chapter 9 maternal and fetal nutrition pg 211-217

pica

-consuming non food substances like clay or starch -indicates anemia

nutrient needs during lactation

-energy (kilocalories), protein, calcium, iodine, zinc, B vitamins, and vitamin c

Pyridoxine (B6)

-essential for carbohydrate, protein, and fat metabolism -involved in the synthesis of RBCs, antibodies, and neurotransmitters

vitamin c

-tissue formation and enhances the absorption of iron -intake should be atleast one or two daily servings of citrus

daily intake of folic acid

0.4mg

daily sodium intake?

1.5g a day

daily intake of vit b6

1.9 mg/day

How much DHA should a pregnant woman consume?

300 mg/day

A pregnant woman asks how much daily iron supplements she should take, what is the appropriate response?

30mg of iron daily starting at 12 weeks

what is the daily intake of water?

8-10glasses (2.3L)

Sources of DHA?

8-12oz of seafood a week

Which guidance might the nurse provide for a client with severe morning sickness? A. Trying lemonade and potato chips B. Drinking plenty of fluids early in the day C. Immediately brushing her teeth after eating D. Never snacking before bedtime

A (Interestingly, some women can tolerate tart or salty foods when they are nauseated. Lemonade and potato chips are an ideal combination. The woman should avoid drinking too much when nausea is most likely, but she should increase her fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.)

Which nutrient's recommended dietary allowance (RDA) is higher during lactation than during pregnancy? A. Energy (kcal) B. Iron C. Vitamin A D. Folic acid

A (Nutrient needs for energy—protein, calcium, iodine, zinc, B vitamins, and vitamin C—remain higher during lactation than during pregnancy. The need for iron is not higher during lactation than during pregnancy. A lactating woman does not have a greater requirement for vitamin A than a nonpregnant woman. Folic acid requirements are the highest during the first trimester of pregnancy.)

Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. However, the nurse or midwife may need to refer a client to a registered dietitian for in-depth nutritional counseling. Which conditions would require such a consultation? (Select all that apply.) A. Preexisting or gestational illness such as diabetes B. Ethnic or cultural food patterns C. Obesity D. Vegetarian diets E. Multifetal pregnancy

A, B, C, D (The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia, as well as an increased risk for perinatal morbidity and mortality, the client with a preexisting or gestational illness would benefit from a referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are congruent with modern knowledge of fetal development and that adjustments can be made to ensure that all nutritional needs are met. The obese pregnant client may be under the misapprehension that, because of her excess weight, little or no weight gain is necessary. According to the Institute of Medicine, a client with a BMI in the obese range should gain at least 7 kg to ensure a healthy outcome. This client may require in-depth counseling on the optimal food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimal combination of amino acids and protein intake is achieved. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation. A multifetal pregnancy can be managed by increasing the number of servings of complex carbohydrates and proteins.)

What measures should the nurse instruct a pregnant patient to take to relieve the symptoms of morning sickness during the first trimester? Select all that apply. A. Consume food when it is not hot. B. Eat food in smaller portions. C. Include smaller amounts of fluids. D. Include foods that are high in fats. E. Include food high in starch content.

A, B, E (Morning sickness is seen in most women during the first trimester. Hot foods have strong odors, which may stimulate the chemoreceptor trigger zone and cause nausea. Therefore the nurse should advise the patient to ingest the food when it is not too hot. The patient is usually taught to have smaller, more frequent meals every 2 to 3 hours because it prevents stomach distention. Starch reduces the concentration of gastric acid, which aids in preventing nausea. Therefore the nurse should teach the patient to incorporate foods that contain higher quantities of starch. Usually patients are instructed to include higher amounts of fluids during pregnancy to prevent dehydration caused by nausea. Fried foods and foods rich in fats tend to produce more acids that can aggravate nausea and contribute to reflux.)

The nurse instructs a Middle Eastern patient who is pregnant regarding the importance of including a good amount of fruits in the diet to improve folate levels in the body. Which fruits should the nurse recommend to the patient? Select all that apply. A. Grapes B. Peaches C. Apricots D. Star fruit E. Pomegranates

A, C (Grapes and apricots are some of the fruits that are common in the diets followed in the Middle East. Therefore the nurse should teach the patient to include grapes and apricots in the diet to improve the nutritional status. Peaches, star fruit, and pomegranates are not popular fruits in Middle East. Peaches are the most common fruits for Native American groups. Star fruit is a fruit commonly eaten by people in Chinese communities. Pomegranates are popular in Italian communities.)

Fat soluble vitamins

A, D, E, K

A pregnant patient does not drink milk because of lactose intolerance. Which foods should the nurse instruct the patient to incorporate in her diet to prevent calcium deficiency? Select all that apply. A. Sardines B. Avocadoes C. Cooked pasta D. Wheat bread E. Refried beans

A, E (Canned sardines and refried beans are rich sources of calcium. Therefore a diet containing these foods should be suggested for patients who do not drink milk. Avocado, cooked pasta, and bread have poor calcium content. These foods are rich sources of folic acid and are suggested to pregnant patients to increase folate levels.)

To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take the recommended iron supplements? A. On a full stomach B. At bedtime C. After eating a meal D. With milk

B (Iron supplements taken at bedtime may reduce GI upset and should be taken at bedtime if abdominal discomfort occurs when iron supplements are taken between meals. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption.)

Which action is the highest priority for the nurse when educating a pregnant adolescent? A. Emphasize the need to eliminate common teenage snack foods because they are high in fat and sodium. B. Determine the weight gain needed to meet adolescent growth, and add 35 pounds. C. Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value. D. Realize that most adolescents are unwilling to make dietary changes during pregnancy.

B (Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Changes in the diet should be kept at a minimum. Snack foods can be included in moderation, and other foods can be added to make up for lost nutrients. Eliminating fast foods would make the adolescent appear different to her peers. The client should be taught to choose foods that add needed nutrients. Adolescents are willing to make changes; however, they still have the need to be similar to their peers.)

Many clients are concerned about the increased levels of mercury in fish and may be reluctant to include this source of nutrients in their diet. What is the best advice for the nurse to provide? A. Canned white tuna is a preferred choice. B. Shark, swordfish, and mackerel should be avoided. C. Fish caught in local waterways is the safest. D. Salmon and shrimp contain high levels of mercury.

B (As a precaution, the pregnant client should avoid eating shark, swordfish, and mackerel, as well as the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. Assisting the client in understanding the differences between numerous sources of mercury is essential for the nurse. A pregnant client may eat as much as 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, then these fish sources should be avoided, limited to less than 6 ounces per week, or the only fish consumed that week. Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant client may eat up to 12 ounces of commercially caught fish per week. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov.)

Which statement made by a lactating woman leads the nurse to believe that the client might have lactose intolerance? A. "I always have heartburn after I drink milk." B. "If I drink more than a cup of milk, I usually have abdominal cramps and bloating." C. "Drinking milk usually makes me break out in hives." D. "Sometimes I notice that I have bad breath after I drink a cup of milk."

B (Lactose intolerance, which is an inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine, is a problem that interferes with milk consumption. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. A woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. A client who breaks out in hives after consuming milk is more likely to have a milk allergy and should be advised to simply brush her teeth after consuming dairy products.)

Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy. Why is this the case? A. Maternal nutritional status is extremely difficult to adjust because of an individual's ingrained eating habits. B. Adequate nutrition is an important preventive measure for a variety of problems. C. Women love obsessing about their weight and diets. D. A woman's preconception weight becomes irrelevant.

B (Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach. Pregnancy is a time when many women are motivated to learn about adequate nutrition and make changes to their diet that will benefit their baby. Pregnancy is not the time to begin a weight loss diet. Clients and their caregivers should still be concerned with appropriate weight gain.)

The nurse notices that the hemoglobin levels of an infant who is breastfed have reduced drastically since birth. What is the probable reason for the infant to have anemia? A. The infant's mother is still taking folic acid and B vitamins. B. The infant's mother is consuming large amounts of caffeine. C. The infant's mother continues to take oral iron supplements. D. The infant's mother drinks large amounts of water and juices.

B(Caffeine intake leads to reduced absorption of iron into the milk. In turn this reduces the concentration of iron in the milk, which may cause anemia in the newborn. Iron supplements are usually prescribed to prevent anemia in the mother. Iron does not cause anemia in the newborn. Folate supplements help prevent spina bifida (SB) in the newborn. Folate does not cause anemia in the newborn. Excess fluids help maintain the blood volume in the mother and enhance the formation of milk. Excess fluids do not cause anemia in the newborn.)

A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. Which dietary requirement is the nurse most concerned about? A. Calcium B. Protein C. Vitamin B12 D. Folic acid

C (A pregnant woman's diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending on the woman's food choices, a pregnant woman's diet may be adequate in calcium. Protein needs can be sufficiently met by a vegetarian diet. The nurse should be more concerned with the woman's intake of vitamin B12 attributable to her dietary restrictions. Folic acid needs can be met by enriched bread products.)

The nurse instructs the patient to eat nuts, legumes, cocoa, and whole grains during the second trimester of pregnancy. What is the rationale for this instruction? The patient has: A. A diet that is low in zinc. B. A low intake of vitamin A. C. A low intake of magnesium. D. Decreased vitamin D intake.

C (A diet containing nuts, legumes, cocoa, and whole grains is suggested for a pregnant patient to improve the levels of magnesium. Magnesium is essential for energy metabolism, tissue growth, and muscle action. Thus the most appropriate reason for adding these in the diet is to eliminate the risk for magnesium deficiency. Nuts, legumes, cocoa, and whole grains are not rich sources of zinc, vitamin A, or vitamin D. Food sources high in zinc are liver, shellfish, meat, whole grains, and milk. Food sources containing vitamin A are dark green leafy vegetables, liver, fruits, fortified margarine, and butter. Foods rich in vitamin D are fortified milk, cereals, oily fish, butter, and liver.)

With regard to weight gain during pregnancy, the nurse should be aware of which important information? A. In pregnancy, the woman's height is not a factor in determining her target weight. B. Obese women may have their health concerns, but their risk of giving birth to a child with major congenital defects is the same as with women of normal weight. C. Women with inadequate weight gain have an increased risk of delivering a preterm infant with intrauterine growth restriction (IUGR). D. Greater than expected weight gain during pregnancy is almost always attributable to old-fashioned overeating.

C (IUGR is associated with women with inadequate weight gain. The primary factor in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. Obese women are twice as likely as women of normal weight to give birth to a child with major congenital defects. Overeating is only one of several likely causes.)

Which minerals and vitamins are usually recommended as a supplement in a pregnant client's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C (Iron should generally be supplemented, and folic acid supplements are often needed because folate is so important in pregnancy. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C is sometimes naturally consumed in excess; vitamin B6 is prescribed only if the woman has a very poor diet; and zinc is sometimes supplemented. Most women get enough calcium.)

If a client's normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy? A. 5 B. 10 C. 25 D. 30

C (The recommended intake of protein for the pregnant woman is 70 g. Therefore, additional protein intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A protein intake of 30 g is more than would be necessary and would add extra calories.)

A client states that she does not drink milk. Which foods should the nurse encourage this woman to consume in greater amounts to increase her calcium intake? A. Fresh apricots B. Canned clams C. Spaghetti with meat sauce D. Canned sardines

D (Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.)

The nurse is providing dietary education to a patient who is 4 months pregnant. Which diet should the nurse suggest to the patient for proper neural development of the fetus? A. Nuts, beans and legumes, cocoa, meats, and whole grains B. Iodized salt, milk and milk products, yeast breads, and rolls C. Citrus fruits, broccoli, melons, strawberries, and tomatoes D. Asparagus, eggs, fortified cereals, and green leafy vegetables

D (A diet rich in vitamin B12 and folic acid is essential for proper neural development of the fetus during pregnancy. Asparagus, fortified cereals, and green leafy vegetables are rich sources of folic acid, and eggs are rich in vitamin B12. Therefore a diet containing these foods is most advisable for the patient to ensure proper neural development of the fetus. Nuts, beans and legumes, cocoa, meats, and whole grains are rich sources of magnesium. Iodized salt, milk and milk products, yeast breads, and rolls contain iodine. Citrus fruits, broccoli, melons, strawberries, and tomatoes are rich sources of vitamin C. Magnesium, iodine, and vitamin C do not affect the neural development of the fetus.)

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant. Which guidance should she expect to receive? A. "Discontinue all contraception now." B. "Lose weight so that you can gain more during pregnancy." C. "You may take any medications you have been regularly taking." D. "Make sure you include adequate folic acid in your diet."

D (A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A woman's folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception that she has been using, discontinuing all contraception at this time may not be appropriate. Advising this client to lose weight now so that she can gain more during pregnancy is also not appropriate advice. Depending on the type of medications the woman is taking, continuing to take them regularly may not be appropriate.)

Which vitamins or minerals may lead to congenital malformations of the fetus if taken in excess by the mother? A. Zinc B. Vitamin D C. Folic acid D. Vitamin A

D (If taken in excess, vitamin A causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy. Zinc, vitamin D, and folic acid are all vital to good maternity and fetal health and are highly unlikely to be consumed in excess.)

Calcium is needed for?

bone and teeth formation

Sources of calcium

dairy products

sources of magnesium

dairy products, nuts, whole grains, and green leafy veggies

Magnesium can help with?

decreasing blood pressure

What kind of fish can pregnant women eat? and how much?

eat as much as 12oz per week of commercially caught fish and shellfish low in mercury like shrimp, salmon, pollock, catfish, and canned light tuna

potassium reduces the risk of?

hypertension

A pregnant woman is considered anemic when?

if the HGB is less than 11g/dl if HCT is less than 33% during first or third trimester or if the HGB is less than 10.5g/dl if HCT is less than 32% during second trimester

does the need for sodium increase or decrease during pregnancy?

increases slightly due to body water expanding (ex: expanding blood volume)

what allows adequate transfer of iron to the fetus and to permit expansion of the maternal red blood cell mass?

iron

Vitamin E

needed for protection against oxidative stress (associated with preeclampsia) Sources: vegetable oils and nuts, green leafy veggies and whole grains

Vitamin A

needed so enough vitamins can be stored in the fetus sources: deep yellow, deep green veggies and fruits, leafy greens, broccoli, carrots, cantaloupe, and apricots warning** high amounts can lead to malformation of fetus (facial abnormalities, heart malformations, cleft palate, hydrocephalus, and deafness and blindness in the infant, and increase risk of miscarriage)

What kind of fish should a pregnant woman avoid? Why?

shark, swordfish, king mackerel and tilefish high levels of mercury

What is the main substance of cells, blood, lymph, amniotic fluid, and other vital body fluids?

water

difference between water soluble vitamins and fat soluble vitams?

water soluble vitamins do not pose a risk for toxicity since they are excreted through the urine