NCM105j-J
Divince O Ekstrom, RN MAN
NUTRITIONAL NEEDS DURING PREGNANCY
Protein requirement is increased by
20% for the pregnant woman
Over 25 and by 25% for the pregnant
adolescent
Proteins -tissue building, and protein-
rich foods are excellent sources of
many other essential nutrients,
especially iron, copper, zinc, and the
B vitamins.
Vitamin A - (more than 3,000 RE) has
been known to cause birth defects :
hydrocephaly , microcephaly , mental
retardation, ear and eye
abnormalities, cleft lip and palate,
and heart defects.
Vitamin K required is given as AI of 75
to 90 ųg depending upon age
Additional vitamin C - develop
collagen and to increase the
absorption of iron.
B vitamins - metabolism and
development of red blood cells
calcium, iron, zinc, iodine, and
selenium are all increased during
pregnancy.
–Calcium - infant’s bones and teeth as
well as for blood clotting, muscle action
–Mother not consuming adequate
calcium -baby will get its calcium from
her bones
iron increases - increased blood
volume, fetus increases its
hemoglobin level
MODULE 8
Prepared by: F. Baddong
FULFILLMENT OF NUTRITIONAL NEEDS DURING
PREGNANCY
To meet the nutritional requirements
of pregnancy, the woman should base
her diet on MyPyramid
Special care should be taken in the
selection of food so that the
necessary calories are provided by
nutrient-dense foods.
Drinking additional milk -protein,
calcium, phosphorus, thiamine,
riboflavin, and niacin.
Fat-free milk - no fat & provides 90
calories per 8-ounce serving = better
choice
Prenatal vitamin supplement in
addition to an iron supplement.
Not advisable - unprescribed nutrient
supplement, as an excess of vitamins
or minerals can be toxic to mother
and infant
Unusual cravings for certain foods
during pregnancy do no harm unless
eating them interferes with the
normal balanced diet or causes
excessive weight gain
 NCM105j-J MODULE 8
Divince O Ekstrom, RN MAN Prepared by: F. Baddong

Excessive Weight Gain

Eliminate foods that do not fit within

MyPyramid
–candy, cookies, rich desserts, chips,
salad dressings (other than fat free),
sweetened beverages.
Drink fat-free milk- proteins, vitamins,
minerals.
A bowl of clean, crisp, raw
vegetables such as broccoli or
cauliflower tips, carrots, celery,
CONCERNS DURING PREGNANCY
cucumber, zucchini sticks, or radishes

Nausea - morning sickness

dipped in a fat-free salad dressing or
Eat dry crackers or dry toast before
salsa
rising
Fruits and custards made with fat-free
Eat small, frequent meals
milk not high in calories.
Avoid foods with offensive odors
Broiling, baking, or boiling foods
Avoid liquids at mealtime.
instead of frying
Hyperemesis gravidarum = parenteral
nutrition
Pregnancy-Induced Hypertension

toxemia or preeclampsia - third

Constipation and hemorrhoids - eating
trimester.
high-fiber foods, getting daily
high blood pressure, presence of
exercise, drinking at least 8 glasses
albumin in urine (proteinuria), edema
of liquid each day, and responding
edema = sudden increase in weight.
immediately to the urge to defecate.
eclamptic (convulsive) stage,
convulsions, coma, and death of
Heartburn - relaxation of the cardiac
mother and child may occur.
sphincter and smooth muscles related
cause of this = not known,
to progesterone.
common
Fetus grows, it pushes on the mother’s
–first-time pregnancies
stomach
–multifetal pregnancies
Eating small, frequent meals; avoiding
–morbid obesity
spicy, greasy foods; liquids with
–inadequate diets - protein-deficient
meals; waiting at least an hour after
diets.
eating before lying down; and waiting
–Pregnant adolescents have a higher
at least 2 hours before exercising.
rate of PIH
 NCM105j-J MODULE 8
Divince O Ekstrom, RN MAN Prepared by: F. Baddong

As a nurse, what would you include in Alcohol, Caffeine, Drugs, and Tobacco
your health teaching, so that the patient

Alcohol consumption is associated

diagnosed with PIH will be able to with subnormal physical and mental
maintain a normal blood pressure? development of the fetus = fetal
alcohol syndrome (FAS).
Pica –premature and have a low birth weight

Craving for nonfood substances – small head, short eye slits that make

Most common among pregnant women eyes appear to be set far apart, a flat

Some believe it relieves nausea. midface, and a thin upper lip, growth

Others think the practice is based on deficiency

cultural heritage.
Consumption of soil should be highly
discouraged
If any of the nonfood substances
replaces nutrient rich foods in the
diet, this will result in multiple
nutrient deficiencies.

Anemia

insufficiency of red blood cells,

hemoglobin, or blood volume A woman who is 2 months pregnant, is experiencing

does not receive sufficient oxygen morning sickness often. As a nurse, how do you
intend to manage this case?
weak and tired, poor appetite, and

appears pale.
NUTRITIONAL REQUIREMENTS: INFANTS
Iron deficiency - most common form-
F i r s t y e a r o f l i f e = d
o u b l e s b i r t h
daily iron supplement

weight by 6 months of age and triples

Folate deficiency can result in a form
it within the first year.
of megaloblastic anemia
infant’s energy, vitamin, mineral, and
Too few red blood cells and by large
protein requirements are higher per
immature red blood cells. The body’s
unit of body weight than those of
requirement for folic acid increases
older children or adults
dramatically when new red blood
98 to 108 calories per kilogram of
cells are being formed=folate
body weight/day
supplement
Low-birth-weight infants= more than
the normal number of calories per
kilogram of body weight.
 NCM105j-J
Divince O Ekstrom, RN MAN
Breast milk or formula= proteins, fats,
carbohydrates, vitamins, minerals,
water
Up to 6 months of age = 2.2 grams of
protein per kilogram of weight each
day
6 to 12 months = 1.56 grams of protein
per kilogram of weight each day
More water per pound of body weight
than do adults
Essential vitamins and minerals can be
supplied in breast milk, formula, and
food.
Born with a 3- to 6-month supply of
iron
6 months of age- iron-fortified cereal
Vitamin D supplement for infants who
are nursed and who are not exposed
to sunlight on a regular basis.
Newborns lack intestinal bacteria to
synthesize vitamin K, so they are
routinely given a vitamin K
supplement shortly after birth
Vitamin A can damage the liver and
cause bone abnormalities
Vitamin D can damage the
cardiovascular system and kidneys
BREASTFEEDING
temporary immunity to many infectious
diseases
economical, nutritionally perfect
saves time
sterile
easy to digest
no gastrointestinal disturbances or
allergic reactions
fewer infections (especially ear
infections)
MODULE 8
Prepared by: F. Baddong
contains less protein and minerals
=reduces the load on the infant’s
kidneys
promotes oral motor development in
infants and decreases the infant’s risk
of obesity and diabetes
first several weeks of life the infant
will nurse approximately every 2–4
hours. The frequency of nursing
sessions will decrease.
recommended that an infant nurse at
each breast for approximately 10 to 15
minutes each session.
growth spurts occur at about 10 days,
2 weeks, 6 weeks, and 3 months.
Sufficient Nutrients and Calories from
Breastfeeding
(1) there are six or more wet diapers a
day
(2) there is normal growth
(3) there are one or two mustard-colored
bowel movements a day
(4) the breast becomes less full during
nursing
bonding
uterus return to normal size, controls
postpartum bleeding, return to pre-
pregnancy weight
 NCM105j-J
Divince O Ekstrom, RN MAN
BOTTLE FEEDING
Cuddled and held in a semi-upright
position during ;less inclined to
develop middle ear infections than
those fed lying down
Burped to release gas in the
stomach; regurgitation
Formulas = based on cow’s milk but
must be modified because it has more
protein and mineral salts and less milk
sugar (lactose)
Sensitive or allergic to infant formula
=Synthetic milk from soybeans
Too little water =too heavy a protein
and mineral load for the infant’s
kidneys.
Too much water =dilute the nutrient
and calorie value so that the infant
will not thrive = brain edema or
seizures
Regular cow’s milk - protein is more
difficult and slower to digest
*gastrointestinal blood loss
*kidneys are challenged by its high
protein and mineral content
What information would you give to a pregnant
woman who is considering breastfeeding her infant
but isn't quite sure why she should?
Wary of foods covered by sauce or
gravy
Can have food jags
MODULE 8
Prepared by: F. Baddong
CHILDREN AGES 1 TO 12
Eating habits develop during childhood
= difficult to change = irritability,
depression, anxiety, fatigue, illness
learn partly by imitation
Nutritious foods should be available at
snack time as well as at mealtime
Appetites vary
Rate of growth is not
constant=children’s attention is
increasingly focused on their
environment rather than their stomach
Appetites and interest in food
commonly decrease during the early
years
A 2-year-old child’s statement “No!” is
his or her way of saying “Let me
decide!”
New foods-introduced gradually, small
amounts, as attractively as possible
Allowing to assist in purchasing and
preparing a new food
Snacks - not fat-laden
Whole milk is recommended until the
age of 2
Not salt their food at the table
Sensitive to and reject hot
(temperature) foods, but they like crisp
textures, mild flavors, and familiar
foods.
Choking in young children = peanuts,
grapes, hotdogs, raw carrots, hard
candy, or thick peanut butter
Snack every 2 to 3 hours for continued
energy finger foods for snacks. Cheese,
fruit, milk, unsweetened cereals
•Mealtime should be pleasant= chronic
 NCM105j-J MODULE 8
Divince O Ekstrom, RN MAN Prepared by: F. Baddong

Food Habits: Adolescents

Mealtime should be pleasant= chronic
Boys - enormous appetites
overeating, anorexia nervosa, or
E a t i n g h a b i t s h a v e
b e e n e s t a b l i s h e d
bulimia
d u r i n g c h i l d h o o d =
n o s e r i o u s p r o b l e m
Rate of growth diminishes = age 1 - 10
Adolescents are imitators = peers and
years
do what is popular
Ex. 6 months = needs about 54
Busy schedules, part-time jobs,
calories per pound of body weight
athletics, social activities, and the lack
10 years = 35 calories per pound of
of an available adult to prepare
body weight
nutritious food
6 months to 10 years= nutrient needs
Inform her or him of nutritional needs
actually increase due to increase in
and of the poor nutrition quality of the
body size
foods she or he is eating = desire for
A variety of foods = offered some
independence and may resent being
choices = psychosocial development
told what to do
Young child will need 2 to 3 cups of
Check her or his food choices for
low-fat or fat-free milk each day
nutrient content
Sweets should be minimized
Calorie requirements increase
Drink 1 ml of water for each calorie
Greater than girls’ because boys are
Fiber needs are calculated according
generally bigger, tend to be more
to age.
physically active, and have more lean
muscle mass than do girls.
Except for vitamin D, nutrient needs
increase
menstruation = iron
The DRIs for vitamin D, vitamin C,
vitamin B12, calcium, phosphorus, and
iodine are the same for both sexes. The
DRIs for the remaining nutrients are
higher for boys than they are for girls

SPECIAL CONSIDERATIONS FOR THE

ADOLESCENT RELATED TO NUTRITION
CONCERNS:
Adolescence is a stressful time for most young
A mother of a 2-year old is having difficulty people.
ensuring the nutrition of her child. The little boy is -numerous physical changes
very mobile and always says “NO” when being asked -an innate need for independence
to sit down and eat his food. What advice can you -increased work and extracurricular demands at
give to the mother? school

-social and sexual pressures

 NCM105j-J MODULE 8
Divince O Ekstrom, RN MAN Prepared by: F. Baddong

Anorexia Nervosa Camille weighs 98 lb. Compute her protein

psychological disorder more common requirement following the format given on the

to women than men

previous slide.

Solution:

drastically reduce calories, causing

altered metabolism, which results in 98 lb ÷ 2.2 = 44.54

hair loss, 44.54 x .08 = 35.63 grams of protein

low blood pressure, weakness,

amenorrhea, brain damage, and even CALORIE REQUIREMENTS

death Begin to diminish after the age of 25, as

has an inordinate fear of being fat. basal metabolism rates decrease.
demanding parents perceive this as After 25 years, a person will gain
their only means of control. weight if the total calories are not
resemble slim fashion models and reduced according to actual need,
have a distorted body image which will be determined by activity,
perfectionistic overachievers who BMI , and amount of lean muscle mass.
want to control their body-pleases Those who are more active will require
them to deny themselves food when more calories than those who are less
they are hungry active.
Late Adulthood
What are some of the factors that could affect
NUTRITIONAL REQUIREMENTS
the nutritional health of an adolescent?
Good nutrition can
speed recovery from

NUTRITIONAL REQUIREMENTS: ADULT

i l l n e s s , s u r g e r y , o r
b r o k e n b o n e s a n d
G r o w t h i s u s u a l l y
c o m p l e t e b y t h e generally can improve the spirits and
age of 25
the quality and even the length of life

Iron requirement for women Protein requirement remains at the

(childbearing years) higher than for
men
Protein needs for healthy adults are
thought to be 0.8 gram per kilogram
of body weight
To determine the specific amount,
one must divide the weight in
pounds by 2.2 to obtain the weight
in kilograms and then multiply the
weight in kilograms by 0.8.
Calcium and vitamin D are essential
for strong bones, found in milk
Bone loss begins slowly, at about the
age of 35 to 40
3 glasses of milk a day
average 50 grams per day for women
and 63 grams for men.
After age 65, it may be advisable to
increase one’s daily protein intake to
1.0 gram per kilogram of body weight.
Vitamin requirements do not change
after the age of 51, except for a slight
decrease in the DRIs for thiamine,
riboflavin, and niacin.
Calorie requirement is reduced after the
age of 51
Calorie requirement decreases
approximately 1% to 2% because
metabolism slows and activity is
reduced.
 NCM105j-J MODULE 8
Divince O Ekstrom, RN MAN Prepared by: F. Baddong

FOOD HABITS
Anorexia
Dementia and Alzheimer’s
Studies: senior citizens consume diets
deficient in protein; vitamins C, D, B6,
B12, and folate; and the minerals
calcium, zinc, iron, and sometimes
calories
If the client consumes less that 1,500
calories a day, a multivitamin-mineral
supplement is recommended.
Water
Elderly people who have long hospital
stays can develop PEM in the hospital.
Teeth can make eating protein foods
difficult
If overweight is a problem

FOOD FADS

Senior citizens spend money on

unnecessary vitamins, minerals, and
s p e c i a l h o n e y , m
o l a s s e s , b r e a d , m i l k ,
a n d o t h e r f o o d s t
h a t m a y b e
guaranteed by the salesperson to
prevent or cure various diseases.

APPROPRIATE DIETS
Hot meals at noon in senior centers
across the country
Social clubs and are immensely
beneficial to the elderly
rovides transportation for those who are
otherwise unable to reach the senior
center for the meal.
When individuals are completely
homebound = Meals-on-Wheels projects
Participating people pay according to
ability. In addition, food stamps are
available and can sometimes be used
for the Meals-on-Wheels programs.