*
* 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, 9th
ed.; p. 717, 10th 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
and consistent prenatal care is essential to a safe care and
early intervention!
* 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 that pulls in all
resources available: WIC, Medicaid-if eligible, Social
Services and support, teen parenting classes.
Nursing coordinates 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, 9th ed.; p. 884, 10th ed.) 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 preeclampsia, 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
71 gms /day
* Carbohydrate
175 g/day
* Calcium
1300 mg/day
* Iron
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 1st prenatal visit. Include pt’s mother as
much as she & pt want. Strive to renew or re-establish positive
relationship
* 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
*
*