Community Health Nursing 1 - Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 16

LESSON TITLE: Maternal, Newborn and Child Health and Materials:

Nutrition
Pen, paper, index card, book, and class List
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
Reference:
1. Determine the proper nutrition at various life-cycle; and,
2. Applying knowledge of proper nutrient functions, food Famorca, Z. U., Nies, M. A., & McEwen, M. (2013).
sources to maternal, newborn & child. Nursing Care of the Community. Elsevier
Gezondheidszorg.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Enumerate the dimensions of evaluation and explain each briefly.
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MAIN LESSON (30 minutes)

Nutrition may be defined as the science of food and its relationship to health and concerned primarily with the part played by nutrients
in body growth, development and maintenance

Nutritional status is the current body status, of a person or a population group, related to their state of nourishment (the
consumption and utilization of nutrients).

A. Nutritional Requirement During Pregnancy

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Concerns for Maternal Nutrition and Weight Do Not End at Delivery
 Nutrition after delivery
 If breastfeeding, still consume additional calories (500 kcal/day)
 Vitamin supplements if deficiencies noted
 Weight after delivery
 Up to 75% of women weigh more than their pre-pregnancy weight at one year postpartum
 Postpartum weight retention
❏ Increases the risk for adverse outcomes in future pregnancies
❏ Influences a woman’s long-term health by increasing risk for developing other conditions such as hypertension and
diabetes.

B. Newborn Nutritional Requirement

Schedules of Newborn Feeding:

A. First feeding.
 May be breastfed immediately following delivery (colostrum is not irritating if aspirated and is absorbed by the
respiratory system).
 Feed in the first hour of life.
 Latest to start feeding is 2–3 hours (when normal low blood sugar occurs).
 First feeding—many facilities give sterile water, a few swallows to half ounce to evaluate feeding capability. (Glucose water
no longer recommended for first feeding due to danger of aspiration pneumonia.)
 Give full-strength formula or breast milk as soon as newborn shows an interest.

B. Subsequent feeding.
 Routine schedule: 2- to 4-hour feedings.
 Self-demand: Baby is fed according to needs, when hungry, usually every 3–4 hours. (Breastfeeding may be 1½–
3 hours.)
 Calories and Fluid Needs

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A. Fluid: 140–160 mL/kg of body weight in 24 hours.
 Fluid needs are high because the newborn is unable to concentrate urine.
 More fluids should be given in hot weather or when the baby has an elevated temperature.
B. Energy
 Healthy term babies grow well with intake of 90-120 kcal/kg/D 125 - 140 kcal/kg/D
C. Protein
 Recommended allowance:15-20 % of daily calories
D. Fat
 Recommended daily intake:
 30-40% for term
 Fat intake of 9 kcal/g triglycerides
 Infancy: 30-50% of total kcal
E. Carbohydrates
 Carbohydrate constitutes 40-50% of total daily calories
 Almost all the CHO in the human milk and infant formula is lactose
F. Minerals
 Accretion of Ca, Phosphorus, Mg and iron is maximal at the third trimester of pregnancy.
G. Supplements
1. Vitamin K: All infants receive at birth
2. Vitamin D: Breastfed infants or infants who take <500 ml/day of vit. D fortified formula
3. Iron: Breastfed infants
 Fe absorption is good from human milk, but concentration is low.
4. Fluoride: May be dependent on water supply

C. Child Nutritional Requirement. Nutritional status of children during the critical period is of paramount importance for later
physical, mental & social development.

Outcomes of inadequate diet:

➢ Poor muscle development
➢ Reduced work capacity
➢ Poor social development
➢ High rates of illness

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 ➢ Difficulty in school

Nutrient 0-6 month 7-12 month 1-5 years

K-Calorie 120 100 1000-1500

Protein 2.3-1.8 gm/kg 1.8-1.5gm/kg 17-22gm

Calcium (Ca) 0.5-0.6 mg 0.5-0.6mg 0.4-0.5mg

Iron (Fe) 6mg 10mg 15-20mg

Vit A 400mg 300mg 250-300mg

Thiamine (B1) 0.3mg 0.3mg 0.6-0.8mg

Riboflavin(b2) 0.4mg 0.4mg 0.7-0.8mg

Vit C 30mg 30mg 30-40mg

Folic acid 35mg 25mg 50-100mg

Complementary Feeding
 Means complementing solid/semi-solid food with breast milk after child attains age of six months.
 It should be timely,
 Adequate, safe
 Should be prepared with locally available food

Purpose:
 After the age of 6 months, child is ready to start eating semi-solid food •
 Breast milk alone is no longer enough for the baby’s nutritional needs
 Breastfeeding must continue along with complementary feeding

What Type of Food Should be Given?

 7. ≥ 4 food groups
 Grains, roots and tubers
 Legumes and nuts
 Dairy products (milk, yogurt, cheese)
 Flesh foods (meat, fish, poultry and liver/organ meats)
 Eggs
 Vitamin-A rich fruits and vegetables
 other fruits and vegetables

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and
another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 20 minutes
for this activity:

Multiple Choice

1. Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet?
a. Fat-soluble vitamins A and D
b. Water-soluble vitamins C and B6
c. Iron and folate
d. Calcium and zinc
ANSWER: _ _

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2. With regard to nutritional needs during lactation, a maternity nurse should be aware that:
a. The mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy.
b. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.
c. Critical iron and folic acid levels must be maintained.
d. Lactating women can go back to their prepregnant calorie intake
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3. When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that:
a. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron.
b. Iron absorption is inhibited by a diet rich in vitamin C.
c. Iron supplements are permissible for children in small doses.
d. Constipation is common with iron supplements.
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4. Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? Select all that apply.
a. Underweight women should gain 12.5 to 18 kg.
b. Obese women should gain at least 7 to 11.5 kg.
c. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale.
d. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.
e. Normal weight women should gain 11.5 to 16 kg.
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5. The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement
would indicate that the mother needs additional teaching?
a. "I can store my breast milk in the refrigerator for 3 months."
b. "I can store my breast milk in the freezer for 3 months."
c. "I can store my breast milk at room temperature for 8 hours."
d. "I can store my breast milk in the refrigerator for 3 to 5 days."
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6. With regard to the nutrient needs of breastfed and formula-fed infants, nurses should understand that:
a. Breastfed infants need extra water in hot climates.
b. During the first 3 months breastfed infants consumes more energy than do formula -fed infants.
c. Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months.
d. Vitamin K injections at birth are not needed for infants fed on specially enriched formula.
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7. All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital
Initiative endorsed by WHO and UNICEF was founded to encourage institutions to offer optimal levels of care for lactating mothers.
Which instruction is not included in the "Ten Steps to Successful Breastfeeding for Hospitals"?

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a. Give newborns no food or drink other than breast milk.
b. Have a written breastfeeding policy that is communicated to all staff.
c. Help mothers initiate breastfeeding within one half hour of birth.
d. Give artificial teats or pacifiers as necessary.
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8. Nutrition is an alterable and important preventive measure for a variety of potential problems such as low birth weight and
prematurity. While completing the physical assessment of the pregnant client, the nurse is able to evaluate the client's nutritional status
by observing a number of physical signs. Which physical sign indicates to the nurse that the client has unmet nutritional needs?
a. Normal heart rate, rhythm, and blood pressure
b. Bright, clear, and shiny eyes
c. Alert and responsive with good endurance
d. Edema, tender calves, and tingling
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9. What are the breast milk composition? Select that all apply
a. Triglycerides
b. Lactose
c. Whey proteins
d. Vitamins, Minerals, and Trace Elements
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10. What deficiencies to be aware of during the complementary feeding stage?

a. Vitamin A and iron
b. A
c. E
d. Vit D
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)

The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the
correct answer and correct/additional ratio in the space provided.

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3. ANSWER: _ _

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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track
how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.
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AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. Record three things you learned from the lesson.
3. Next, two things that you found interesting and that you’d like to learn more about.
4. Then, record one question you still have about the lesson.

Three things you learned:

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Two things that you’d like to learn more about:

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One question you still have:

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