Transcript Document
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Content on physical development of the adolescent is covered in the PPT Adolescence based on Chapter 19 of Hockenberry.
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Teen-age Pregnancy adds a whole new set of risks because the adolescent is still developing physically and psychologically
* See birth rates: Figure 17-1 p. 379 Olds, 9 th ed.
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Early Adolescence (14 yrs and <)
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Rapid physical changes:self-centeredness but locus of control is
external—parents and school authorities
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Egocentric
and
concrete thinker
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Fantasy thinker, doesn’t foresee consequences of behavior
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Middle Adolescence (15-17 years)
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Challenges authority—often experiment with drugs, alcohol,
thinks she is invincible
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Locus of control still external—
now peers and support group
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Fluctuates between
wanting
to be adult but
fearing
responsibility
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Moving from
concrete thinker to formal operational thought
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Late Adolescence (18-19 years)
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Thinks abstractly and anticipates consequences
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More confident of personal identity
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Socioeconomic and Cultural Factors
* Poverty, Race * Low educational achievement *
High-Risk Behaviors
* Sense of invulnerability * 46% of all teens 15-19 years have had sex (AGI, 2010) * Media influence—TV, internet, movies, etc.
* Varied sexual practices—multiple partners, STI’s , inconsistent use of contraceptives *
Psychosocial Factors
* Teen may have underlying desire to retaliate against parent, her form of delinquency, but may improve her health choices * Higher risk of mental illness in the future * Int’l Perspective— culture may encourage early pregnancy *
* Physiologic: preterm births, LBW babies, pre eclampsia/eclampsia, iron deficiency anemia, CPD.
early intervention!
Early and consistent prenatal care is essential to a safe care and
* Psychologic: the risk of interruption of progress in her developmental tasks of establishing her own identity (see Table 17-3); different for early, middle, vs late adolescence *
Key to care:
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Be non-judgmental in approach
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Ensure confidentiality
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Integrate teen’s mother/parents in plan of care.
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Evaluate support system and encourage building relationships
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* Sociologic—teen pregnancy may result in prolonged dependence on parents, dropping out of school, poorer job opportunities, single parenting, larger family * Dating violence may be perceived as ‘normal’ in young teen *
Cost to taxpayers: $7 billion each year (Pinkleton et al, 2008)
* Risks to her Child—high rates of family instability, * behavioral problems, * developmental delays, poor success in school, * higher rates of abuse and neglect, and * may in turn become adolescent parent.
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* Research shows that 2/3 of adolescent dads are in their 20’s * Many are in serious, supportive relationship with teen mom, engaged in the whole pregnancy, and present for labor and delivery * Relationships among teens often deteriorate over time partly due to conflicts with baby’s grandparents, financial struggles * Fathers are included in birth certificate, and legal paternity helps with benefits for baby * Some teen moms may want nothing to do w/dad, esp. in cases of rape, incest, or exploited sex. RN must investigate to protect mom and baby—social services referral is indicated.
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Assessment :
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Hx family & personal physical health, OB hx, gyne hx, substance abuse hx
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Developmental health and acceptance of pg
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Family & social support network + or --
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Father of baby’s involvement
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Nursing Dx:
(possibilities)
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Imbalanced Nutrition: less than body requirement R/T poor eating habits
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Risk for Situational Low Self-esteem R/T unanticipated pregnancy
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Nsg Plan and Implementation—early is essential. Establish trust and rapport!
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Community-Based Nursing Care
—helps
provide coordinated care
Nursing coordinates that pulls in all resources available: WIC, Medicaid-if eligible, Social Services and support, teen parenting classes.
teaching
at appropriate cognitive and developmental level
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Social media—Facebook—may be a good venue for teaching
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Issues of confidentiality & consent for care—review
emancipated minor (p. 387) status!
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Development of a trusting relationship with the teen mom—be gentle if this is first pelvic exam. Explain and describe all procedures simply and calmly.
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* Promotion of Self-Esteem & Problem-Solving Skills— * Involve in all decision-making re: plan of care.
* Provide overview of pregnancy; always focus on effect of pregnancy on teen mom because of egocentrism.
* Promotion of Physical Well-being— * Careful monitoring of weight and BP is critical * Discuss realistic weight gain:pp.408-410 and Table 18-1 Dietary References Intake pp. 396-397 for adolescent.
* Figures as high as 50Cal/kg/day for active young adolescents * Iron supplements—30-60mg of iron/day indicated to prevent anemia * Adequate Calcium also essential to prevent hypertension and pre eclampsia, LBW infant. May need to supplement * Assess teen’s eating habits over time not just 24-hr period. Individualize and focus on mom’s health to keep her fit.
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* Protein * Carbohydrate * Calcium * Iron * 71 gms /day 175 g/day 1300 mg/day 27 mg/ day
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Promotion of Physical Well-being
— cont’d * Screen early for STI’s—gonorrhea, chlamydia, candida, Trichomonas, & Gardnerella, syphilis, HIV.
* Discuss substance abuse: tobacco, alcohol, drugs, caffeine.
* Monitor fetal growth: McDonald’s rule, US, quickening, etc.
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Promotion of Family Adaptation
* Assess family system at 1 relationship st prenatal visit. Include pt’s mother as much as she & pt want. Strive to renew or re-establish positive * Assess pt’s mother & father’s involvement * Integrate baby’s father—prenatal visits, prenatal classes, US, health teaching.
* Facilitation of Prenatal Education—prenatal educ’n in HS with school nurse. Keep mainstreamed AMAP. Offer teen birthing classes. Include content on breastfeeding.
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* Hospital-based Nursing Care: respect & support essential * Importance of sustained presence—teen mom’s choice * Provide education to help with choices. Integrate teen dad as much as he wants to be involved.
* Integrate non-pharmacological interventions. Doula might be a great advocate to the adolescent.
* Educate! Educate! Educate! In the postpartum period.
* Safe and effective contraception must be discussed prior to discharge: condoms plus OC, or IUD( ACOG approved 2007), or long-acting OC.
* Discuss community resources to support her—WIC, Lactation Consultant, sx of PP Depression * Return to high school—home tutor required by state of IL for 6 weeks *