*

*

Content on physical development of the adolescent is covered in the PPT Adolescence based on Chapter 19 of Hockenberry.

*

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.

*

*

Early Adolescence (14 yrs and <)

*

Rapid physical changes:self-centeredness but locus of control is

external—parents and school authorities

*

Egocentric

and

concrete thinker

*

Fantasy thinker, doesn’t foresee consequences of behavior

*

Middle Adolescence (15-17 years)

*

Challenges authority—often experiment with drugs, alcohol,

thinks she is invincible

*

Locus of control still external—

now peers and support group

*

Fluctuates between

wanting

to be adult but

fearing

responsibility

*

Moving from

concrete thinker to formal operational thought

*

Late Adolescence (18-19 years)

*

Thinks abstractly and anticipates consequences

*

More confident of personal identity

*

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:

*

Be non-judgmental in approach

*

Ensure confidentiality

*

Integrate teen’s mother/parents in plan of care.

*

Evaluate support system and encourage building relationships

*

* 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.

*

* 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.

*

*

Assessment :

*

Hx family & personal physical health, OB hx, gyne hx, substance abuse hx

*

Developmental health and acceptance of pg

*

Family & social support network + or --

*

Father of baby’s involvement

*

Nursing Dx:

(possibilities)

*

Imbalanced Nutrition: less than body requirement R/T poor eating habits

*

Risk for Situational Low Self-esteem R/T unanticipated pregnancy

*

*

Nsg Plan and Implementation—early is essential. Establish trust and rapport!

*

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

*

Social media—Facebook—may be a good venue for teaching

*

Issues of confidentiality & consent for care—review

emancipated minor (p. 387) status!

*

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.

*

* 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.

*

* Protein * Carbohydrate * Calcium * Iron * 71 gms /day 175 g/day 1300 mg/day 27 mg/ day

*

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.

*

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.

*

* 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 *