HEALTH PROMOTION DURING PREGNANCY

HEALTH PROMOTION DURING PREGNANCY

4. Nutrition
a. Always start with diet history when it comes to giving nutrition instruction to the mother.
b. The nutrition profile should include:
1. Pregnant and current nutrition status.
2. Dietary habits – pica, junks, empty-caloric foods, regularity of meals, peer pressure, adequacy of foods/available finances, cultural and religious restrictions.
3. Knowledge of nutrition needs and the daily recommended allowances.
4. Physical findings indicative of poor nutritional status
- Anemic, underweight / overweight states
- Dull hair
- Dry scaly skin
- Pale / dull mucous membrane / conjunctiva

5. Factors / conditions requiring special attention
a. Young adolescent mother
b. Primigravidity
c. Low pregnant weight
d. Obesity
e. Low socioeconomic status
f. Prepregnant debilitating conditions
g. Vegetarians – lack essential proteins and minerals
h. Successive pregnancies
i. Education – not so much to what they know but how much they can warn to but essential foods

6. Nutritional considerations in pregnancy
1. Several caloric restrictions in pregnancy is contraindicated
2. Weight reduction should never be started as regimen in pregnancy
3. Weight gain should be evaluated with regards to the quality of weight of gain.
4. Sodium restriction in normal pregnancy is potentially hazardous to both mother and fetus.
5. Proper nutrition can prevent most of the discomforts of pregnancy
6. Dietary assessment and counseling should be an integral part of prenatal management for every pregnant woman.
7. Breastfeeding women need more calories (500 more).
8. Failure to gain weight is a danger sign – implies small for date for date fetuses
9. Maternal smoking reduces appetite, thus decreases caloric and nutritional intake = small fetuses.
10. Dietary regimen and changes should consider the woman’s sociocultural, economic, psychological implication of food habits and physical maternal and fetal nutritional demands.


7. Nutritional needs during pregnancy
• Calories- increase need to meet BMR demands and to provide energy source for fetus.
• Protein- increase in pregnancy for maternal tissue growth; uterus; breasts; blood volume; feel growth
• Vitamin C- needed for tissue growth and cell development (for bone and tooth bud formation)
• Vitamin D- need for calcium and phosphorous absorption; for bone and tooth mineralization
• Vitamin E- for tissue growth; RBC and cell wall integrity of both mother and fetus
• Folic Acid- needed to meet increased metabolic demands in pregnancy; production of blood products
• Minerals
1. IRON – most important mineral that must be taken in supplementary amount – needed to increase maternal RBC mass and fetal liver storage in the third trimester
2. Calcium and phosphorous – needed for maternal calcium phosphorous metabolism and fetal skeletal and bone growth.
3. Sodium – not to be restricted in pregnancy

BATH / BREAST CARE

a. Daily bath is required
b. Avoid soaps on nipples – with drying effect
c. Towel dry breast to increase integrity
d. Tub bath: may cause slipping for pregnant women have difficulty in maintaining balance – usually contraindicated except when there is care in getting into and out of bath tub, plus rubber mat on bath tub floor to prevent falls
e. Douching: not needed to manage vaginal discharge; daily bath is sufficient

CLOTHING / DRESSING

a. Loose, comfortable cloths, pf cotton material for more comfort
b. No constrictions around breast, abdomen, legs: no round garters
c. Flat – heeled shoes for comfort and balance
d. Support hose for varicosities
e. Maternity girdle as necessary

SLEEP and REST

a. Assessment of activities to identify need for rest and sleep
b. Average number of hour of sleep – 8 hours; may need 1-2
c. Hours of attention nap
d. Plan rest times during the day
e. Every 2 hour break from work to stand and walk about for few minutes (if tasks requires prolonged standing, needs time to walk about and sit at intervals)

TRAVELING

a. Long distance traveling by land needs stop-overs where woman can get out of car and walk
b. Seatbelts needed
c. Traveling by air requires pressurized planes
d. Best time to travel: second trimester. Reasons:
- mother is most comfortable
- danger of abortion is not great
- threat of premature labor is at a minimum
e. Journals close to term are discourage


EXCERCISES

a. PELVIC ROCK. This is the MOST IMPORTANT exercise for comfort during pregnancy
Purposes – increase flexibility of lower back
 strengthens the abdominal muscles
 shifts center of gravity back toward the spine
 relieves backache, IMPROVES POSTURE and appearance in late pregnancy

b. SQUATING / TAILOR – SITTING. These exercise strengthen perineal muscles
- makes pelvic joints more pliable.

c. ABDOMINAL BREATHING. This type of breathing utilizes the diaphragm primarily and not the chest muscle; helpful during the first half of labor and when use together with total relaxation – can carry woman, through of the first stage.

d. KEGEL / Pelvic Floor Contractions. This exercise improves
pubococcygeal muscle, perineal muscles, vaginal and pelvic floor muscle tone.

 White sitting or working around the house, tighten the perineum
 Helpful in postpartum period; promote perineal healing, increase sexual
Responsiveness and help prevent incontinence in later life.

c. PAINTING is the best for crowing period and actual delivery of the baby leaving, the work to be accomplished by the uterus. Only by painting can you keep the mother from pushing.

Nursing Considerations Related to Exercise in pregnancy
1. Regular exercise are needed
2. Not necessary to limit exercises provided she does not become fatigued or risk injury to self and fetus
3. Literature reports that regular exercises in pregnant women result to lower CS rate and length of hospitalization
4. Evidences support that women who are used to aerobic exercises before pregnancy should continue them during pregnancy, provided fatigued is avoided
5. Exercises in standing position to prevent pressure on the inferior vena cava and against the diaphragm
6. Excessive exercises caused increased blood flow to muscles and bones diminishing blood flow to uterus, placenta, and therefore fetus. This possibility of fetal distress in severe exercises
7. Excessive exercises can cause increased body temperature; elevated temperature is theoretically teratogenic.


MARITAL RELATIONS / COITUS

a. Generally no contraindications except in the presence of:

 PROM
 Premature labor
 History of abortion
 Bleeding
 Deeply engaged head in late pregnancy
 Incompetent cervix
b. I n health, pregnant women, sexual intercourse usually does NO HARM before the last 4 weeks or so (4 – 6 weeks) of pregnancy.
c. Like any other activity, avoid fatigue; exercise moderation and hygiene
d. Couple may need counseling regarding more comfortable position. The traditional man-on-top position is uncomfortable for many couples. Suggested position: side – lying and the woman – on top positions.

EMPLOYMENT

The pregnant woman may continue to work provided the work, work area and working conditions don’t pose hazards to health of mother and fetus.

DENTAL CARE

Regular examination of the teeth and gums should be part of the prenatal general examinations because of the estrogen effect on vascularity.

Example of Nursing Diagnosis related to health promotion of the pregnant woman and fetus may include:
 Health – seeking behaviors related to health promotion of the optimal health in pregnancy
 Anxiety related to minor symptoms of pregnancy
 Risk for deficient fluid volume related to nausea and vomiting of pregnancy
 Risk for in effective sexual patterns related to fear of harming the fetus during the pregnancy.