Question

Renee is a 21-year-old African American woman in her 35^th week of pregnancy. She is married and the mother of two young children. Her pre-pregnancy BMI was 18.1. She has gained 24 pounds since becoming pregnant, but at her most recent prenatal visit, she was found to have lost a pound over the past week. She says that her weight loss is due to “stress.” Renee says she enjoys eating canned spinach cooked in tomato sauce with chopped onions and craves “Napoleon” flavored ice cream. Her 24-hour recall is as follows:

Breakfast:	16 oz kiwi strawberry drink
Lunch:	16 oz lemonade 1½ baked chicken breast 3 cups canned spinach cooked in canned tomato sauce and onion 2 slices of carrot cake with cream cheese frosting
Snack:	8 oz whole milk 1 peanut butter and jelly sandwich
Dinner:	16 oz decaffeinated tea 5 oz beef and rice dinner 4 scoops Neapolitan-style ice cream
Snack:	24 oz water 1 buttermilk biscuit

1. Why can’t the nurse use Renee’s current weight to calculate a BMI for her?

2. Considering Renee’s pre-pregnancy BMI, what weight gain goals would you give Renee?

3. Plot Renee’s weight gain on the prenatal weight-gain grid (Figure E-1, Appendix E of your text). What is your assessment of her weight gain?

4. What other factor besides energy intake from foods could cause a pregnant woman to gain weight?

5. On reviewing her 24-hour dietary recall, what suggestions might you have for Renee about:

a. her food choice for breakfast?

b. her intake of fruits and vegetables?

c. her intake of concentrated sweets?

d. increasing her calcium intake?

Answer 1

Answers:

1. The nurse can't use Renee's current weight because of her pregnancy state. Her 24-hr diet recall was rich in fat and empty calorie which profuse her weight gain.

2. Her pre-pregnant BMI is 18.1 which shows underweight. An underweight woman should gain 28 to 40 pounds during pregnancy. The goal is to reach a weight gain of at least 1 pound per week in the remaining pregnancy state.

3. Assessment of weight gain:

• Weight gain by week
• weight gain by trimester.
• Pre-pregnancy weight and nutritional status
• Nutritional status during pregnancy
• Attain of the recommended range of total weight.

4. Factors that cause a pregnant woman to gain weight:

• stress
• Gestational diabetes
• Lack of physical activity
• unhealthy eating behaviors.

5. a. Her breakfast does not meet nutritional demands. Breakfast should include of iron and vitamins. Fiber content should be included in breakfast.

b. Variety of vegetables to be included in her daily diet. Fruit should be taken as a whole or as fresh juice. Avoid taking in the form of cakes and ice creams.

c. Concentrated sweets increase her glucose level and increase body fat. Avoid taking of sweetened beverages to avoid excessive fat in her daily diet. This will increase her empty calories.

d. Calcium is necessary during pregnancy and lactation. A pregnant woman should meet at least 1000mg/day. she must include milk, yogurt, broccoli, dried peas, and beans to meet the requirements.