Transcript for:
Education for Pregnant Patients

Hi, I'm Meris, and in this video, I'm going to be  talking to you about different education we need   to provide to a pregnant patient during their  pregnancy. Things such as nutritional guidance,   weight gain, warning signs of complications,  and other things along those lines. So if   you're ready, I would invite you to go ahead and  follow along using our Maternity Flashcards. If   you don't have a set for yourself yet, these  are available on our website leveluprn.com.  All right. Let's get started. So first up, we're  going to be talking about nutritional guidance for   pregnant patients. And if you look here on the  card, you can see that there is a lot of bold   red text because there's a lot of really important  stuff that you need to teach your patients about.   The three big things that I think of when I think  of nutritional teaching for a pregnant patient is   going to be folic acid, iron, and protein. These  are really important for pregnancy for a bunch of   different reasons. But those are the ones that  we provide really specific and direct teaching   to our patients. So on here, you'll see that we  have under folic acid, that a pregnant patient   needs to increase their intake of folic acid to  600 micrograms per day. This is so incredibly   important because it helps to prevent neural tube  defects. So remember that when that embryo is   forming, it forms around a tube, the neural tube.  And if the patient doesn't have enough folic acid,   there can be a defect in this tube which can lead  to birth defects and even death in some cases. So   very important teaching. Now, protein, why does  protein matter? Well, remember that protein is   the building blocks of life. So literally when  we are building new life, we need to have more   protein. So here we have 60 grams per day. That's  going to be an important number to know as well.   And then iron. Remember that during pregnancy,  a patient's blood volume increases significantly   and we need to have enough iron in the body to  make enough hemoglobin to transport the oxygen   in this larger volume of blood. So on here,  we have that iron should be increased to 27   milligrams per day. And you'll see that a lot of  your patients will actually start taking an iron   supplement. The best teaching for anybody taking  an iron supplement is to take it with vitamin C,   such as orange juice or eating citrus fruit  or even just taking vitamin C supplements to   increase the absorption of that iron. So very  important stuff here. Now, we also do have   here that a patient who has Phenylketonuria,  PKU, this patient needs to follow a strict   low protein diet because of the presence  of something called phenylalanine. So that   is the one time that we would not encourage  our patient to follow a high protein diet.  Moving on to maternal teaching for weight gain and  calorie intake, you'll see here that we have a lot   of bold red tags. And I'm saying this frequently,  but it's because there's some really important   stuff in these cards. This in particular, a  lot of maternity is, what are you going to   teach your patients? So there's a lot of really  important stuff to know. So you'll see on here   that we have weight gain guidance based on BMI.  Now, this is pre-pregnancy BMI. And of course,   BMI is not always the best indicator of health  status. So in the real world, this may be   different based on a specific patient's experience  or context for their care. But in general,   an underweight patient needs to gain 28 to 40  pounds. A patient with average weight should gain   25 to 35 pounds. And remember, average means that  that's what most people are. So that's the number   that I would be focusing on the most, because most  of your patients will be of average weight. And   then for a patient with an overweight BMI, they  should gain between 15 to 25 pounds in pregnancy.  You'll also see on here that we have the weight  gain broken down by trimester. So in the first   trimester, only 2.2 to 4.4 pounds should be  gained in total in that entire first trimester.   That's going to be one to two kilograms. When we  get into the second and third trimesters, however,   then we expect our patients to be gaining  about one pound per week. So very important   to know that we have very little weight gain in  that first trimester and then one pound a week   thereafter. You'll see here too, that calorie  intake that is recommended based on trimester.   I'll let you go through that on your own, but just  know that it does vary and the caloric needs will   vary throughout pregnancy and breastfeeding. Moving on, we're going to be talking about   things to avoid in pregnancy and warning signs  of complications. This is so important in that   first trimester visit to make sure that your  patients understand what's normal and what   is something that could be concerning where  they need to follow up with their provider.   So this is a hugely important card to review.  Things to avoid during pregnancy, it's more   than we could ever possibly fit on a flash card,  right? There's so much to avoid in pregnancy.   Alcohol is going to be the big one, along with  smoking. If your patient is able or interested   or willing to talk about smoking cessation,  that's going to be huge for the pregnancy.   Caffeine should be limited. The intake of certain  fish should be limited as well. And the hot tubs   and saunas as well. So there's way more than  that. Those are just some of the highlights.   But specific drugs should be avoided. And in  general, when I worked in outpatient OBGYN land,   we said that you shouldn't take any medication  during pregnancy without speaking to your OBGYN,   because there's just very few that are considered  across the board to be okay. So every medication   should be reviewed and approved by your provider. Now warning signs of possible complications to   notify your doctor of. So, so, so important to  know these: diarrhea, fever, and chills. Anything   like that, we don't like it. We want to know about  it. Severe abdominal cramping. It is normal and   expected to have some cramping in pregnancy. The  uterus is growing and changing and pulling on   ligaments and all of these different things. It's  going to be a little uncomfortable. But if your   patient is having severe pain or cramping, that is  something that they need to call the doctor about.   Severe vomiting, which we will talk about in  another video. But severe vomiting can be a really   big warning sign that your patient is experiencing  something called hyperemesis gravidarum. They are   very much at risk for dehydration and electrolyte  imbalances. And then decreased fetal activity.   This, of course, only applies once the patient  is able to feel the fetal activity in the first   place, which is usually going to be somewhere  between 17 and 24 weeks, depending on the patient   and the location of their placenta. But once they  feel fetal activity, it's going to become more and   more consistent and kind of fall into a pattern.  If your patient recognizes decreased movement,   that is always a time to call the doctor. Okay, moving on, let's talk about unpleasant   side effects. These are pretty common. You may be  familiar with a bunch of them already, but these   are things to just tell your patients, "Hey, this  might happen to you. It's okay. It's expected.   It's a side effect of pregnancy, but we just want  you to be aware of it." So congestion, again,   remember, we have that increased blood flow.  So we're going to end up with nasal congestion.   They can use a normal saline spray. But again,  we're avoiding any kind of medication unless we   talk to the doctor. Constipation. That uterus  is putting tons of pressure on the bowels   and it's going to make it really hard for  things to move through there unobstructed.   That's normal. Increase your fluid and fiber,  right? Very important. Epistaxis, meaning nose   bleed. Again, very, very common because of that  increased blood flow. So here we would tell our   patients to use a humidifier if possible. And then things like fatigue and heartburn   are expected as well. Gingivitis, again,  remember, we have this blood flow situation,   so we're going to end up with gingivitis. We also  have a decreased immune response because we're   trying to suppress the immune response to protect  the baby. So we can end up with gingivitis,   dental caries. This is why you need to educate  your patients to continue good oral hygiene,   but also to continue to see the dentist during  pregnancy. On this last card that we're covering,   some more really fun, unpleasant side effects,  hemorrhoids. Okay. Hemorrhoids are prolapsed   vessels in or around the rectum. Again, we  have increased blood flow and constipation.   Your patient is probably straining with bowel  movements. So, again, fiber and fluid. And then   if they actually have hemorrhoids, they can  use witch hazel to try and soothe that or   warm sits baths where they actually sit in  warm water to help relieve some of that pain.   Nausea and vomiting. I don't think I know a single  person who made it through pregnancy without at   least a little nausea and vomiting. So things  that we can tell our patients to do would be to   eat crackers or a carbohydrate heavy snack before  getting out of bed. My doctor told me, literally,   she said, "Before you even sit up in bed, I  want you to take a handful of Teddy Grahams or   Saltines or something like that and eat them." And  that really did help me with some of my nausea,   because it helped to settle my stomach before I  got the day started. They can also eat frequent   meals which are smaller. So rather than  three large meals, five or six small ones   and bland foods. It's also going to be up to  patient preference. Whatever helps your nausea   is what we want you to eat, right? For me, it was  milkshakes. All I could stomach was a chocolate   milkshake. And my doctor said, "That's fine.  Just drink it. We want you to get some calories."  Urinary frequency. More blood volume means more  blood that gets filtered and turned into urine,   right? Plus a large, heavy uterus pushing on that  bladder. You're going to be using the bathroom   more frequently. Varicose veins also are something  that you may experience in pregnancy, so wear   compression garments and things of that nature. All right. I hope that review was helpful for   you. If it was, please, like this video so that  I know. If you think of something I left out or   a really great way to remember it, I would love  to hear it in the comments below, and be sure   to subscribe so that you're the first to know  when the next video in this series comes out.   Thanks so much for joining me and happy studying. I invite you to subscribe to our channel and share   a link with your classmates and friends in nursing  school. If you found value in this video, be sure   and hit the like button, and leave a comment and  let us know what you found particularly helpful.