Psychotropics, Anticonvulsants, Nutritional Assessment, Patient Education


Psychotropics

  • Lithium. Of 183 reported cases, 20 had malformations, most involving the cardiovascular system.
  • Valium. Recent well-controlled studies indicate no increase in clefting among fetuses exposed to valium

Anticonvulsants

  • Hydantoin. A recognized syndrome is seen in approximately 11 percent of exposed infants. Effects include digital and nail hypoplasia, depressed nasal bridge, mental retardation, and slightly increased incidence of congenital heart disease.
  • Valproic acid. This is associated with an increased risk of neural tube defects.
  • Phenobarbital. There is no increased risk of malformation with the use of phenobarbital alone

Nutritional Assessment

Nutritional assessment during the initial prenatal visit should include the following subjective data:

  • Pre-pregnancy weight (height to weight profile)
  • Diet history with evaluation of barriers to adequate nutrition intake (e.g., financial, cultural, food fads, pica), and special dietary patterns (e.g., vegetarian, lactose intolerance, caffeine, Aspertane).
  • Objective data should include:
  • Height, weight, normal weight, percentile for height, weight, weight/height, desirable body weight.; desirable body weight, body frame,
  • Fluctuations in weight gain vs weight loss.
  • Age, race
  • Significant laboratory data pertinent to nutritional status.
  • Medications which may influence nutritional status.
  • Dietary supplements, e.g. vitamins, calcium
  • 24-Hour Diet Recall Results: Calculate the nutrient intake utilizing USDA Handbook 456, Food Values of Portions Commonly Used and/or other appropriate methods. Determine the appropriateness of the diet using the Recommended Dietary Allowances as a standard. Record the amounts of each nutrient, vitamin or mineral as appropriate for the specific diet requirements and/or nutritional status.
  • Fluid Intake: the amount in cubic centimeters (cc.) and types of fluids.
  • Drug/Nutrient Interactions: interactions that may increase/decrease absorption of the nutrient/drug, and increase/decrease toxicity of medication, and decrease effect of drugs.
  • Environmental assessment related to nutrition include factors that affect nutritional status, e.g., no working refrigerator, no indoor plumbing, etc.
  • Level of Understanding of Diet: Understanding of dietary needs of patient/significant other.

Patient Education

Patient education in pregnancy is very important in helping women, particularly women at risk to learn appropriate compliance behaviors aimed at appropriate outcomes. Patient education provides the following:

  • Anticipatory guidance for expectations of pregnancy
  • Clear directions for compliance with regimens aimed at delivering quality care, with assurance of positive outcomes
  • Assessment of patient's knowledge base before discussing the following issues:
    • Scope of services provided
    • Laboratory studies likely to be performed
    • Expected course of the pregnancy
    • Signs and symptoms to be reported to the Physician or Nurse-Midwife (e.g. vaginal bleeding, rupture of membrane or decreased /cessation of fetal movement
    • Anticipated scheduled visits
    • Physician coverage of labor and delivery
    • Cost of prenatal care and delivery and services available (e.g. Insurance plan Preparation, WIC,)
    • Recommend practices to promote health maintenance
    • Educational programs available, and provide appropriate referral
    • Discharge planning for mother and child-care
    • Promote and encourage breast feeding
    • Choosing a Pediatrician
    • Danger signs in pregnancy, including signs and symptoms of premature labor
    • Frequency of prenatal visits
    • Childbirth and parenting classes
    • Maternal Nutrition including weight gain, exercise, rest, and fatigue
    • Effects of tobacco, alcohol and drug use on pregnancy outcomes
    • Continued employment, and the work environment's effect on pregnancy.
    • Personal hygiene, oral Health
    • Planning for hospitalization after 26-28th weeks, of pregnancy.
      • Recognizing signs and symptoms of false/true labor
      • Special regimens for women with specific medical conditions or diseases, e.g. Diabetes, Hypertension, Heart disease, HIV
    • Information on the pros and cons of circumcision