Objectives. Discuss the incidence of and factors which contribute to adolescent pregnancy.Discuss the physiological and psychosocial consequences of pregnancy for the teen mom and dad.Discuss the developmental tasks interrupted by adolescent pregnancy.Identify data needed for the assessment of th
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1. Lecture Four: Adolescent Pregnancy NURS 2208
T. Dennis RNC, MSN
2. Objectives Discuss the incidence of and factors which contribute to adolescent pregnancy.
Discuss the physiological and psychosocial consequences of pregnancy for the teen mom and dad.
Discuss the developmental tasks interrupted by adolescent pregnancy.
Identify data needed for the assessment of the pregnant adolescent.
Formulate diagnosis and select interventions for the adolescent patient.
3. Physical Changes of Adolescence Puberty lasts from 1.5 to 6 years.
Generally coincides with adolescence.
Signs include a growth spurt, weight change, and the appearance of secondary sexual characteristics.
First menstrual period usually evidenced in the last half of the maturing process (average age between 12 and 13).
4. Psychosocial Development Does not occur simultaneously with puberty (particularly cognitive development).
Developmental tasks are significant during the transition from child hood to adulthood.
5. Developmental Tasks Developing an identity
Gaining autonomy and independence
Developing intimacy in a relationship
Developing comfort with one’s own sexuality
Developing a sense of achievement
6. Early Adolescence Age 14 and under
Authority seen in parents
Spends more time with friends
Peer pressure (clothes, behavior)
Rich fantasy life
Struggling with body image (real and perceived)
Egocentric, concrete thinker
7. Middle Adolescence Age 15 - 17 years
Rebellious- possible experimenting with drugs, alcohol, and sex
Turns to peers
Believes he or she is invincible; does not recognize consequences
Wants to be treated as an adult
8. Late Adolescence Age 18 - 19 years
More at ease with individuality and decision-making
Thinks abstractly and anticipates consequences
More confident of personal identity
Feels more in control
9. Statistics Over 1 million teenage
girls in the United States
become pregnant each
10. Statistics ….continued Most teen pregnancies are unplanned
1/3 are terminated by therapeutic abortion
14% end in miscarriage
More than 1/2 choose to keep infants
Very few choose adoption
11. Statistics….continued Birth rate for adolescents dropped steadily from 1991 to 1996
US continues to have the highest rate of adolescent childbearing among industrialized nations..3 times that of France and 9 times that of Japan
Sexual activity among adolescents is same
12. WHY……? Family influences
Greater openness about sexuality
Better access to contraceptives
More comprehensive approach to sex education
13. Contributing Factors Peer pressure
Sexually active early
Poor birth control use
Escape home To have someone to love
Cultural beliefs and customs
14. Partners of Adolescent Mothers Almost 1/2 of partners of pregnant teens are 20 years of age or older
Similar to adolescent fathers socio-economically and developmentally
Face negative reactions
Sign paternity forms
Participate in birth but may not be key
May not continue relationship after infancy
15. Physiologic Risks Pre-term births (STD’s, Drugs, Alcohol)
Low Birth Weight (LBW) infants
Pregnancy Induced Hypertension (PIH) and sequelae
Iron deficient anemia
Cephalopelvic Disproportion (CPD)
16. Psychological Risks The most profound risk is the interruption of the progress in developmental tasks.
Not only does the adolescent have to accomplish the tasks of adolescence but also the tasks associated with becoming a mother.
17. Sociologic Risks Prolonged dependence on parents
High school drop out
Never completes education
Fails to establish a stable family
Have more children during adolescence
Majority of adolescent marriages end in divorce
18. What is the result? Family instability
Poor academic performance
Higher rates of behavior problems
Increased incidence of abuse and neglect
6.9 billion healthcare dollars spent
More families on welfare
19. Responses and Social supports Varied…anger, excitement depending on family goals
Mother of pregnant adolescent is typically first told
Mother helps obtain healthcare
May participate in childbirth classes, delivery and post-partum care
May care for infant after hospitalization
20. Nursing Care Management Remember …adolescents think differently than adults.
Adolescents tend to be more concrete thinkers than adults and tend not to plan ahead.
Have more difficulty anticipating consequences.
May have missed appointments.
Must be highly motivated to access healthcare without a parent for pregnancy, STD’s or birth control.
21. Nursing Assessment Family and personal health history
Developmental level (age appropriate)
Obstetric and Gynecologic history
Substance abuse history
Social/emotional/financial support systems
Father’s degree of involvement
22. Nursing Diagnosis Altered Nutrition: Less than body requirements related to poor eating habits
Self-esteem Disturbance related to unanticipated pregnancy.
23. Nutritional Concerns Nutritionally at risk by ADA
Teens are more likely to be underweight
Low weight gain
Consider the number of years since menarche…adolescents who become pregnant fewer than 4 years after menarche are at a high biologic risk because of their physiologic and anatomic immaturity.
24. Specific Nutrient Concerns Adequate Iron Intake…iron supplements of 30 to 60 mg of elemental iron.
Vitamin C enhances iron absorption.
Calcium Supplement for clients with aversions or allergies to milk or milk products.
A low-dose vitamin and mineral supplement may be necessary.
25. Nursing Plan and Implementation Community-Based Care Early prenatal care
Early Intervention Program
Right from the Start Medicaid
Perinatal Case Management (PCM)
Pregnancy Related Services (PRS)
Counseling and Education
26. Issues of Confidentiality Emancipated minors: An adolescent may be considered emancipated if he or she is self-supporting, living away from home, married, pregnant, a parent or in the military.
Has the right and responsibility to consent to healthcare.
Has a right to confidentiality and respect.
27. Developing a Trusting Relationship Important….motivate the adolescent to attend her prenatal visits as scheduled with the physician or the clinic.
Be attentive and positive…she may not come back.
First pelvic…..educate, be considerate, use a mirror.
Honesty, respect and a caring attitude can make the difference in self-esteem and self-care.
28. Promote Self-Esteem Education, explanations and rationale of the prenatal course fosters a feeling of control over the pregnancy process.
Actively involving the client in plan of care gives a sense of participation and responsibility.
Focus on healthcare habits that affect the client and the fetus.
29. Promote Physical Well-Being Baseline weight and Blood pressure
Baseline hemoglobin and hematocrit
Nutrition education about weight gain and iron deficient anemia
PIH is the most prevalent medical complication of pregnant adolescents
Serology test (increased incidence of STI’s)
30. Promotion of Family Adaptation Assess family situation
Determine level of involvement of family , father and mother
Include in prenatal visits, classes, ultrasounds and delivery process
Include in post-partum education
31. Facilitation of Prenatal Education Mainstreaming in schools
Growth and development classes
Keep teaching simple,direct and important to immediate needs
Keep class age specific (more responsive to own age group)
Use a variety of teaching strategies (Breathing techniques, exercises, models)
32. Hospital Based Care Adolescent’s mother is often present during labor and birth
Sexual partner (may be father/may not)/Girlfriends present
Ask the mother who her support person is for the labor process
Be a sustained presence
Prior to discharge, focus on contraception
Educate concerning community resources
33. Support During Birth Each labor is different
Has there been prenatal care?
Attitudes and feelings about pregnancy?
Age specific needs met/unmet?
Expectations and fears?
Education: teach adolescent clients in a format focusing directly on issues important to them (acne, good looks, weight control, etc.).
Review prenatal history
Recognize risk factors (PIH, CPD, LBW infants, Drug abuse, STIs)
Provide support and positive reinforcement
35. Prevention of Adolescent Pregnancy 1980’s Abstinence Only Programs funded
National campaign to prevent Teen pregnancy in 1996 supported by professional organizations
Community Challenges…agreeing to disagree
Address poverty, low educational achievement, poor self-esteem, and high-risk factors
36. Post-Partum Care of the Adolescent Assess maternal/infant interaction
Assess roles of support people
Plan for discharge
Community health service (PRS)
Provide care at the bedside
Give positive feedback
Provide group classes/support groups
37. Questions? Angel Davis is 15 years old and has come to the clinic for her third prenatal visit. She tells the nurse, “ I’ve been thinking about this pregnancy thing and I think it will be neat to have a little baby. This baby will be mine to love and love me back.” How should the nurse respond to the client?
“Babies are a lot of work”
“Tell me how you think things may change after the baby is born.”
“I know, I can’t wait for you to deliver.”
“Do your mom and dad agree with this idea?”
38. References Whitney, E., Rolfes, S. 1996. Understanding Nutrition. West Publishing Company: St. Paul, MN (pg. 43,81-82).