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High Risk Nutrition Care Plan Guidelines 7

• Counsel based on assessment findings. • Make referrals according to Section 3.5 of the WIC Procedure Manual, specifically for smoking cessation and substance abuse, as appropriate.

Documentation: • Check “High Risk Education” on the Nutrition Education screen under Nutrition Education Topics and enter “Hypertension or Prehypertension” under Topic Status. • Document the specific details regarding the nutritional assessment and nutrition care plan in the Nutrition Assessment field on the Care Plan Summary. This includes documentation of any prescribed medications and current medical care plan.

Recommendations for the WIC CPA: • Learn about and reinforce the health care team’s plan of care and encourage participants/caregivers to keep all appointments and take any prescribed supplements, including prenatal vitamins, or medications as directed. • Encourage improved intake of vegetables, fruits, whole grains, low-fat or fat-free dairy products, fish, poultry, beans, and nuts. • Encourage limited intake of foods that are high in saturated fats (such as fatty meats, full-fat dairy products, and tropical oils) and sugar-sweetened beverages and sweets. • Encourage regular physical activity. • Achieve and maintain a healthy weight. *Note: a low sodium diet and/or weight loss is not recommended during pregnancy. Pregnant women should be encouraged to focus on healthy weight gain. • Breastfeeding should be strongly encouraged unless contraindicated. Studies show the longer a woman breastfeeds, the less risk she has for developing HTN.

Risk 372 Alcohol and Substance Use (Woman)

Prenatal women with any alcohol, illegal substance use and/or abuse of prescription medications and/or any marijuana use in any form. Breastfeeding or postpartum women with any illegal substance use and/or abuse of prescription medications and/or high risk (routine consumption of >8 drinks per week or >4 drinks on any day) or binge (routine consumption of >4 drinks within 2 hours) drinking of alcohol. Any marijuana use in any form by breastfeeding women.

Substance use is known to lead to vitamin and mineral deficiencies that threaten physical and mental health, damage vital organs and the nervous system, and decrease immunity. Malnutrition occurs when the substance replaces other dietary nutrients or as a result from improper nutrient metabolism, absorption, utilization, or excretion even though the diet may be adequate. Harmful lifestyles are often associated with addiction, such as poor eating patterns, lack of exercise, and changes in sleep patterns. These compounding factors result in