MATERNAL CHILD HEAL TH NUR2 513 STUD Y GUIDE EXAM 1 1
Mat ernal Child Health GENERAL
Know t rends influen cing mater nal and child healthcar e
Initiating Cost Containment- Cost containment refers to reducing the cost of health care by closely moni toring the costs of personnel, use and brands of supplies, length of hospital sta ys, inpatient to outpatient ratios as is clinically appropriate, number of procedures carried out, and number of referrals requested while main taining quality care.
Changes in Health Insurance Coverage- Nurses have important roles at healthcare agencies to ensure people receive comprehensive care and encourage more children and women to receive preventive care .
Increasi ng Alternative Settings and Styles for He alth Car e-This statistic is predicted to increase in the future because increasing numbers of women are choosing home birth or birthing in freesta nding alternative birth centers. Women who give birth in these alternative settings feel they have a greater control of the ir birth experience and their family can be more involved in the birth. Alternative settings also allow more practice opportunities for nurses in advanced practice roles, such as nurse-midwives clinics or at home. Increasi ng Use of T echnology- The field of assisted reproduction technology such as in vitro fertil ization and the possibility of stem cell research are for ging new pathways. Charting by computer into elec tronic health records and monitoring fetal heart rates by Doppler ultrasonography are other examples In a ddition to learning these technologies and rules, maternal and child health nurses must be able to e xplain their use and their advantages to patients. Otherwise, patients may find new technologies more frightening tha n helpful to them.
Meeting W ork Needs of Pregnant and Br eastfeeding Women- To support the aim of the law , many employers are
now also allowing women to breastfeed at work if doing so does not disrupt their work schedule or work outcome.
Regionalizing Intensive Car e-When regionalization concepts of newborn care were first introduced, transporting the ill or premature newborn to the regional care facility was the me thod of choice. T oday, if it is known in advance that a child may be born with a life-threatening condition, it ma y be safer to transport the mother to the regional center at the time of birth because the uterus has advantage s as a transport incubator that far exceed those of any commercial incubator yet designed.
Increasi ng Use of Alternative T reatment Modalities- There is a growing tendency for families to use alternative forms of therapy , such as acupuncture or therapeutic touch, in addition to or instead of traditional healthcare measures. Nurses have an increasing obligation to be aware of comple mentary or alternative therapies as they have the potential to either enhance or detract from the ef fectiveness of traditional therapy Know t he 2020 National He alth Goals f or Pregnancy
Attain high-quality , longer lives fr ee of pre vent able disease, disability , injury and prematur e death; Achieve h ealth equity , eliminate disp arities and impro ve the health of all groups; 7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 1/44 MATERNAL CHILD HEAL TH NUR2513 STUD Y GUIDE EXAM 1 2
Crea te social and ph ysical envi ronments that pr omote good health f or all; and
Promot e quality of life, health y development and he althy b ehavior s across all lif e stages. Smoking and pregn ancy
increases t he risk of health pr oblems for developin g babies, including pre term bir th, low birth weigh t, and birth def ects of the mouth and lip. Smoking during and a fter pregnancy also incr eases the risk of sudden inf ant dea th sy ndrome ( SIDS).
prema ture r upture of the m embran es
preterm labor
placent al abruption
placent a previa
fetus small f or gestation al age
Nutrition counseling/health counseling: heme iron a nd iron- fortified foods
Vitamin C
400 mcg of f olic acid per day
8-12 oz o f seaf ood a week 4-6 glasses of w ater per day- needed for health y the av erage woman should gain 1 1.3 to 15.8 kg (25 to 35 lb) duri ng pregnanc y. During the fir st trimest er reco mmended weigh t gain is 2-4 lbs. In the se cond and third trimest er 1lb per we ek. The nurse n eeds to consider their body m ass index (BMI) = weight/ height.
Folic Acid-T he USPS TF recom mends that all w ome n who ar e planning or capable o f pregnancy t ake a daily supplement c ontaining 0.4 to 0.8 mg (400 to 800 m cg) of foli c acid. Foli c acid is crucial f or neurologic al dev elopment and the pr evention of f etal neur al tube def ects (U.S. Pr eventive Services T ask Force, 2017).
Iron -- Physiologic anemia of pregnancy or p seudoanemia due to increased pl asma vol that dilu tes H/H. The normal mean hemoglobin le vel in pr egnancy is 11-12g /dL of blood. Should encour age adequate hydration with 6-8 glasses o f wat er each da y and incr ease the int ake of protein a nd iron via die tary sources. Some times moms will need an ir on supplement in their pr enatal vi tamin (PNV).
Calcium-- The daily reco mmen dation is 1,000 m g/day
Fluid- The reco mmendation is to consume 2L -3L of fluid daily
Restriction of Caff eine should be limited to 3 00mg /day .
Nutrition During Lacta tion
During breas tfeeding, an ener gy intak e incr ease of 500 k cal more than a w oman’ s non-pregnant in take is reco mmended. Smoking, alcohol in take, and ex cessive caff eine intak e should be av oided during lactation.
Checklist f or a Healthy Pr egnancy
1.Start with ear ly Prena tal ca re and main tain regular visits7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 2/44 MATERNAL CHILD HEAL TH NUR2513 STUD Y GUIDE EXAM 1 3
2.Do not Smok e or Drink
3.Take the prescribed pre natal vitamins with 400 M CG of F olic Acid
4.Get plenty o f res t and adequa te ex ercise 30 mins 3 x week
5.Eat a Nutritional Diet
6.Wear a Seatbelt
7.Spend time with f amily , but education o n changes both ph ysically and emotionally should be
discussed with f amily
What vit amins/minerals are encour aged? protein in women is 34 to 46 g. During pregnancy , the need for protein increase s to 71 g daily .
Pregnant women should ingest 200 and 300 mg of omega-3 fatty acids daily . An added advantage of using
vegetable oils rather than animal-bas ed oils (butter) is that they have low cholesterol cont ents.
TABLE 13.2 VIT AMIN NEEDS FOR TH E PREGNANT WOMAN
Vitamin Essential Functions Signs of DeficiencyRelevant Foods and SupplementationRecommended Amounts Evidence-Based Evaluation
Vitamin DAids calcium absorption, formation of bones/teeth, and immune functionLow birth weight, increased rates of preeclampsiaFortified milk, eggs, salmonNo standard, suggested 600 IU dailyNot recommended to improve maternal or perinatal outcomes by WHO; concern for a dverse effects—fa t-soluble vitamin
Vitamin ANew cell growth, healthy skin, oral health, visionTender gums or tongues, cracks in skin around mouth,
poor night visionDark green and yellow vegetables and fruits, liver , milk, butter , cheese, eggsIn areas where vitamin A deficiency is a severe public health problem:
10,000 IU daily or 25,000 IU weeklyNot recommended to improve maternal or perinatal outcomes by WHO; only to impr ove night vision during pregnancy; concern
for overdose—fat-soluble vitamin
Vitamin CAntioxidant, collagen formationScurvy , easy bruising,
swollen and bleeding gumsFresh vegetables and fruitSuggested 85 mg daily No benefit seen with standard supplementation with vitamin C; not recommended to improve maternal or perinatal outcomes by WHO
Folic acid Red blood cell formation, prevents neural tube defectsMegaloblastic anemia, fetal neural tube defectsFresh vegetables and fruit400 μg daily Clear evidence of benefit, WHO recommends daily supplementation7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 3/44 MATERNAL CHILD HEAL TH NUR2513 STUD Y GUIDE EXAM 1 4
TABLE 13.3 MINERAL NEEDS FOR THE PREGNANT WOMA N
Mineral Essential FunctionsRelevant Foods and Supplementation Recommended Amounts Evidence-Based Evaluation
Calcium Calcification of fetal bones (as early as 8 weeks)Milk, cheese, yogurt, leafy greens, almondsAdolescents—1,300 mg, Adults
—1,000 mgIn populations with low dietary intake, supplementation is recommended; reduces risk of preeclampsia
Iodine Thyroid gland function Iodized salt, seafood, cranberries Suggested 250 μg daily where iodized salt use is less than 20%Strong evidence that populations without iodized salt need supplementation
Iron Fetal cell development, physiologic anemia of pregnancyOrga n meats, eggs, leafy greens, whole grains, enriched breads, dried fruit30–60 mg elemental iron daily Strong evidence supplementation reduces maternal anemia, puerperal sepsis, low birth weight, and preterm
birth
Fluoride Tooth development Fluoridated water Supplements only warranted in areas without fluorinated waterLack of evidence suggesting routine supplementation
Zinc Immune health Oysters, red meat, poultry , beans, nuts, whole grains, dairy productsSupplementation only in context of researchNot standard recommended by WHO given lack of evidence
FOODS T O AVOID OR LIMIT IN PREGNANCY
Foods to avoid during pregnancy include those that are known to be teratogenic and, because a woman’ s immunologic resistance is lowered, those that may spread bacteria, such as:
• Raw eggs and undercooked chicken (danger o f salmonella)
• Soft unpasteurized cheese (can harbo r bacteria) Listeria
• Raw milk
• Raw seafood and sushi (can harbor hepat itis A virus)
• Cold cuts (deli meats should be heated un til steaming to kill any bacteria)
• Alcoholic beverages (known to cause fet al alcohol spectrum disorder)
• Saccharin (has a long half-life and so can r each toxic levels in a fetus)
• Fish with high mercury content such as mack erel and swordfish
• W eight loss diets or supplements (women need add itional nutrients, not less in pregnancy)
• Caffe ine (excessive amounts may be a caus e of miscarriage, although research is sti ll ongoing)
CONTRAC EPTION/BIRTH C ONTROL: T ypes, contr aindicati ons, consider ations, populations, patient education, e tc.
IUD: intrauterine device (IUD) is a small plas tic device that i s inserted in to the uter us throu gh the vagina . IUDs
can be either hor monal or nonhormonal.7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 4/44
Mat ernal Child Health GENERAL
Know t rends influen cing mater nal and child healthcar e
Initiating Cost Containment- Cost containment refers to reducing the cost of health care by closely moni toring the costs of personnel, use and brands of supplies, length of hospital sta ys, inpatient to outpatient ratios as is clinically appropriate, number of procedures carried out, and number of referrals requested while main taining quality care.
Changes in Health Insurance Coverage- Nurses have important roles at healthcare agencies to ensure people receive comprehensive care and encourage more children and women to receive preventive care .
Increasi ng Alternative Settings and Styles for He alth Car e-This statistic is predicted to increase in the future because increasing numbers of women are choosing home birth or birthing in freesta nding alternative birth centers. Women who give birth in these alternative settings feel they have a greater control of the ir birth experience and their family can be more involved in the birth. Alternative settings also allow more practice opportunities for nurses in advanced practice roles, such as nurse-midwives clinics or at home. Increasi ng Use of T echnology- The field of assisted reproduction technology such as in vitro fertil ization and the possibility of stem cell research are for ging new pathways. Charting by computer into elec tronic health records and monitoring fetal heart rates by Doppler ultrasonography are other examples In a ddition to learning these technologies and rules, maternal and child health nurses must be able to e xplain their use and their advantages to patients. Otherwise, patients may find new technologies more frightening tha n helpful to them.
Meeting W ork Needs of Pregnant and Br eastfeeding Women- To support the aim of the law , many employers are
now also allowing women to breastfeed at work if doing so does not disrupt their work schedule or work outcome.
Regionalizing Intensive Car e-When regionalization concepts of newborn care were first introduced, transporting the ill or premature newborn to the regional care facility was the me thod of choice. T oday, if it is known in advance that a child may be born with a life-threatening condition, it ma y be safer to transport the mother to the regional center at the time of birth because the uterus has advantage s as a transport incubator that far exceed those of any commercial incubator yet designed.
Increasi ng Use of Alternative T reatment Modalities- There is a growing tendency for families to use alternative forms of therapy , such as acupuncture or therapeutic touch, in addition to or instead of traditional healthcare measures. Nurses have an increasing obligation to be aware of comple mentary or alternative therapies as they have the potential to either enhance or detract from the ef fectiveness of traditional therapy Know t he 2020 National He alth Goals f or Pregnancy
Attain high-quality , longer lives fr ee of pre vent able disease, disability , injury and prematur e death; Achieve h ealth equity , eliminate disp arities and impro ve the health of all groups; 7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 1/44 MATERNAL CHILD HEAL TH NUR2513 STUD Y GUIDE EXAM 1 2
Crea te social and ph ysical envi ronments that pr omote good health f or all; and
Promot e quality of life, health y development and he althy b ehavior s across all lif e stages. Smoking and pregn ancy
increases t he risk of health pr oblems for developin g babies, including pre term bir th, low birth weigh t, and birth def ects of the mouth and lip. Smoking during and a fter pregnancy also incr eases the risk of sudden inf ant dea th sy ndrome ( SIDS).
prema ture r upture of the m embran es
preterm labor
placent al abruption
placent a previa
fetus small f or gestation al age
Nutrition counseling/health counseling: heme iron a nd iron- fortified foods
Vitamin C
400 mcg of f olic acid per day
8-12 oz o f seaf ood a week 4-6 glasses of w ater per day- needed for health y the av erage woman should gain 1 1.3 to 15.8 kg (25 to 35 lb) duri ng pregnanc y. During the fir st trimest er reco mmended weigh t gain is 2-4 lbs. In the se cond and third trimest er 1lb per we ek. The nurse n eeds to consider their body m ass index (BMI) = weight/ height.
Folic Acid-T he USPS TF recom mends that all w ome n who ar e planning or capable o f pregnancy t ake a daily supplement c ontaining 0.4 to 0.8 mg (400 to 800 m cg) of foli c acid. Foli c acid is crucial f or neurologic al dev elopment and the pr evention of f etal neur al tube def ects (U.S. Pr eventive Services T ask Force, 2017).
Iron -- Physiologic anemia of pregnancy or p seudoanemia due to increased pl asma vol that dilu tes H/H. The normal mean hemoglobin le vel in pr egnancy is 11-12g /dL of blood. Should encour age adequate hydration with 6-8 glasses o f wat er each da y and incr ease the int ake of protein a nd iron via die tary sources. Some times moms will need an ir on supplement in their pr enatal vi tamin (PNV).
Calcium-- The daily reco mmen dation is 1,000 m g/day
Fluid- The reco mmendation is to consume 2L -3L of fluid daily
Restriction of Caff eine should be limited to 3 00mg /day .
Nutrition During Lacta tion
During breas tfeeding, an ener gy intak e incr ease of 500 k cal more than a w oman’ s non-pregnant in take is reco mmended. Smoking, alcohol in take, and ex cessive caff eine intak e should be av oided during lactation.
Checklist f or a Healthy Pr egnancy
1.Start with ear ly Prena tal ca re and main tain regular visits7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 2/44 MATERNAL CHILD HEAL TH NUR2513 STUD Y GUIDE EXAM 1 3
2.Do not Smok e or Drink
3.Take the prescribed pre natal vitamins with 400 M CG of F olic Acid
4.Get plenty o f res t and adequa te ex ercise 30 mins 3 x week
5.Eat a Nutritional Diet
6.Wear a Seatbelt
7.Spend time with f amily , but education o n changes both ph ysically and emotionally should be
discussed with f amily
What vit amins/minerals are encour aged? protein in women is 34 to 46 g. During pregnancy , the need for protein increase s to 71 g daily .
Pregnant women should ingest 200 and 300 mg of omega-3 fatty acids daily . An added advantage of using
vegetable oils rather than animal-bas ed oils (butter) is that they have low cholesterol cont ents.
TABLE 13.2 VIT AMIN NEEDS FOR TH E PREGNANT WOMAN
Vitamin Essential Functions Signs of DeficiencyRelevant Foods and SupplementationRecommended Amounts Evidence-Based Evaluation
Vitamin DAids calcium absorption, formation of bones/teeth, and immune functionLow birth weight, increased rates of preeclampsiaFortified milk, eggs, salmonNo standard, suggested 600 IU dailyNot recommended to improve maternal or perinatal outcomes by WHO; concern for a dverse effects—fa t-soluble vitamin
Vitamin ANew cell growth, healthy skin, oral health, visionTender gums or tongues, cracks in skin around mouth,
poor night visionDark green and yellow vegetables and fruits, liver , milk, butter , cheese, eggsIn areas where vitamin A deficiency is a severe public health problem:
10,000 IU daily or 25,000 IU weeklyNot recommended to improve maternal or perinatal outcomes by WHO; only to impr ove night vision during pregnancy; concern
for overdose—fat-soluble vitamin
Vitamin CAntioxidant, collagen formationScurvy , easy bruising,
swollen and bleeding gumsFresh vegetables and fruitSuggested 85 mg daily No benefit seen with standard supplementation with vitamin C; not recommended to improve maternal or perinatal outcomes by WHO
Folic acid Red blood cell formation, prevents neural tube defectsMegaloblastic anemia, fetal neural tube defectsFresh vegetables and fruit400 μg daily Clear evidence of benefit, WHO recommends daily supplementation7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 3/44 MATERNAL CHILD HEAL TH NUR2513 STUD Y GUIDE EXAM 1 4
TABLE 13.3 MINERAL NEEDS FOR THE PREGNANT WOMA N
Mineral Essential FunctionsRelevant Foods and Supplementation Recommended Amounts Evidence-Based Evaluation
Calcium Calcification of fetal bones (as early as 8 weeks)Milk, cheese, yogurt, leafy greens, almondsAdolescents—1,300 mg, Adults
—1,000 mgIn populations with low dietary intake, supplementation is recommended; reduces risk of preeclampsia
Iodine Thyroid gland function Iodized salt, seafood, cranberries Suggested 250 μg daily where iodized salt use is less than 20%Strong evidence that populations without iodized salt need supplementation
Iron Fetal cell development, physiologic anemia of pregnancyOrga n meats, eggs, leafy greens, whole grains, enriched breads, dried fruit30–60 mg elemental iron daily Strong evidence supplementation reduces maternal anemia, puerperal sepsis, low birth weight, and preterm
birth
Fluoride Tooth development Fluoridated water Supplements only warranted in areas without fluorinated waterLack of evidence suggesting routine supplementation
Zinc Immune health Oysters, red meat, poultry , beans, nuts, whole grains, dairy productsSupplementation only in context of researchNot standard recommended by WHO given lack of evidence
FOODS T O AVOID OR LIMIT IN PREGNANCY
Foods to avoid during pregnancy include those that are known to be teratogenic and, because a woman’ s immunologic resistance is lowered, those that may spread bacteria, such as:
• Raw eggs and undercooked chicken (danger o f salmonella)
• Soft unpasteurized cheese (can harbo r bacteria) Listeria
• Raw milk
• Raw seafood and sushi (can harbor hepat itis A virus)
• Cold cuts (deli meats should be heated un til steaming to kill any bacteria)
• Alcoholic beverages (known to cause fet al alcohol spectrum disorder)
• Saccharin (has a long half-life and so can r each toxic levels in a fetus)
• Fish with high mercury content such as mack erel and swordfish
• W eight loss diets or supplements (women need add itional nutrients, not less in pregnancy)
• Caffe ine (excessive amounts may be a caus e of miscarriage, although research is sti ll ongoing)
CONTRAC EPTION/BIRTH C ONTROL: T ypes, contr aindicati ons, consider ations, populations, patient education, e tc.
IUD: intrauterine device (IUD) is a small plas tic device that i s inserted in to the uter us throu gh the vagina . IUDs
can be either hor monal or nonhormonal.7/20/24, 8:30 PM Exam 1 Blueprint maternal child complete
about:blank 4/44
