ch 15 adolescent pregnancy

health promotion education

- Classes about growth and development, beginning with the newborn and early infancy, can help teenage parents have more realistic expectations of their infants and may help decrease child abuse. -Some schools provide infant and toddler child care facilities -Prenatal education and mentoring are essential because teens frequently encounter ambivalence, anxiety, stress, and depression during their pregnancies -During prenatal classes, offer information on breastfeeding, which has significant health benefits for both the adolescent mother and her infant.

promotion of self esteem and problem solving skills

-Assist the adolescent in her decision-making and problem-solving skills so that she can proceed with her developmental tasks and be-gin to assume responsibility for her own as well as her newborn's life. -An overview of what the young woman will experience over the prenatal course, along with thorough explanations and rationale for each procedure as it occurs, will foster the adolescent's understanding and give her some measure of control.

early adolescence - psychosocial development

- (age 14 and under), psychosocial development is marked by rapid physical changes that bring about selfcenteredness and start the struggle for independence. - sees authority as resting with the parents. -perceives her locus of control as external; that is, her destiny is controlled by others, -begins the process of "leaving the family" by spending more time with friends, especially friends of the same sex -Conformity to peer group standards - struggling to become comfortable with her changing body and body image and to fit this image with her fantasy life -very egocentric and is a concrete thinker

recommendations for parents to help teen avoid pregnancy

- Parents should be clear about their own sexual attitudes and values in order to communicate clearly with children. 2. Parents need to talk with their children about sex early and often and be specific in the discussions. 3. Parents should supervise and monitor their children and teens with well-established rules, expectations, curfews, and standards of behavior. 4. Parents should know their children's friends and their families. 5. Parents need to clearly discourage early dating as well as frequent and steady dating. 6. Parents should take a strong stand against allowing a daughter to date a much older boy; similarly, they should not allow a son to develop an intense relationship with a much younger girl. 7. Parents need to help children set goals for their future and have options that are more attractive than early pregnancy and childrearing. 8. Parents should show their children that they value education and take school performance seriously. 9. Parents need to monitor what their children are reading, listening to, and watching. 10. It is especially important that parents build a strong, loving relationship with their children from an early age by showing affection clearly and regularly, spending time with them doing age-appropriate activities, building children's self-esteem, and having meals together as a family often.

risks to teen mothers - sociologic

- adolescent mother is at higher risk for social and economic disadvantages than her teenage counterpart who is not pregnant and lives in the same social environment. -Being forced into adult roles before completing adolescent developmental tasks causes a series of events that may result in a prolonged dependence on parents, lack of stable relationships with the opposite sex, and lack of economic and social stability. -lack of education; incomplete schooling -Some pregnant adolescents choose to marry the father of the baby, who may also be a teen -Dating violence is often an issue for teens, especially for younger girls dating older boys; interpret such actions as hitting, pushing, and making verbal threats as signs of love, caring, and a deep commitment to the relationship that will ultimately produce long-term positive results. -delaying these births could result in significant savings because of the improvement in both education and occupational status of these young women. -The increased incidence of maternal complications, premature birth, and LBW babies among adolescent mothers also has an impact on society because many of these mothers are on welfare.

assessment - pregnant teen

- history of family health and personal physical health, developmental level and impact of pregnancy, and emotional and financial support; assess the family and social support network and the father's degree of involvement in the pregnancy. -ask very specific questions and give examples if the young woman appears confused about a question. -Family and personal health history • Medical history • Menstrual history • Obstetric and gynecologic history • Substance abuse history -assess the maturational level of each person. -The mother's self-concept (including body image), the teen's relationship with the significant adults in her life, her attitude toward her pregnancy, and her coping methods in the situation are just a few of the significant factors that need to be assessed. - It is important to ask specifically about dating violence. -have information about expectant adolescents' feelings and perceptions about themselves, their sexuality, and their coming babies

risks to teen mother - psychologic

- interruption of progress in her developmental tasks; young woman has an overwhelming amount of psychologic work to do, the success of which will affect her own and her newborn's future -early adolescent's response reflects her level of development, with pregnancy as an interruption of the normal process of development. -middle and late adolescent responds differently, reflecting her maturational progress through the developmental tasks. -the amount of nurturing the pregnant adolescent receives is also a critical factor in the way she handles pregnancy and motherhood

Factors contributing to adolescent pregnancy - socioeconomic & cultural factors

- poverty is a major risk factor for adolescent pregnancy. In fact, 85% of births to unmarried teens occur to those from poor or low-income families -the adolescent birth rate is higher among African American and Hispanic teens than among white teens. -Higher levels of competence cognitively, behaviorally, and socially tend to have a protective effect on adolescent sexuality and reproductive health; Intelligence and academic ability are positively associated with delayed sexual activity, greater use of contraception, and lower rates of pregnancy -Low educational achievement is another major risk factor for adolescent pregnancy. -Family obligations, which compete with the time and energy needed to attend school, and a lack of vocational opportunities may influence poor teens' misuse of contraception -adolescents who have had an abortion or recent birth become pregnant again within two years

risks to teen mother - physiologic

- teenage mothers are more likely to smoke than older pregnant women and less likely to gain sufficient weight during their pregnancy. Thus risks for pregnant adolescents include preterm births, low-birth-weight (LBW) infants, preeclampsia-eclampsia and its sequelae, iron deficiency anemia, and cephalopelvic disproportion (CPD) -Iron deficiency anemia is a problem in all pregnant women. The adolescent who begins her pregnancy already anemic, however, is at increased risk and must be followed closely and counseled carefully -Teenagers 15 to 19 years old have a high incidence of STIs including herpes virus, syphilis, and gonorrhea.

areas of concern for pregnant teens

- • Discomforts of pregnancy • Healthy diet during pregnancy • Body image issues • The birth process, especially coping with pain • Newborn care • Health dangers for the baby • How to recognize when the baby is ill • How to keep the baby safe from accidents • How to make the baby feel happy and loved • How to be a good parent • Sexuality • Peer relationships • Challenges of teen parenting • Importance of continuing education after the birth

Middle adolescence - psychosocial development

-(15 to 17 years) is the time for challenging authority. -Experimentation with drugs, alcohol, and sex is a common method of rebellion -struggles for independence and challenges the family's values and expectations. -seems like a child; at other times she is surprisingly mature -move from concrete thinking to formal operational

Late adolescence - psychosocial development

-(18 to 19 years), the young woman is more at ease with her individuality and decision-making ability. -think abstractly and anticipate consequences. -more confident of her personal identity. -capable of formal operational thought -ability to understand and accept the consequences of her behavior. -learning to solve problems, to conceptualize, and to make decisions

partners of adolescent mothers

-Adolescent males tend to become sexually active at an earlier age than females, and they have more sexual partners in their teenage years; has not yet completed the developmental tasks of his age group and is no better prepared psychologically to deal with the consequences of pregnancy than the adolescent mother. -Teenage father-hood may lead to a decrease in the years of schooling the male receives and increases the rate of cohabitation and early marriage. - The adolescent who attempts to assume his responsibility as a father faces many of the same psychologic and sociologic risks as the adolescent mother. -many adolescent couples are involved in meaningful relationships. Adolescent fathers may be very involved in the pregnancy and may be present for the birth. - Fathers are being included on birth certificates far more frequently today than in the past. This helps ensure the father's rights and encourages him to meet his responsibilities to his child. - In some situations, the pregnant adolescent may not want to identify or contact the father of the baby, and the father may not readily acknowledge paternity. Those situations include rape, exploitative sexual relations, incest, and casual sexual relations - further investigation required -In situations in which the adolescent father wants to assume some responsibility, healthcare providers should support him in his decision. - If the adolescents perceive that they have a caring relationship, the adolescent father may want to be supportive and protective but probably does not understand the physical and psychologic changes that his partner is experiencing - need education regarding pregnancy, childbirth, child care, and parenting; Mentoring programs can be useful tools -not unusual for her to want her mother as her primary support person during labor and birth. -the nurse should assess the young man's stressors, his support systems, his plans for involvement in the pregnancy and childbearing, and his future plans. He should be referred to social services for an opportunity to be counseled

hospital based nursing care

-Adolescents want their care provider to be respectful, caring, and supportive. You must be readily available and should answer questions simply and honestly, using lay terminology. -encourage him to work within his own level of comfort to play an active role in all phases of the birth process, perhaps by feeding ice chips to the mother, timing her contractions, and coaching her with her breathing. -Before discharge, it is important to provide information about the resumption of ovulation and the importance of contraception. -Condoms are by far the most common method of contraception among teens - Healthcare providers often recommend a dual approach to prevent pregnancy and STIs—a condom combined with a second method of contraception, typically a hormonal method such as a combined oral contraceptive

issues of confidentiality and consent to care

-An adolescent may be considered emancipated if he or she is self-supporting and living away from home, married, pregnant, a parent, or in the military service. -All states either explicitly allow minors to give consent for their children's medical care or have no policy about it

promotion of family adaptation

-Assess the family situation during the first prenatal visit and ascertain the level of involvement the adolescent desires from each of her family members and the father of the child as well as her perception of their present support. -help the mother assess her daughter's needs and assist her in meeting them. -father of the adolescent's infant can be included to promote the family's successful adaptation to the pregnancy. He may be asked to attend prenatal visits, classes, and health teaching and to be present at the birth itself and involved to the extent that he wishes and that is acceptable to the teenage mother.

risks to teen mother - risks for her child

-Children of adolescent parents are at a disadvantage in many ways because teens are not developmentally or economically prepared to be parents. -children of teenage mothers are at a developmental disadvantage -Many factors contribute to these differences, especially the adverse social and economic conditions many teenage mothers face. -these children do not do as well in school and are less likely to complete high school. -Children born to adolescent mothers also have higher rates of abuse and neglect and are more likely to become adolescent parents themselves

adolescence - psychosocial development

-Developing an identity • Gaining autonomy and independence • Developing intimacy in a relationship • Developing comfort with one's own sexuality • Developing a sense of achievement -need to "try on" various roles in a process of experimentation and exploration as adolescents grapple with ideas about who they want to be and how they want to live. - Teens work to separate themselves from their parents to establish their own identity, and they begin to express themselves with music, clothing, and hairstyles.

factors contributing to teen pregnancy - psychosocial factors

-Family dysfunction and poor self-esteem are also major risk factors for adolescent pregnancy. -may use pregnancy for various subconscious or conscious reasons: to punish her father and/or mother, to escape from an undesirable home situation, to gain attention, or to feel that she has someone to love and to love her; woman's form of acting out -Teenage pregnancy can result from an incestuous relationship. In the very young adolescent, incest or sexual abuse should be suspected as a possible cause of pregnancy. -Teenage pregnancy could also be caused by other nonvoluntary sexual experiences such as acquaintance rape. These experiences often lead the teen herself to engage in risk-taking behaviors such as smoking and alcohol consumption and may lead to mental health problems such as depression.

reactions of family and social support to teen pregnancy

-In families who foster educational and career goals for their children, adolescent pregnancy is often a shock. Anger, shame, and sorrow are common reactions. - In populations in which adolescent pregnancy is more prevalent and more socially acceptable, family and friends may be more supportive of the adolescent parents. -For some male partners of these adolescent mothers, pregnancy and the birth of a baby are seen as a sign of adult status and increased sexual prowess—a sense of pride. -The mother of the pregnant adolescent is usually among the first to be told about the pregnancy. She becomes involved with decision making, especially with the younger adolescent, about issues such as maintaining the pregnancy, abortion, and dealing with the father-to-be and his family. -Efforts to persuade adolescent patients that they should involve their parents in their medical care may be very beneficial; -Once the decision about the pregnancy has been made, it is usually the mother who helps the teen access health care and accompanies her to her first visit. -The nurse can update the pregnant teen's mother on childbearing practices to clarify any misconceptions she might have. - The younger the adolescent when she gives birth, the more she needs her mother's support.

community based nursing care - teen pregnancy

-Nurses in all community-based agencies can help adolescents access the healthcare system as well as social services and other support services (i.e., food banks and the Special Supple-mental Food Program for Women, Infants, and Children [WIC]). - teaching adolescents in groups according to their ages may be more effective for learning -Soliciting ideas from the teens themselves and identifying their values may also contribute to better education and success of programs for pregnant teens.

development of a trusting relationship

-Provide a thorough explanation of the procedure. A gentle and thoughtful examination technique will help the young woman to relax. -Honesty and respect for the individual and a caring attitude promote self-esteem.

goals for prenatal classes

-Providing anticipatory guidance about pregnancy. • Preparing the participants for labor and birth. • Helping participants identify the problems and conflicts of teenage pregnancy and parenting. • Increasing self-esteem. • Providing information about available community resources. • Helping participants develop more adaptive coping skills.

factors contributing to teen pregnancy - international perspective

-The highest birth rates are found in sub-Saharan Africa and in some parts of Latin America and South Asia. -adolescent women are more likely to welcome a pregnancy in a country where Islam is the predominant religion, where large families are desired, where social change is slow in coming, and where most childbearing occurs within marriage. -the rates of adolescent child-births have dropped significantly in most regions and countries. -a significant number of girls in developing countries have experienced coercive (forced) sex

adolescence - physical changes

-growth spurt, weight change, and the appearance of secondary sexual characteristics. -Menarche, or the time of the first menstrual period, usually occurs in the last half of puberty, with the average age between 12 and 13.

Prevention of Adolescent Pregnancy

-increase the use of contraception by sexually active teens, and reduce the number of their sexual partners. - importance of encouraging abstinence while also providing counseling on risk-reduction approaches including the use of latex condoms for every act of sexual intercourse; emphasizes the need to ensure ready access to contraceptive services and appropriate follow-up. -provision of services that ensure accessible and high-quality reproductive health care; sex education programs that provide developmentally appropriate, evidence-based curricula; and youth development strategies to enhance life skills, connection to supportive adults, and educational and economic opportunities -National Campaign to Prevent Teen and Unplanned Pregnancy (NCPTUP) - reduce the proportion of unplanned pregnancies among women under age -Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) - focus on adolescent pregnancy prevention. -comprehensive programs that support both abstinence and the use of contraceptives and condoms

promotion of physical well being

-may be encouraged to take part in her care by measuring and recording her weight. -introduce the subject of nutrition during measurement of baseline -Preeclampsia-eclampsia is the most prevalent medical complication of pregnant adolescents; characterized by high blood pressure, proteinuria, and edema. -Adolescents have an increased incidence of STIs. The initial prenatal examination should include gonococcal and chlamydial cultures and wet prep for Candida, Trichomonas, and Gardnerella. - discuss substance abuse with adolescents. It is important to review the risks associated with the use of tobacco, caffeine, drugs, and alcohol. -Special attention should be paid to evaluating fetal growth by determining when quickening occurs and by measuring fundal height, fetal heart tones, and fetal movement. I

nursing care mgmt for pregnant teen

-recognize that missed appointments are not unusual. -Teens may avoid health care because they are underinsured, are uninsured, or lack the funds to pay for care.

factors contributing to teen pregnancy - high risk behaviors

-sense of invulnerability that leads to the mistaken idea that harm will not befall them. This sense of invulnerability and "it won't happen to me" thinking -tremendous peer pressure to become sexually active during the teen years. Premarital sexual activity is commonplace, and teenage pregnancy is more socially acceptable today -The Internet provides teens with unlimited access to information about sex as well as a steady supply of people willing to discuss it with them. These experiences and images feed the adolescent's rich fantasy life and may glamorize unprotected intercourse as proof of "true love." -sexting, in which teens and young adults use electronic activity to send or post sexually suggestive text and images. - incidence of oral sex is increasing. - Adolescents, however, remain inconsistent contraceptive users. Many teens lack accurate and adequate knowledge about contraceptive options.