Mod 13: Pregnancy in Special Populations
The nurse determines that teaching about SIDS has been effective when the client makes which statement? A. "No definite cause of death is found at autopsy." B. "Infants who sleep on their backs are more at risk for SIDS." C. "Bottle-feeding causes SIDS" D. "Genetic disorders are the cause of SIDS"
"No definite cause of death is found at autopsy."
what happens in the shock and numbness phase
"this is all a bad dream" Parents have difficulty making choices. Usually lasts about 2 weeks
violence against women factoids
1 in 3 women will be abused at some time in their lives Violence affects women of all ages, races, ethnic backgrounds, religions, and all socioeconomic and educational levels
phases of bereavement
1. Shock & Numbness 2. Searching & Yearning 3. Disorientation 4. Reorganization
what percent of high school students reported having sexual intercourse
47%
abstract thinking
Ability to connect separate events and understand later consequences
disadvantages of delaying childbirth
Anxiety about antepartum testing Pregnancy complications Exhaustion
risks to babies born to adolescent mothers
At greater risk for preterm birth More likely to be low birth weight Higher infant mortality rate More likely to grow up without a father
why is tobacco use bad during pregnancy
Causes vasoconstriction of vessels & reduces placental blood flow Resulting in reduced oxygen to the fetus
Factors Contributing to Adolescent Pregnancy: misinformation
Many think they can't become pregnant the first time they have intercourse Use of douching after intercourse-sperm may enter cervix soon after ejaculation Coitus interruptus- requires control over timing of ejaculation than most adolescent boys have Some teens will develop their own contraception methods if money is an issue or if they listen to unknowledgeable peers Douching with Coca-Cola after intercourse Saran Wrap for a makeshift condom
Fetal Alcohol Spectrum Disorders (FASD) Characteristics
Prenatal and postnatal growth restriction CNS impairment: a leading cause of mental retardation Visually recognizable facial anomalies
does alcohol cross the placenta
alcohol easily crosses the placenta
what comes first: concrete or abstract thinkning?
concrete is first then abstract
Factors Contributing to Adolescent Pregnancy
knowledge deficit misinformation socioeconomic and cultural factors debate about teaching about birth control in sex education classes high-risk behaviors psychosocial factors
when a teen is pregnant...
physical development as well as developmental tasks of adolescence are interrupted According to Piaget, consistent problem solving skills and abstract thinking is not seen until age 18
adolescent age range
ranges from age 11 to age 20 years these years are the Biologic and psychological transition from childhood to adulthood
sexual assault statistics
1 out of every 6 American women has been the victim of an attempted or completed rape in her lifetime 9 of every 10 rape victims were female Every 2 minutes, someone in the U.S. is sexually assaulted. Sexual assault is one of the most under reported crimes, with 60% still being left unreported Only about 6% of rapists ever serve a day in jail
adolescent pregnancy factoids
1/3 of teenagers who have been pregnant (live birth or abortion) will get pregnant again within 2 years The baby is more likely to grow up and also be a teen mom High cost: costs taxpayers $10.9 billion annually (NCPTUP, 2013)
Alcohol use during pregnancy factoid
1/3 of women who consume alcohol during pregnancy report binge drinking (2015, CDC) No safe level of alcohol has been established for pregnancy, therefore it is recommended that women abstain.
advanced maternal age defined as ...
> 35 years of age
About ____% of women quit for pregnancy, but _____% resume smoking within 1 year
About 50% of women quit for pregnancy, but 60-80% resume smoking within 1 year
Does marijuana cross the placental barrier
Active ingredient THC crosses placental barrier also note that this slide states marijuana is a narcotic
Attributes of Adolescence
Adolescent often described from parents as Self-centered, Lazy, Irresponsible, Forgetful Recent studies show that teen lack of "doing chores" is due to immature synapse development resulting in inability to "multitask." Adolescents often spend much time being self- absorbed Lack of commitment and frequent changes of interest Peer groups Media: for many, the media serves as their primary source of sexual education
adolescents and consequences factoids
Adolescents from age 12-14 cannot comprehend the negative consequences that can result from sex. Adolescents of ages 15-17 think that negative consequences are not likely to happen to them.
Pregnancy in Special Populations: Substance Abuse factoids
Approximately 1 in 10 women in the US (regardless of socioeconomic status or ethnic background) is currently abusing a substance It is important for the nurse to keep that in mind: Ask important questions about drug use. Be alert for the signs of substance abuse 1 in 10 infants is exposed to one or more mood altering drugs during pregnancy As many as two-thirds of all people in treatment for drug abuse report that they were physically, sexually, or emotionally abused during childhood (National Institute on Drug Abuse & Addiction, nd)
sexual assault offender stats
Approximately 2/3 of rapes were committed by someone known to the victim 73% of sexual assaults were perpetrated by a non-stranger 38% of rapists are a friend or acquaintance 28% are an intimate 7% are a relative The average age of a rapist is 31 years old. 52% are white 22% of imprisoned rapists report that they are married Juveniles accounted for 16% of forcible rape arrestees in 1995 and 17% of those arrested for other sex offenses In 1 in 3 sexual assaults, the perpetrator was intoxicated In 2001, 11% of rapes involved the use of a weapon — 3% used a gun, 6% used a knife, and 2 % used another form of weapon 84% of victims reported the use of physical force only
The nurse suspects that a patient who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman is very emotional and hesitant in responding to the questions, verbally she denies abuse. While waiting for the results of the pregnancy test, the nurse decides to teach the patient about partner abuse anyway. The rationale for the nurse's decision is that all women should be informed about what? A. The nurse's ethical responsibility to protect patients B. The cycle of violence, which continues and escalates over time once it begins C. Women's legal right not to be controlled by men D. The masochistic nature of women who stay in abusive relationships
B. The cycle of violence, which continues and escalates over time once it begins
What would be an appropriate interpretation by the nurse when a substance abusing pregnant woman presents herself for prenatal care? A. She is ready to stop abusing illegal substances B. She must be reported to the authorities C. She recognizes the need for caring interventions D. She will lack appropriate parenting skills
C. She recognizes the need for caring interventions
The plan of care for a pregnant client who experienced an unexplained IUFD during her last pregnancy should include which of the following? Select all that apply A. Education about the causes of IUFD for both parents B. Encouragement to think positively and not dwell on the previous fetal loss C. Support for increased fears as this fetus reaches the gestational age of the previous fetal loss D. Facilitation of grieving the lost fetus through carrying a photo and a lock of hair at all times E. Asking open-ended questions to determine how the parents are coping and identify any concerns
C. Support for increased fears as this fetus reaches the gestational age of the previous fetal loss E. Asking open-ended questions to determine how the parents are coping and identify any concerns
A client who admits to substance abuse during pregnancy tells the nurse, "I know I am really just a weak person, but I will try to cut down while I am pregnant." Which response by the nurse would be the most therapeutic? A. "I am concerned about you and your baby. What can I do to help you." B. "I don't believe that you are weak at all. You just need to say no to drugs." C. "I have heard that before. You need to get serious now or your baby will suffer." D. "That is a very positive plan. Could you tell me more about feeling like a weak person?"
D. "That is a very positive plan. Could you tell me more about feeling like a weak person?"
The client who had a stillborn infant at term has come to the clinic for her postpartal exam accompanied by her husband. What should the nurse anticipate at this time? A. Both parents will express their grief in the same way B. The parents will use similar coping mechanisms C. The parents will be in the same grief work stage D. The parents will have differences in how they are grieving
D. The parents will have differences in how they are grieving
cognitive developmental tasks in adolescents
Development of intellectual reasoning Being able to reason from concrete to abstract thinking
Signs and Symptoms of Recent Cocaine Use
Diaphoresis, hypertension, tachycardia, irregular respirations Dilated pupils, increased body temperature Sudden onset of severely painful contractions Fetal tachycardia, excessive fetal activity Angry, caustic, abusive reactions; paranoia
Second hand smoke around children increases risk of
Ear infections, respiratory tract illnesses
Interventions for the Pregnant Teenager
Eliminating barriers to health care Applying teaching/learning principles Counseling Nutrition Self-care Stress reduction Attachment to the fetus Breastfeeding Promoting family support Labor support Providing referrals
Factors Contributing to Adolescent Pregnancy: Psychosocial Factors
Family dysfunction Poor self-esteem In pregnancy in the very young, suspect incest or sexual abuse Physical, emotional & sexual abuse are risk factors increasing likelihood of adolescent pregnancy Many don't seek prenatal care, or are noncompliant
advantages of delaying childbirth
Financial resources Psychosocial maturity Self-confidence
concrete thinking
Focuses on the present with little thought to later consequences
primary care of abused women
Forensic nursing provides clear, precise, detailed descriptions of the abuse that occurred Oral, vaginal, anal swabs, external, and internal exams Inspect for pubic hair, skin surfaces for sperm
fetal effects of heroin use
Hypoxia Prematurity IUGR Risk for stillbirth
fetal risks of cocaine use
IUGR Marked irritability Microcephaly Increased risk of SIDS
tobacco use during pregnancy increased risk for
IUGR/Prematurity/low birth weight Placenta previa Abruptio placenta PROM Delayed neurological functioning High risk for ADD/ADHD 2x risk for SIDS
developmental tasks in adolescents
Identity formation Sexual identity Vocational identity Developing intimacy in relationship Developing a sense of achievement Gaining independence
Newborn/Child effects of marijuana use during pregnancy
Impaired neurodevelopment Decreased attention span Behavioral and learning problems
Behaviors Associated with Drug Abuse
Inadequate nutrition (Poor weight gain) Inadequate prenatal care (Late entry or no prenatal care) Noncompliant Often deny use Increased incidence of sexually transmitted diseases (Hepatitis, HIV) Injuries to the expectant mother and fetus - abusive relationship is common
two most common forms of violence against women
Intimate partner violence (domestic violence) Worldwide 35% of all women 38% of all female murders perpetrated by an intimate partner Sexual assault (One of the most underreported violent crimes in the US)
The negative consequences associated with unintended pregnancies are greater for teen parents and their children.
Less likely to finish high school Less likely to go to college More likely to be single Less likely to receive child support More likely to live in poverty More likely to require public assistance Pregnancy does motivate some teens to stay in school and do well for the baby/become more goal oriented ("old 16")
reasons for the dramatic increase in the age group of >35 having babies
Longer life-span Effective, available contraception Women in the workforce Delayed first marriage Frequency of divorce and remarriage Infertility advancements Educational opportunities High cost of living: delays childbearing until perceived financial security
Newborn/neonatal effects of cocaine use during pregnancy
Low birth weight Tremors Tachycardia Irritability Muscle rigidity Poor response to outside stimuli such as noise or voice Hyperactive reflexes especially Moro reflex Poor feeders Frequent diarrhea Continued developmental delays throughout life (Learning difficulties, Delayed motor and language)
Factors Contributing to Adolescent Pregnancy: knowledge deficit
Many have little knowledge about their own anatomy & physiology Often are misinformed by other teenagers Intercourse often unplanned/not prepared with contraception Many adolescent girls have irregular periods, so they think they can't become pregnant Many do not understand contraception techniques & can become pregnant due to lack of information
Factors Contributing to Adolescent Pregnancy: Debate about teaching about birth control in sex education classes
Many parents think it's the job of the parents to educate their children about sex, and that providing sex education in schools will promote sexual activity. Research shows that it does not cause kids to have sex earlier, rather it helps teenagers understand the risks of having sex too soon (AGI, 2012)
risks to children born to adolescent mothers
More likely to do poorly in school Increased risk for abuse and neglect More likely to live in poverty Daughters of teen mothers 3X more likely to become teen mothers themselves (NCPTUP, 2014)
Adolescent Fathers
Most teen fathers educationally disadvantaged (High school drop outs) More of these fathers suffer from... Behavior problems Academic problems Drug abuse problems Low paying job
child outcomes from mom who had them in adolescence, increased risk for....
Neglect and abuse Chronic cognitive defects Developmental delays Chronic behavioral problems School failure/withdrawal Chronic runaway Foster/alternative placement
newborn effects from a mom who used heroin during pregnancy
Neonatal abstinence syndrome.... Restlessness Lack of habituation Shrill, high-pitched cry Irritability Fist sucking Vomiting Seizures Developmental/Learning delay Prone to abuse & neglect by parent
what happens in the reorganization phase
Numbness wears off, reality of loss 18 months to 2 years
tobacco use occurs during ___% of pregnancies
Occurs during 20 - 30% of pregnancies
maternal effects of heroin use
Poor appetite Anemia/poor health Increased risk of preeclampsia, preterm labor, PROM & meconium staining
Infants born to substance abusers often have the following characteristics:
Poor feeding (Cant coordinate suck, swallow) Poor sleep Difficulty handling physical stimulation (holding) Hyperactive reflexes High-pitched cry
Factors Contributing to Adolescent Pregnancy: Socioeconomic & Cultural Factors
Poverty Lack of economic opportunity Social marginalization Higher teen birth rate among African American & Hispanic teens
nursing care of older women: whats different
Prenatal testing Genetic counseling (possibly if advanced paternal age as well; associated with increased risk of learning disorders & autism) Prescreening (before pregnancy) for physical and psychological problems Education about related risks to mom and bb and about birthing process Refer to support group of women in same age group
Pregnant teens are at increased risk for:
Preterm birth Low birth weight babies Pre-eclampsia Anemia High weight gain or low weight gain High incidence of STI's (Increases risk to fetus) Being in an abusive relationship Substance abuse
maternal risks of cocaine use
Preterm labor Abruptio placenta High incidence of spontaneous abortion PROM, Stillbirth Precipitous delivery
teenage outcomes from mom who had them in adolescence, increased risk for...
Repeat cycle Poor school performance More likely to be incarcerated
teen pregnancy and parenting
Risk for poor parenting: Cause undetermined, Premature births attribute to poor parenting, Low socioeconomic status, Status of home environment Less sensitive to infant cues for care Less interaction with infant Disillusioned about infant care, time and difficulty Are not instrumental in seeking out ways to gain information about infant care Teen mothers do not do as well parenting if father is not involved
Substance Abuse and Pregnancy:Nursing Care Management
Screen all pregnant women Be matter-of-fact & nonjudgmental Assess woman's understanding of impact of use on pregnancy Focus on ongoing assessment & patient teaching Discuss strategies to help quit & treatment options
what happens in the searching and yearning phase
Searching for answers Mom might feel phantom fetal movements & hear baby crying, may feel like they're "going crazy" Lasts from 2 weeks after loss to 4 months, longest phase
Effects of cocaine on a woman
Short-acting CNS stimulant Causes vasoconstriction Increased heart-rate Increased blood-pressure Increased oxygen consumption
abuse in OB increases risk for
Spontaneous abortion Placenta abruption d/t physical trauma Premature labor Low birth weight Fetal death Increased rates of maternal depression and suicide
rape aftermath
The trauma of rape is associated with extreme distress. Highly-qualified doctors and nurses would provide forensic examinations Will be given the morning-after pill Testing for sexually transmitted infections Psychological support extremely important. Acute distress with dissociation and amnesia Depression and anxiety, anger, numb Chronic post traumatic stress syndrome for longer than three months may lead to self injury Every rape survivor works through his or her feelings differently Talking about the rape in a safe environment is the best way to heal
consider these when birth of an infant with congenital anomalies
Timing and manner of being told Prior knowledge of the defect Type of defect Grief and mourning Promoting bonding and attachment Providing accurate information Facilitating communication Preparing for discharge
Substance Abuse and Pregnancy: Postpartum Nursing Care Management
Tox screen the baby Collect first urine "bag" the baby (The first void of the baby will have highest concentration) If positive, refer to social services. We try to keep baby with family while mom goes to rehab
advances maternal age comes with an increased risk for...
Trisomy 21 (Down Syndrome) Low birth weight infant Preterm birth Miscarriage Perinatal morbidity & mortality Other than trisomy 21, health risks are more likely for people who have a chronic condition like HTN or diabetes, or who are in poor general health
what happens in the disorientation phase
Usually seen as depression During first week, but may last months to years Intensifies and subsides Regrieving may happen especially during holidays & birthday anniversaries
significants of intimate partner violence in OB
Violence may start or increase in frequency during pregnancy Incidence during pregnancy is between 1-20% In more than 50% of homes where the woman is abused, the children are also injured
Remind Victim of Sexual Assault NOT to:
Wash. Shower. Change clothing. Douche.
what is stillbirth?
When fetal death occurs after 20 weeks of pregnancy, it is referred to as stillbirth, or a fetal demise. A fetal death prior to 20 weeks is a miscarriage, or spontaneous abortion
Factors Contributing to Adolescent Pregnancy: High-risk Behaviors
Younger adolescents unable to foresee consequences Take more risks because they don't think they will become pregnant Have a sense of invulnerability "it won't happen to me" Peer pressure Nearly ½ of all new cases of STIs in ages 15-24 Inconsistent use of contraceptives
does the female reproductive system decline with older age?
yes 95% decrease in fertility in women age 40-45 there is also an increased frequency of diseases with older age (diabetes, HTN, obesity) If the woman has no existing health problems, her risk during pregnancy is not appreciably higher than that of the general population
