Running head: PRENATAL TEACHING PLAN

NFDN2004

Prenatal Teaching Plan

Catherine Fedoruk
NorQuest College
Fauziya Ali
NFDN 2004
ID 1015449
Assignment 1
April 1, 2016

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Ruby is a 43 year old woman. She has 2 children, aged 10 and 13. She teaches high school.
She had been having heavy irregular periods and went to see her physician to discuss the
possibility of menopause. A pregnancy test was performed and it came back positive. Her
physical exam confirmed an enlarged uterus and an ultrasound was performed. It confirmed that
she is 16 weeks pregnant. She has come to see you for her first prenatal visit. She currently
weighs 140 pounds. She states that she has gained 5 pounds in the last 3 months. She also states
that she is still shocked that she is pregnant. I believe this information was a shock to Ruby as
she stated she came in assuming she was starting menopause, only to find out that she is
expecting again. This would mean she has to adjust her life differently than she was expecting. I
believe Ruby is in Eriksons developmental stage 7, generative vs. self-absorption and
stagnation. Middle- aged adults should be able to see beyond their needs and accomplishments
and view the needs of society. Dissatisfaction with ones achievements often leads to selfabsorption and stagnation (Potter & Perry, 2010, p. 321). Middle-aged adults need to be
nurturing of the younger generation, and failing to do so can lead to self-indulgence and sense of
stagnation. People who have dedicated themselves to only one role are more likely to have a
narrow perspective and lack the ability to cope with change. As, in Rubys case, her current and
primary roles are to nurture her older children and those children she teaches at work, adjusting
to a unexpected pregnancy could be a difficult task.
An unplanned and unexpected pregnancy can impact Rubys willingness and readiness to
learn because of the unexpected news, and can cause a psychological shock. An unexpected
pregnancy at any age can be overwhelming, but one that comes when you are expecting
menopause and have the mindset that you will not be able to bear children is even more
overwhelming. If Ruby is feeling overwhelmed by the sudden changes, she may be less receptive

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to information, make fewer healthy choices, and be less engaged. Her prior experiences as a
mother and her nurturing attitude as seen by her job description may make her more open to
making the changes needed to provide a healthy nurturing environment for the fetus and, in turn,
the child.
The two health education priorities that I have addressed for Ruby include increasing the
knowledge of adequate nutritional status during pregnancy and preeclampsia due to her age and
span between pregnancies. Due to Rubys age, she has a higher risk for developing preeclampsia.
Typically, women over 40 develop preeclampsia due to poor vessel elasticity. Providing
knowledge or prevention can improve the fetus and mothers outcome during pregnancy.
Preeclampsia is characterized by high blood pressure which damages organ systems, especially
to kidneys and, if left untreated, can cause serious fetal conditions, including fetal death. The
only cure for preeclampsia is delivering your baby; if it is too early for delivery, close monitoring
and other interventions can be done. Teachings will include ensuring adequate nutritional intake
(which we will cover later in this paper), providing adequate rest periods, and the use of
pharmacological substances to control the preeclampsia. Prior treatments included bed rest, the
use of baby aspirin, diuretics, and antihypertensive; these are typically not recommended
anymore and show very little evidence that they in fact help treat preeclampsia. The World
Health Organization is currently developing guidelines for the treatment and prevention of
preeclampsia. Their current recommendations include providing rest periods and increasing
calcium and vitamin C, as well as the use of intravenous or intramuscular magnesium sulphate
regimens (World Health Organization, 2011). Teachings will be done based on doctor
recommendations and will be supplemented with the use of pamphlets so she may review them

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in her own time. Having the patient repeat teachings she learnt about treatments and preventions
checks that she has retained the teachings.
Women in their mid-life tend to eat food low in calcium, protein and folic acid. Ensuring
an adequate nutrition during pregnancy ensures the health of both mother and baby. It is
important to stress that eating for two is a myth and only an additional 300 calories are needed
to meet the body requirements for pregnancy. Choosing foods rich in calcium, protein and folic
acid will help meet nutritional needs. The Canadian Food Guide recommends at least 71g of
protein daily, 200-300mg of omega-3 fatty acids daily, and at least 150g of cooked fish weekly. I
have also recommended that Ruby increase her vitamin C and calcium intake, along with her
prenatal vitamins to help prevent preeclampsia. These nutrients help with cell formation and
prevent neural tube defects. I would use handouts, along with the Canadian Food Guide as a
visual aid and teaching guide for Ruby to assist her in making healthier choices. I have also
recommended she keep a daily food journal, as this will give us a clinical baseline for her food
consumption as well as provide Ruby with a visual guide to see what she is eating. It is
recommended to focus on nutrition counselling and maintain adequate nutrition during
pregnancy, based on the lifestyle changes for women over 40 (Pilletteri, 2014, p. 318).
Two health education priorities I have assessed for Ruby are taking prenatal vitamins and
attending a prenatal course. Importance needs to be placed on taking prenatal vitamins, as
women over 40 are at risk for chromosomal abnormalities and neural tube defects with
pregnancy. Neural tube defects include spina bifida and anencephaly. They occur when the
neural tube does not close completely during the third and fourth week of pregnancy. Even
though Ruby is beyond this time frame, studies have shown that a prenatal vitamin can aid in
reduced incidences of cleft lip or palate as well as other birth defects. Teachings would include

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the use of visuals such as pamphlets, websites to aid in learning as well as suggesting a prenatal
course, where they discuss the use of prenatal vitamins in reducing neural tube defects. Teaching
will also include adjusting the time the vitamins are taken if she experiences any gastric irritation
with the vitamins. This can include taking the vitamins with meals, before bed, or trying a
different brand in the event of GI irritation. Reducing the side effects of her prenatal medications
can help increase compliance in regards to taking the vitamins as prescribed.
Attending a prenatal class will also be beneficial for Ruby. Her youngest child is 10 years
old, and she may feel out of place due to age. Joining a prenatal class with similar aged women
may help her feel greater support and less stress with the unexpected pregnancy. Such classes
for this age group are often on how to avoid complications such as varicosities, how to integrate
pregnancy with full-time work, and supplying discussion time on how women are reacting to this
dramatic life change (Pillitteri, 2014, p. 603). I would encourage her to attend this prenatal class
and provide her with information about upcoming classes located near her home or work. I
would also provide brochures about different prenatal classes in the area, and health websites on
a variety of prenatal topics. Encouraging her to attend these classes will help her feel better about
her pregnancy and ensure she feels ready for it at this stage in life.
The second one is to help Ruby to change her attitude towards having an infant with her
busy schedule and incorporate this new role into her life. It will be important to emphasize to
Ruby that she can find a way to balance both work and family, to discuss her plans for after the
birth, and to help inform her of childcare arrangements or daycare programs in order to help her
feel more prepared. Helping pregnant women to balance work, incorporate rest periods
throughout the pregnancy, and to help prepare for the arrival of the new born is important
support (Pillitteri, 2014, p. 281). To help Ruby address these concerns, I would review with her

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how to adjust her schedule to include rest periods, meals, and leisure time during her pregnancy
so she would have a more enjoyable pregnancy and would help her balance work. Teaching
Ruby to plan a schedule to help her balance both family and work is an appropriate teaching
strategy, as women of this age can feel ambivalent about their pregnancy and work life;
discussing this conflict and how it feels can help her to balance her life and manage two life
phases (Pillitteri, 2014, p. 602). I also would teach Ruby about how to find adequate child care
once the baby is born, such as by informing her of different child care agencies, and encourage
her to use the help of family and friends.
I believe these strategies will be beneficial for Ruby. Currently, the shock of the
unexpected pregnancy may be affecting her ability to be an active participating patient. The use
of visual devices such as brochures and websites allow her to read them over when she has time
and is willing to participate in her prenatal care.

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References
Pillitteri, A. (2014). Maternal and child health nursing: Care of the childbearing and
childrearing family (7th ed.). Philadelphia: Lippincott Williams & Wilkins.
Potter, P. A., & Perry, A. G. (2010). Canadian Fundamentals of Nursing (4th ed. Rev.). Ross-Kerr,
J. C., & Wood, M. J. (Canadian ed.). Toronto, ON: Elsevier.
World Health Organization. (2011). WHO recommendations for prevention and treatment of preeclampsia and eclampsia. Retrieved from https://www.guideline.gov/content.aspx?id=39
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