CHAPTER 7: PREGNANCY AND LACTATION

Question 1

What is the additional recommended intake of calories during 2nd trimester?

Answer 1

recommended that women consume additional 340 calories/day

Question 2

What is the additional recommended intake of calories during 3rd trimester?

Answer 2

recommended that women consume additional 450 calories/day

Question 3

What is the additional recommended intake of calories during lactation?

Answer 3

recommended additional 330 calories/day (first 6 months)

▪ Additional 400 calories/day after that

Question 4

How many pounds are gained during the 1st trimester (total 3 months) of pregnancy?

Answer 4

2-4 lbs.

Question 5

How many pounds are gained during the 2nd and 3rd trimester of pregnancy?

Answer 5

2-4 lbs. per month

Question 6

What is the normal BMI of a pregnant woman after the total weight gain during pregnancy?

Answer 6

25-35 lbs.

Question 7

What is the underweight BMI of a pregnant woman after the total weight gain during pregnancy?

Answer 7

28-40 lbs.

Question 8

What is the overweight BMI of a pregnant woman after the total weight gain during pregnancy?

Answer 8

15-25 lbs.

Question 9

What are the dietary recommendations during pregnancy?

Answer 9

o Limit caffeine intake to 300 mg/day or less
o 600 micrograms a day of folic acid (helps prevent neural tube defects)
o Iron supplements during pregnancy (remember vitamin C increases absorption) to get 27 grams
o Fish and shellfish should be avoided due to mercury levels

Question 10

What education should be provided to a pregnant woman experiencing N/V?

Answer 10

advise to eat dry crackers or toast so they should focus on low fat carbohydrates to decrease nausea.

Question 11

What other education should be provided to a pregnant patient?

Answer 11

o Avoid drinking water with meals 
▪ Caffeine
▪ Fatty foods
▪ Spicy Foods
o Can help to serve foods at room temperature or chilled
▪ Warmer hot foods give off more odor 
o Maintain good oral hygiene

Question 12

What education should be provided to a pregnant woman experiencing constipation?

Answer 12

encourage to increase fiber and fluid intake

o Engage in physical activity to increase bowel motility

Question 13

What is PKU?

Answer 13

Maternal Phenol Ketonuria

Question 14

What should moms that have PKU avoid?

Answer 14

high protein foods
o So that means no meat, fish, poultry, eggs, nuts or dairy products
o They will also need to get their phenylketonuria levels taken throughout pregnancy (frequent blood tests); if mom has PKU, start diet BEFORE pregnancy

Question 15

How does the weight of an infant change over the course of 6 months to a year?

Answer 15

birth weight will double by 6 months & triple by 1 year

Question 16

When should breast milk be used?

Answer 16

exclusively for the first 4-6 months

Question 17

When should you introduce a baby to solid foods?

Answer 17

once the baby can sit up and has good head control

Question 18

What is the first solid food that is introduced?

Answer 18

iron fortified cereal
▪ After that we can introduce new foods ONE AT A TIME
** 1 new food for 5-7 days **

Question 19

When should cows milk and honey be given?

Answer 19

not until the baby is 1 year old (honey increases r/f botulism)

Question 20

How should a baby with cleft lip be fed?

Answer 20

feed them upright

Question 21

How should breast milk be stored?

Answer 21

Can be stored for 5-8 days in the refrigerator

Question 22

What should you do with unused breast milk?

Answer 22

any unused breast milk should be discarded

Question 23

Why should you never microwave breast milk?

Answer 23

it kills the antibodies

Question 24

How long can breast milk be frozen?

Answer 24

up to 6 months in regular freezer or 12 months in deep freezer
** Use thawed milk within 24 hours (never refreeze) **

Question 25

What are some infant nutrition concerns?

Answer 25

- colic - lactose intolerence - diarrhea - dehydration

Question 26

What are the s/sx of colic and what education should be provided to mom?

Answer 26

- persistent crying for 3 hours or more a day, usually resolves around 3 months old + abdominal tension and legs drawn to belly - If the mom is breast feeding, suggest eliminating cruciferous vegetables (cauliflower, broccoli, brussel sprouts), cow milk, onion, and chocolate (triggers)

Question 27

What are the s/sx of lactose intolerance and what education should be provided to mom?

Answer 27

- gas, abdominal distention, diarrhea. | - You can try using a soy based or cosine hydrolysate (casein) formula

Question 28

What is the frequent cause of diarrhea and what can be used to treat the baby?

Answer 28

- often caused by ROTAVIRUS | - Use an oral rehydration solution (8oz/loose stool) and notify PCP

Question 29

What are the s/sx of dehydration?

Answer 29

Lethargy, sunken eyes, sunken fontanelles, decreased tears, decreased urine output, dried mucous membranes

Question 30

How many pounds do children gain a year on average?

Answer 30

5 pounds

Question 31

What foods are considered choking hazards for children?

Answer 31

- Popcorn - Raisins - Peanuts - Bagels - Grapes - Raw carrots - Hotdogs - Celery - Peanut butter - Candy (fruit gel bites) - Tough meat

Question 32

How much juice should a child drink a day?

Answer 32

no more than 4-6 ounces/day

Question 33

How much milk should a child drink a day?

Answer 33

no more than 24 ounces/day

Question 34

What can the overconsumption of milk lead to in a child?

Answer 34

iron deficiency anemia o Milk is low in iron *** Increase intake of iron rich foods (vit. C) ***

Question 35

_______ is important for bone development in children also because it helps with absorption of calcium

Answer 35

Vitamin D

Question 36

What are some adolescent nutrition concerns?

Answer 36

Eating disorders begin during adolescence: o Anorexia nervosa o Bulimia

Question 37

What are some older adult nutrition concerns?

Answer 37

- They have lower BMR which means they require fewer calories because of their slower metabolism. - Dehydration is common and is due to decreased thirst sensation as well as medication side effects o Diuretics will really dry you up - Decreased absorption of B12, folic acid, and calcium - Some have issues with chewing and swallowing o Need to mince or chop foods to help minimize difficulty with chewing and we may need to thicken liquids for easier swallowing

Question 38

When does osteoporosis occur?

Answer 38

Beginning at age 35 (bone loss)

Question 39

Who is at a higher risk for osteoporosis?

Answer 39

white women

Question 40

What education should be provided to patients at r/f osteoporosis?

Answer 40

o Pt who are at risk or have osteoporosis to increase their intake of calcium and vitamin D o Engage in weight-bearing exercise (NOT SWIMMING!!) o Limit alcohol consumption

Question 41

How much protein is needed in the diet during pregnancy?

Answer 41

20%

Question 42

How much fat is needed in the diet during pregnancy?

Answer 42

30%

Question 43

How much carbs is needed in the diet during pregnancy?

Answer 43

50%

Question 44

Why should you not prop the babys bottle?

Answer 44

it increases the r/f tooth decay

Question 45

What schedule should you be on when breastfeeding?

Answer 45

feed every 3-4 hrs for 8-12x/day (wake the baby if you have to) *** watch for hunger cues ***

Question 46

What should be added to breast milk if exclusively breastfeeding?

Answer 46

iron supplementation at 4 months

Question 47

What education should be provided to a mother about formula feeding?

Answer 47

- follow mixing direction - throw out if left out >2hr - feed <32oz/24hr unless directed by provider

Question 48

When should a infant be eating 3 meals and 3 snacks a day?

Answer 48

by 8 months

Question 49

How long can baby food be stored?

Answer 49

24hrs

Question 50

What education should be provided to a mom whose baby is failing to thrive (inadequate growth)?

Answer 50

give them a high calorie, high protein diet and assess for physiological or psychological reasons

Question 51

What education should be provided to a mom whose baby is experiencing constipation?

Answer 51

properly dilute formula

Question 52

What are food jags?

Answer 52

ritualistic preferences for one food (this is common and self limiting in children between 3-6)

Question 53

Children are at a r/f choking until what age?

Answer 53

4 years old

Question 54

Who is at a r/f lead poisoning?

Answer 54

children <6 yo

Question 55

Preschoolers dislike ______ but enjoy _______

Answer 55

strong tasting veggies (onions, cabbage); raw veggies as finger foods

Question 56

What education should be provided to school aged children (6-12)?

Answer 56

to only eat when hungry (they need more calories, proteins and fluids; we should be concerned about them not eating breakfast and being obese or overweight)

Question 57

What concerns are there about adolescence diets?

Answer 57

eating and snacking and skipping meals or eating nutritionally poor foods and/or not taking in enough iron and calcium)