Care of Mother and Child At-Risk or

with Problems (Acute and Chronic)-RLE

Module #19 Student Activity Sheet

Name: Class number:

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Section: ____________ Schedule: Date:

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Lesson Title: Nutrition and Diet Therapies Materials:

SAS, OB book, pens
Learning Targets:
At the end of the module, students will be able to: Reference:
1. Define the recommendations for complementary and
alternative therapies that could be use during labor Pilliteri, Adele and Silbert-Flagg, JoAnne
and delivery. (2018) Maternal and Child Health
Nursing, 8th Edition. USA: Lippincott
2. Integrate the knowledge of recommendations for
Williams and Wilkins
complementary and alternative therapies that could be
use during labor and delivery and describe specific
management on these recommendations in
formulating nursing care plan in giving quality maternal
and child health nursing care.

A. LESSON REVIEW/PREVIEW

B. MAIN LESSON
Please refer to Chapter 13: The Nursing Role in Promoting Nutritional Health During Pregnancy-Promoting Nutritional
Health During Pregnancy p. 294 and Women with Unique Needs p.299

FAMILY CONSIDERATIONS FINANCIAL CONSIDERATIONS

 Meal planning is best if it involves the
entire family because even if a woman is
receptive to changing her eating habits,
she may have difficulty carrying out
recommendations if her family resists the
change.
 In families where a member has a special
nutritional need, such as restricted
sodium, change may be even more
difficult.
 You may need to speak with the person
who prepares meals for a pregnant
 Women generally view this increased
expense as an investment in their child’s
health and do not regard it as a burden.
 A woman on a marginal income,
however, although she understands the
importance of this, may have difficulty
actually doing it.
 If this occurs, review what foods the
woman is eating to be certain she is not
filling her plate with less expensive
starchy foods, such as pasta, in
preference to higher protein foods such

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 Care of Mother and Child At-Risk or
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Module #19 Student Activity Sheet

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adolescent as well as the adolescent to as meat

be certain recommended changes will be
carried out.
 For the pregnant woman, foods typically
offered by the program include those with
high-quality protein, iron, calcium, and
vitamins A and C, such as fresh fruits and
vegetables, eggs, milk, legumes, whole
grain cereals and breads, and canned
fish.
 Vegetarian families or those with allergies
can receive tofu and soy-based
beverages or foods

CULTURAL CONSIDERATIONS
 When helping plan nutrition during pregnancy, try to suggest foods that are individually or
culturally favored, as these are the foods women tend to enjoy most and so will eat most
consistently.
 “Americanized” women may prepare few foods from their ethnic background because their
spouse or significant other is of a contrasting culture with differing preferences.

Group and Staple Foods Common Customs

Place of
Origin
Hispanic Steamed white rice; many
Americans varieties of beans; starchy
from Puerto vegetables, such as
Rico cassavas or yams; salted
fish or pork; sugared fruit
juices; cafe con leche
(coffee and hot milk)
Hispanic Many varieties of beans;
Americans steamed rice; corn products
from Mexico, such as tortillas; chili
Central peppers, fresh fruit,
Milk is rarely consumed as a
beverage. Most foods are
cooked for long periods of
time or fried. Malt beer is
believed to be nutritious and
may be given to children and
breastfeeding mothers.
Most vegetables are cooked
for a long time so they lose
most of their nutritional
value. Diet is high in fiber

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America potatoes; meat; fish; poultry;
eggs; milk cheeses; milk
custards and bread
puddings
Hispanic Stews and casseroles; soup is
Americans served daily; fried foods,
from Cuba especially fish, poultry, and
eggs; rice; many varieties of
beans
Southern Hominy grits; biscuits; corn
African bread; rice; legumes; sweet
Americans potatoes; okra; green leafy
from West vegetables cooked in salt
Africa pork; pork, poultry, and fish;
thick stews; bread puddings;
pies and sweets
Chinese Rice; wheat noodles; many
Americans seasonal cooked vegetables
(diets vary and fruits; various shoots;
sometimes soybean products such as
with region) tofu, soy sauces, and soy
milk; small portions of meat,
fish, poultry, and seafood
Japanese Rice; vegetables; tofu, bean
Americans paste, and soy sauce; fruits;
salads; fish, green tea; milk
is rarely used by adults
Vietnamese Rice, rice noodles; curries of
Americans asparagus and potatoes;
salads; tropical fruits and
vegetables; small portions of
poultry; eggs; fish; nuoc
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and starch. Animal fat is
frequently added during food
preparation. Diet may be
inadequate in calcium, iron,
vitamin A, and vitamin C.
Fruits and vegetables are not
eaten on a regular basis.
Main meal is usually served
at lunch.
African American food patterns
are similar to Caucasians in
same region. Northern
African Americans may be
unfamiliar with “soul food.”
Frying is common; diet tends
to be high in fat and salt, low
in calcium.
Yin (feminine)–yang
(masculine) concept of
balancing intake; moderation
is valued. Diet is high in fiber
and many nutrients, is low in
fat, and may be low in
protein.
Foods are broiled, steamed,
boiled, and stir fried. Meat
portions are small. Diet is
low in fat, rich in nutrients,
high in sodium.
Rice may be eaten at every
meal. Lactose intolerance is
common. Little fat is used in
preparation. Diet may be low
in iron and calcium.
 Care of Mother and Child At-Risk or
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Module #19 Student Activity Sheet

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mam (a strong, fermented

fish sauce)
Native Southeast: corn; cornmeal; Food has great religious and
Americans coontie (flour from a social significance. Corn is a
palmlike plant); fried breads; status food for most tribes.
vegetables; alligator, snake, Milk is seldom used; calcium
wild hog, duck, fish, and intake may be low.
shellfish; Northeast: many
berries, beans; corn;
pumpkins; fish, lobster, and
wild game; Midwest: bison;
beans; corn; fruits and
vegetables; Southwest:
corn, beans, squash,
pumpkins, chili peppers,
melons, cactus; Northwest:
salmon, other fish, bear, elk,
wild fruits, nuts, wild greens.
MANAGING COMMON PROBLEMS AFFECTING NUTRITIONAL HEALTH
Specific nutrition problems may result from a 2. Cravings
number of factors or circumstances during Cravings for food or aversions to certain foods
pregnancy. during pregnancy are so common they are
1. Nausea and Vomiting considered a normal part of adaptation to
As many as three fourths of pregnant women pregnancy.
report nausea and vomiting in early pregnancy.  When taking a nutrition history, ask if a
No definite cause has been established for this woman notices any particular cravings.
symptom of early pregnancy, but it may be
related to:  As long as this is a healthy type of food,
help her plan an intake that includes the
 Sensitivity to the high level of chorionic
food, at least in moderation, to help her
gonadotropin hormone produced by the
enjoy her pregnancy without feeling
trophoblast cells
guilty.
 High estrogen or progesterone levels
 Some women report a craving for foods
 Lowered maternal blood sugar caused by such as oranges or chocolate.

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the needs of the developing embryo
 Lack of pyridoxine (vitamin B6)
 Diminished gastric motility
MANAGEMENT
 The traditional solution for preventing
nausea is for women to keep dry
crackers, such as saltines, by their
bedside and eat a few before rising
because increasing carbohydrate intake
seems to relieve nausea better than any
other nutrition remedy. Sucking on sour
candies may serve the same purpose.
 A woman may then eat a light breakfast
or delay breakfast until 10 AM or 11 AM,
or past the time her nausea seems to
persist.
 To be certain she maintains good food
intake during pregnancy even in the face
of nausea, urge her to be certain to
compensate for any missed meals later in
the day.
If preparing food for others makes her
feel queasy, she might try to give this
responsibility to another family member,
at least through the worst phase of this
symptom.
 Preparing and freezing meals ahead of
time, perhaps at night when the nausea is
less bothersome, may also help.
 Other therapy such as acupressure, anti–
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 Others, however, crave a nonfood
substance (termed pica, from the Latin for
magpie, a bird that is an indiscriminate
eater).
 The most common form of pica in the
past was a craving for laundry starch.
 Today, women are more apt to report
cravings for clay, dirt, cornstarch, or ice
cubes
MANAGEMENT
 Always ask women at prenatal visits if
they crave any nonfood items, as most
women do not supply this information
unless asked directly.
 They worry you will find their behavior
odd, or they may not realize their habit is
pregnancy related as much as being a
nervous habit.
 Stopping the woman from eating the
nonfood substance may be difficult
because the habit may be deeply
ingrained.
 Because pica is a symptom that often
accompanies iron-deficiency anemia,
suggest that her primary care provider
assess her serum iron levels as
correcting this underlying problem with an
iron supplement may correct the pica.
 At subsequent visits, be certain to assess
if a woman’s hemoglobin is increasing
 Care of Mother and Child At-Risk or
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Module #19 Student Activity Sheet

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motion sickness wrist bands, and and ask if she has noticed any difference
avoiding fluid with meals are other in her cravings.
measures effective for many women.
 It is a good rule for women not to go
longer than 3 to 4 hours between meals
during pregnancy to prevent
hypoglycemia.
 To prevent this from happening, women
may need to eat a snack before bedtime
to compensate for a late breakfast. Some
women are able to tolerate fruit and raw
vegetables during the morning before
other food.
 Urge a woman to experiment with soups
or vegetable drinks she may not usually
think of as breakfast foods but that can
give her early-morning calories.
3. Diminished Gastric Mobility 4.Pyrosis
 As peristalsis slows from the effect of  a burning sensation along the esophagus
progesterone and the weight of a growing caused by regurgitation of gastric
uterus presses against her bowel, contents into the lower esophagus.
constipation occurs in nearly 50% of
 In pregnancy, it may accompany early
pregnant women.
nausea; it may also persist beyond the
 Discuss preventive measures with resolution of nausea and even increase in
women early in pregnancy to help them severity as pregnancy advances.
avoid this problem.
 Pyrosis is probably caused by decreased
MANAGEMENT gastric motility (an effect of progesterone,
 Encourage them to evacuate their bowels which slows gastric emptying) as well as
regularly (many women neglect this first the effect of pressure from the expanding
simple rule); increase the amount of uterus pushing up against the stomach.
roughage in their diet by eating raw fruits,

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bran, and vegetables; and drink at least
eight 8-oz glasses of water daily.
 Some women find that prescribed oral
iron supplements contribute to
constipation. Because this supplement is
necessary to build fetal iron stores, help a
woman find a method to relieve or
prevent constipation other than omitting
taking the supplement.
 Women should not use mineral oil to
relieve constipation as it can prevent
absorption of fat-soluble vitamins A, D, E,
and K, vitamins necessary for both good
fetal and maternal health.
 Enemas also should be avoided because
their action might initiate labor.
 Over-the-counter laxatives are also
contraindicated, as are all nonessential
drugs during pregnancy, unless
specifically prescribed or sanctioned by a
woman’s primary healthcare provider.
 If dietary measures and attempts at
regular bowel evacuation fail, a stool
softener such as docusate sodium
(Colace) or evacuation suppositories
such as glycerin may be helpful.
 Some women have extensive flatulence
accompanying constipation. Recommend
avoiding gas-forming foods, such as
cabbage or beans, to help control this
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MANAGEMENT
 Eat small meals frequently rather than
large meals.
 Sleep on the left side with two pillows to
elevate the upper torso.
 Do not lie down immediately after eating;
try to wait at least 2 hours.
 Avoid fatty and fried foods, coffee,
carbonated beverages, tomato products,
and citrus juices.
 Aluminum hydroxide (Amphojel,
pregnancy class N or not classified) or a
combination of aluminum and magnesium
hydroxide (Maalox, class B) may be
prescribed for relief. If these do not
relieve the discomfort, an H2 receptor
antagonist such as cimetidine (Tagamet,
class B) or ranitidine (Zantac, class B)
may be prescribed.
 Be certain a woman understands this
“chest” pain is from her gastrointestinal
tract and, although it is called heartburn, it
has nothing to do with her heart.

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problem.
WOMEN WITH SPECIAL NEEDS
THE ADOLESCENT
 A pregnant adolescent needs a higher
caloric intake (2,400 calories per day)
than a mature woman to supply energy
because of the dual demand of
consuming enough food to provide for
fetal growth and for her own continuing
growth.
 The nutrients most often lacking from a
typical adolescent diet tend to be calcium,
iron, folic acid, and total calories.
 Look for sources of these when analyzing
a teenager’s pregnancy intake.
 An adolescent who is trying to hide an
unintended pregnancy may eat very little
to keep her abdomen from growing or eat
a lot hoping the overall weight she gains
will hide the size of her abdomen.
 She may have been on a diet before
pregnancy and want to continue this to
“not get fat.” Because she’s not meeting
nutritional needs with any of these eating
patterns, she runs a high risk of
developing anemia, which can lead to
fetal growth restriction and possibly
preterm birth
MANAGEMENT
 To help an adolescent plan nutritional
intake for pregnancy, respect her right to
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THE WOMAN OLDER THAN 40 YEARS OF
AGE
 The nutritional needs of women in this
age group are not well studied, but it is
obvious women in this age group should
maintain the same careful pregnancy
nutrition as younger women.
 women in this age group may have
slightly decreased kidney function, they
should be certain to maintain a high fluid
intake to remove waste products for
themselves and for their fetus.
MANAGEMENT
 They need adequate calcium to prevent
bone density loss.
 Many women at this point in life may also
be caring for elderly parents and/or have
delayed childbearing to establish a
career; this means they may eat whatever
they are preparing for elderly parents or
depend on packed or fast-food lunches
for at least part of their nutrition.
 Focus your nutrition counseling on
maintaining adequate nutrition during
pregnancy, based on these changing
lifestyles.
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reject traditional foods as long as what

she does eat includes sufficient nutrients.
A cheese and sausage pizza, a glass of
milk, and an apple compose a lunch that
provides all basic food groups (meat:
sausage; bread: pizza crust; vegetable:
tomato sauce; dairy: cheese and milk;
fruit: apple). A fish or hamburger taco
(fish or hamburger, salsa, sour cream,
and taco shell) plus a mango or tangerine
provides the same.
 You may need to speak to a parent or a
support person (with permission) who
does prepare foods to alter the
adolescent’s nutrition pattern.
 Encourage the food preparer to suggest
a number of foods that would fill a deficit
and let the adolescent choose from them
to provide a sense of control.
 Adolescents with eating disorders
(bulimia or anorexia nervosa) enter
pregnancy with major nutrient
deficiencies.
 It is important to identify these teens at
the first pregnancy visit so they can
receive close supervision and
supplementation of specific nutrients as
needed
THE WOMAN WITH STRESSFUL LIFESTYLE
 A stressful lifestyle can interfere with pregnancy nutrition as such women may simply have
too many other stresses in their lives to concentrate on eating healthy meals.

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 Examples of women who have this problem might be a busy executive trying to meet project
time lines; one taking care of an ill child, partner, or aging parents; or one who is homeless
or lacking enough money to purchase adequate food.
 Women who live in a situation with intimate partner violence may not have enough freedom
to select what foods they prepare or serve to include all food groups every day.
 A conscientious assessment of women at first prenatal visits (hopefully at preconception
visits) can help identify women in this group and provide the additional support they need to
achieve adequate nutrition and a safe pregnancy outcome.
THE WOMAN WITH NUTRITIONAL DEFICIENCIES
The Woman With Decreased Nutritional Stores
 A woman with high parity or a short interval between pregnancies or one who has been
dieting rigorously to lose weight before pregnancy may enter pregnancy with such
depleted nutritional reserves she has little to draw on during the first part of pregnancy.
 If her folic acid intake has been inadequate, her fetus is susceptible to neural tube defects
 Be alert for:
 Women from low-income families, who may enter pregnancy with anemia because they
haven’t been able to purchase iron-rich foods
 Women who used diuretics for a dieting program, who may be deficient in potassium as this
can be removed in urine by some diuretics
 Women who have been taking oral contraceptives, who may have decreased folate stores
 Women who were using intrauterine devices or who have menorrhagia (heavy menstrual
flow), who may be deficient in iron from excessive blood loss with menstrual flows
 Women who drink alcohol excessively, who may be deficient in thiamine
 Women with these decreased nutritional stores need to be identified early in pregnancy
through history taking so they can be referred to a nutritionist for specific nutritional
counseling.
 They may need additional supplements during pregnancy to help restore a particular nutrient

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 Care of Mother and Child At-Risk or
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The Woman Who Has Been Dieting or Following a Food Fad

 Women who have been dieting and those who have been following a food fad such as
eating nothing but cabbage soup are another group who may enter pregnancy with nutrient
deficiencies.
 Be certain to ask if a woman has been dieting at a first prenatal visit.
The Woman Who Eats Many Fast-Food Meals
 This means nutritional counseling for pregnancy must include helping women who rely on
packed lunches or fast-food meals to ingest adequate pregnancy nutrition.
 One big difficulty with fast-food restaurants is the limited choice of food available.
 This can cause a woman to grow tired of the same thing and either eat little or have little
choice but to eat foods with more empty calories than nutritionally effective ones.
 Unless there is a salad bar, the menu is apt to be particularly limited in fruits and vegetables.
MANAGEMENT
 It is helpful to advise her to carry an apple or other fruit to eat along with what she selects
from the menu to achieve a better food balance.
 A packed lunch poses few problems in pregnancy as long as a woman uses creativity in
preparation so she does not grow so tired of packed lunches that she reduces her noontime
intake or substitutes fast food in their place.
 Packing her lunch at bedtime rather than in the morning, when she may feel nauseated (and
therefore packs little because nothing looks good), is a good recommendation early in
pregnancy. Late in pregnancy, a woman may feel too tired at bedtime to do this and so could
change back to preparing it in the morning when she may have more energy.
 Including a thermos with a cream soup is a good way to add milk and calcium to her diet.
Packing sliced oranges or cucumbers, tomatoes, or apples helps to make a lunch nutritious
and also makes food available for a midmorning or midafternoon snack.
The Woman Who Cannot Obtain Culturally Preferred Foods
 a pregnant woman may find herself living in a community where grocery stores do not stock
the foods she is most comfortable eating.

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 If she lives in an apartment, she also has no opportunity to grow any favorites.
 This situation presents a good opportunity to discuss what she can find as substitutes.
 Fortunately, most major stores carry a wide range of ethnic foods.
 Support a woman’s efforts to speak to her grocery store manager to stock an item she
prefers as practice for motherhood when she will need to learn to serve as a strong
supporter or advocate for her child.
THE WOMAN WHO HAS HAD BARIATRIC THE WOMAN WHO IS VEGETARIAN
SURGERY  Some women are vegetarians because of
 Bariatric surgery is a weight-control religious guidelines or moral conviction.
method to reduce overeating by surgically
 Others turn to vegetarianism to both
reducing stomach size from about 30 to
maintain healthy nutrition and avoid
40 oz to 3 to 4 oz.
excess fat and food contaminants.
 For gastric bypass surgery, the smaller,
 Vegetarian diets are have been shown to
upper part of the stomach is stapled to
be protective in pregnancy.
separate it from the rest of the stomach,
thereby reducing the amount of food a
woman can eat.  Most women vegetarians are closer to
MANAGEMENT their ideal weight and have lower serum
cholesterol and blood pressure levels
 After surgery, all women are required to
than women who eat a more typical
maintain a conscientious diet of small but
American diet. Nurses may find many
healthy portions as well as to take daily a
pregnant women, therefore, who want to
chewable or liquid multivitamin
exclude meat from their intake.
supplement that includes iron, folate,
vitamin B12, vitamin A, vitamin B1  Vegetarians vary as to what they can eat:
(thiamine), and zinc.
 Lacto-ovo vegetarians eat no animal flesh
 Ask if women have been taking their or fish, but dairy products and eggs are
supplement to establish whether they are allowed.
entering pregnancy with vitamin deficits.
 Lacto-vegetarians eat no meat, fish, or
 Urge them to eat their protein source first eggs, but dairy products are allowed.
in a meal, so they are certain to ingest

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enough protein.
 If a woman does neglect eating a small
meal and eats a large one or one
extremely rich in calories (e.g., birthday
cake with butter cream frosting, ham with
buttered sweet potatoes), this can cause
a “dumping syndrome” or sudden
symptoms of nausea, bloating, and
diarrhea.
 Be certain to mark the chart of a woman
who has had bariatric surgery, so her
primary healthcare provider can decide if
a 50-g glucose tolerance test will be safe
or stimulate acute dumping symptoms.
 Because a woman who has undergone
bariatric surgery will have an overall small
intake during pregnancy, her weight gain
will be less than others; she is prone to
develop iron, protein, folic acid, and
vitamin B12 deficiencies.
 Women who have had a gastric bypass
are also prone to fat-soluble vitamin
(vitamins A, D, E, and K) deficiencies
because fat is no longer well absorbed.
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 Vegans eat nothing derived from an
animal, including butter and eggs.
 Semi-vegetarians usually restrict meat,
fish, and poultry.
 Macrobiotics eat whole grains such as
brown rice and vegetables; they avoid
meat, eggs, milk, and cheese.
 To replace meat, fish, and poultry at
meals, women need to eat three or more
servings a day of both fruits and
vegetables, six or more servings per day
of grains, and two or more servings per
day of legumes such as kidney, black, or
lima beans.
 Most vegetarians are knowledgeable
about nutrients needed and can discuss
what foods are high in various nutrients
and how they incorporate such foods into
their daily intake.
 Special concerns during pregnancy are
that vegetarians may lack vitamin B12
(meat is the chief source of this), an
adequate intake of calcium because milk
is a prime source of this (recommend
dark green vegetables or soy milk to
supplement this), and vitamin D (fortified
soy milk and sunlight are good sources of
this).
 Urge women who are vegetarians to
remember to take their daily prenatal
supplement, like all women, to ensure

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THE WOMAN WITH A MULTIPLE
PREGNANCY
 Twinning occurs naturally at about 4 in
every 1,000 births, but the increased use
of intrauterine fertilization has caused the
number of multiple births to increase to as
high as 15 per 1,000.
 A woman with a multiple pregnancy tends
to gain more weight overall and at a
faster pace than a woman carrying a
single child because of the increased fetal
weight.
MANAGEMENT
 woman with a multiple pregnancy must
ingest high levels of protein and
carbohydrate as well as iron and folic
acid.
 For this reason, a multiple pregnancy
needs to be recognized early so
nutritional supplements as well as overall
close supervision can be added as
needed.
THE WOMAN WITH LACTOSE
INTOLERANCE
 The sugar in milk is called lactose. In the
intestines, lactose is broken down into
glucose and galactose by the enzyme
lactase.
 Most of the world’s population has
sufficient lactase as an infant to make this
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adequate iron and folic acid.
THE WOMAN WITH A CONCURRENT
HEALTH PROBLEM
 Any health concern that requires rigid
salt, protein, or carbohydrate restriction
poses a potential threat to fetal nutrition.
 That means women who have medical
problems such as kidney disease,
diabetes, tuberculosis, bulimia,
inflammatory bowel disease, celiac
disease, or anorexia nervosa should
consult their primary care provider before
pregnancy because of the specific
metabolic disorders involved with these
illnesses.
 Women who develop gestational diabetes
need the same type of nutrition
counseling.
THE WOMAN WITH PHENYLKETONURIA
 A fetus of a woman with uncontrolled
PKU can develop a cognitive impairment,
microcephaly, intrauterine growth
restriction, and neurologic damage from
exposure to excessive phenylalanine
levels
 Women with the disorder need to avoid

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conversion, but the amount of lactase
available fades by school age.
MANAGEMENT
 When people who are lactose intolerant
drink milk, they experience nausea,
diarrhea, cramps, gas, and a general
feeling of bloating.
 For these women, fortified soy milk is a
good substitute; it is rich in protein,
calcium, and vitamin D and is easily
digestible.
 Women who don’t like the taste of soy
milk may be able to eat cheese because
the processing of cheese changes its
lactose content; yogurt may also be
tolerated.
 Lactase tablets to be chewed before
ingesting milk products can be prescribed
to supplement absent lactase, although
the woman needs to consult with her
primary healthcare provider before taking
these as they are a class N drug (not
assigned a pregnancy category of safety).
 Even if a woman does take lactase
tablets, a calcium supplement (1,200 mg
daily) and a vitamin D supplement (400
International Units) may also be
prescribed.
 This is because the amount of cheese or
yogurt needed to replace the calcium of
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Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #19 Student Activity Sheet
Class number:
_______
Date:
________________
foods high in phenylalanine, which are
those high in protein such as meat and
legumes; examples of foods low in
phenylalanine are fruits and vegetables
such as orange juice, bananas, squash,
spinach, and peas.
 Children with PKU follow a diet with
restricted phenylalanine intake until at
least past adolescence.
 A woman with PKU should consult her
healthcare provider when she is planning
to become pregnant and, if she is not
following a restricted intake, should return
to a low-phenylalanine diet for at least 3
months before she becomes pregnant.
 She then follows this low-phenylalanine
diet during the pregnancy and as long as
she is breastfeeding.
 A woman needs to discuss with her
primary healthcare provider if she should
continue to take sapropterin
dihydrochloride (Kuvan), a drug to lower
phenylalanine serum levels, during
pregnancy as it is a class C category drug
(its safety during pregnancy is unproven)
 Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #19 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

milk is too large to be practical.

 Because milk is also a good source of
protein, be sure to assess whether,
without milk, a woman’s intake of protein
is adequate.
THE WOMAN WITH HYPEREMESIS GRAVIDARUM
 weight loss can be severe because, with so much nausea and vomiting, a woman cannot
maintain her usual nutrition.
 Urine may test positive for ketones, evidence the woman’s body is breaking down stored fat
and protein for cell growth.
 An elevated hematocrit concentration may be detected at a monthly prenatal visit because
the inability to retain fluid has resulted in hemoconcentration (which is dangerous because it
can lead to thromboembolism).
ASSESSMENT
Always try to determine exactly how much nausea and vomiting women are having during
pregnancy. Ask the patient to describe the events of the day before:
 How late into the day did the nausea last?
 How many times did she vomit and how much?
 What was the total amount of food she was able to eat?
MANAGEMENT
 All oral food and fluids are usually withheld for the first 24 hours. Intravenous fluid (e.g.,
3,000 ml Ringer’s lactate with added vitamin B1) may be administered to increase hydration.
An antiemetic, such as metoclopramide (Reglan, pregnancy class B), may be prescribed to
control vomiting.
 Throughout this period, carefully measure intake and output, including the amount of
vomitus, so the degree of hydration can best be evaluated.
 If there is no vomiting after the first 24 hours of oral restriction, small amounts of clear fluid
can be started and the woman discharged home, usually with a referral for home care. If she

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 Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #19 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

can continue to take clear fluid without vomiting, small quantities of dry toast, crackers, or
cereal can be added every 2 or 3 hours, after which the woman may be gradually advanced
to a soft diet and then to a regular diet. If vomiting returns at any point, enteral or total
parenteral nutrition may be prescribed to ensure she receives adequate nutrition

Check for Understanding

Students will work by themselves to answer these questions and write the rationale for each question.

1. Mikki is giving dietary instructions on a client who is on a vegan diet. She provides dietary teaching
focus on foods high in which vitamin that may be lacking in a vegan diet?
A. Vitamin A.
B. Vitamin D.
C. Vitamin E.
D. Vitamin C.

2. Mario is teaching a client who has iron deficiency anemia about foods she should include in her diet.
He determines that the client understands the dietary instructions if she selects which of the following
from her menu?
A. Nuts and fish.
B. Oranges and dark green leafy vegetables.
C. Butter and margarine.
D. Sugar and candy.

3. When planning a diet with a pregnant woman, the nurse's FIRST action would be to:
A. Review the woman's current dietary intake.
B. Teach the woman about the food pyramid.
C. Caution the woman to avoid large doses of vitamins, especially those that are fat-soluble.
D. Instruct the woman to limit the intake of fatty foods.

4. Rachel a pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be
gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her
pattern of weight gain should be approximately:
A. A pound a week throughout pregnancy.
B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy.
C. A pound a week during the first two trimesters, then 2 lbs per week during the third trimester.
D. A total of 25 to 35 lbs.

This document is the property of PHINMA EDUCATION

 Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #19 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

5. Sharon a pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent
episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better.
The nurse midwife could suggest that the woman:
A. Drink warm fluids with each of her meals.
B. Eat a high-protein snack before going to bed.
C. Keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed.
D. Schedule three meals and one midafternoon snack a day.

6. Sherien a pregnant woman experiencing nausea and vomiting should:

A. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
B. Eat small, frequent meals (every 2 to 3 hours).
C. Increase her intake of high-fat foods to keep the stomach full and coated.
D. Limit fluid intake throughout the day.

7. Sharie a pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse
would be most concerned regarding what this woman consumes during and after tennis matches.
Which is the MOST important?
A. Several glasses of fluid
B. Extra protein sources, such as peanut butter
C. Salty foods to replace lost sodium
D. Easily digested sources of carbohydrate

8. Joyce a pregnant woman with an inadequate weight gain during pregnancy are at higher risk of
giving birth to an infant with:
A. Spina bifida.
B. Intrauterine growth restriction.
C. Diabetes mellitus.
D. Down syndrome.

9. 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

10. 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.

This document is the property of PHINMA EDUCATION

 Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #19 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

C. Critical iron and folic acid levels must be maintained.

D. Lactating women can go back to their prepregnant calorie intake

C. LESSON WRAP-UP
AL Strategy: Minute Paper
1. Please prepare a question or write a question in an index cards or half-sheets of paper to write
feedback to the following questions:
a. What was the most useful or the most meaningful thing you have learned this session?
b. What question(s) do you have as we end this session?

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