1. Anticipatory Guidance During PregnancyBy
Catherine Ramos Marin, MSN/Ed(c), WHCNP, RN

2. First Trimester (1-13 weeks)
Discomforts of pregnancy (N/V, frequent urination)
Increase sleep needs (8 hrs./day)
Exercise (fine as long as the client is able to converse easily whle exercising)
Work: no exposure to hazardous chemicals or toxins
Ingest no medication, no alcohol/drugs and to stop smoking

3. Second Trimester (14-26 weeks)
Sexual needs and desire: encourage communication b/w husband and wife
Regular dental check-up: maintain dental hygiene, delay radiographs and major dental work if possible (gum hypertrophy is common)

4. Third Trimester (27 weeks to 40 weeks)
Schedule childbirth classes
Increase urinary frequency and dyspnea
Review interventions on leg cramps, nasal stuffiness, varicose veins, and constipation
Breastfeeding teachings
Choosing pediatrician and clinic
Nutritional needs: period of rapid fetal growth
Teach s/s of preterm labor
Teach danger signs of pre-eclampsia and eclampsia

5. Nutritional Teachings
Increase intake by 300 calories above basal and activity needs
Increase protein by 30 gm/day
Increase intake of Iron (30+ mg) and folic acid (800 to 1000 mcg) through diet and supplements
Increase intake of Vitamin A, Vit. C and calcium through diet

6. Weight Gain 2-4 lbs. in the 1st trimester is considered normal
0.9 lb./week thereafter
Is normal (> 2 lbs/week may be related to pre-eclampsia: edema
Total weight gain during pregnancy: lbs.

7. Substance Abuse During Pregnancy
Smoking: low birth weight infant
Alcohol: fetal alcohol syndrome
Cocaine: preterm labor and abruptio placenta
Teach that teratogenic fetal effects are highest in the first trimester

8. Anemia during Pregnancy
A decrease in the oxygen carrying capacity of blood
Often related to Iron deficiency and reduced dietary intake
Occurs in 20% of pregnant women
Associated with increase incidence of abortion, PTL, pre-eclampsia

9. Anemia Hgb < 11 g/dl, Hct < 37 % during 1st trimester
Hgb <10.5 g/dl, Hct < 35% during 2nd trimester
Hgb <10 g/dl, Hct < 32% during 3rd trimester

10. Nursing Interventions
24 hr. dietary recall
Oral administration of Iron
Teach nutritional requirements

11. Oral Administration of Iron
Best absorbed on an empty stomach
Taken with Vit. C such as OJ to increase absorption
Take in the evening if problem exist w/ morning sickness
Stools will turn dark green to black
Lab values should be checked for increased reticulocytes and rising Hgb and Hct

12. Teenage Adolescent Pregnancy
Pregnancy at age 19 or younger
Highly associated with anemia, pre-eclampsia, CPD, STDs, IUGR, and ineffective parenting
Assess: Nutritional status (24 hr. diet recall), attitude toward pregnancy and becoming a mother, social support system (family, spouse, BF, friends), domestic violence, peer activities (smoking, drugs, alcohol), economic status, educational status, access to prenatal care