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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). 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

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  1. Anticipatory Guidance During Pregnancy By Catherine Ramos Marin, MSN/Ed(c), WHCNP, RN

  2. 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

  3. 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)

  4. 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

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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

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

  11. 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

  12. 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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