. 3. 4. 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 1. 2. 3. 4. 2 -4 lbs. in the 1 st 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: 2535 lbs.

Substance Abuse During Pregnancy Smoking: low birth weight infant p Alcohol: fetal alcohol syndrome p Cocaine: preterm labor and abruptio placenta p p Teach that teratogenic fetal effects are highest in the first trimester

Anemia during Pregnancy A decrease in the oxygen carrying capacity of blood p Often related to Iron deficiency and reduced dietary intake p Occurs in 20% of pregnant women p Associated with increase incidence of abortion, PTL, pre-eclampsia p

Anemia Hgb < 11 g/dl, Hct < 37 % during 1 st trimester p Hgb <10. 5 g/dl, Hct < 35% during 2 nd trimester p Hgb <10 g/dl, Hct < 32% during 3 rd trimester p

Nursing Interventions 24 hr. dietary recall p Oral administration of Iron p Teach nutritional requirements p

Oral Administration of Iron Best absorbed on an empty stomach p Taken with Vit. C such as OJ to increase absorption p Take in the evening if problem exist w/ morning sickness p Stools will turn dark green to black p Lab values should be checked for increased reticulocytes and rising Hgb and Hct p

Teenage Adolescent Pregnancy at age 19 or younger p Highly associated with anemia, preeclampsia, CPD, STDs, IUGR, and ineffective parenting p 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 p