NURS-354 Final: Lecture 13 (Pregnancy in Special Populations)

Interventions for the Pregnant Teenager

1.) Eliminating barriers to health care. 2.) Applying teaching/learning principles. 3.) Counseling. 4.) Nutrition. 5.) Self-care. 6.) Stress reduction. 7.) Attachment to the fetus. 8.) Breastfeeding. 9.) Promoting family support. 10.) Labor support. 11.) Providing referrals.

Substance Abuse and Pregnancy: Marijuana

1.) Narcotic. 2.) Active ingredient THC crosses placental barrier. 3.) Newborn/Child effects: → Impaired neurodevelopment. ⤷ Decreased attention span. ⤷ Behavioral and learning problems.

Resources

1.) The Compassionate Friends (online). 2.) Empty Cradle of San Diego.

#2 Sample Question

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."

What to say? What not to say?

Your thoughts...

Violence against Women

1.) 1 in 3 women will be abused at some time in their lives. 2.) Violence affects women of all ages, races, ethnic backgrounds, religions, and all socioeconomic and educational levels. 3.) Two most common forms: → 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.

Sexual Assault Statistics

1.) 1 out of every 6 American women has been the victim of an attempted or completed rape in her lifetime. 2.) 9 of every 10 rape victims were female. 3.) Every 2 minutes, someone in the U.S. is sexually assaulted. 4.) Sexual assault is one of the most under reported crimes, with 60% still being left unreported. 5.) Only about 6% of rapists ever serve a day in jail.

Substance Abuse and Pregnancy: Alcohol

1.) 1/3 of women who consume alcohol during pregnancy report binge drinking (2015, CDC). 2.) Alcohol easily crosses placenta. 3.) Fetal Alcohol Spectrum Disorders (FASD). → Characteristics. ⤷ Prenatal and postnatal growth restriction. ⤷ CNS impairment: a leading cause of mental retardation. ⤷ Visually recognizable facial anomalies. 4.) No safe level of alcohol has been established for pregnancy, therefore it is recommended that women abstain.

What is Grief?

1.) A very personal experience. 2.) Misconception that this type of loss is not as relevant as other losses because of lack of interaction with the infant. 3.) 90% of couples who've experienced perinatal loss believe that it was the worst thing that ever happened to them. 4.) No one can share the exact same experience 5.) When parents hear the heartbreaking news that their baby has died in the womb, their grief can be overwhelming. 6.) In a few brief moments, they go from happy anticipation of their baby's birth to the intense pain of confronting his death.

Rape Aftermath (2)

1.) Acute distress with dissociation and amnesia. 2.) Depression and anxiety, anger, numb. 3.) Chronic post traumatic stress syndrome for longer than three months may lead to self injury. 4.) Every rape survivor works through his or her feelings differently. 5.) Talking about the rape in a safe environment is the best way to heal.

Adolescent Pregnancy (1)

1.) Adolescence ranges from age 11 to age 20 years. 2.) Biologic and psychological transition from childhood to adulthood. 3.) 47% of high school students reported they have had sexual intercourse (NCPTUP, 2012). 4.) 1/3 of teenagers who have been pregnant (live birth or abortion) will get pregnant again within 2 years. 5.) High cost: Costs taxpayers $10.9 billion annually (NCPTUP, 2013).

Attributes of Adolescence (1)

1.) 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." 2.) Adolescents often spend much time being self- absorbed.

Cycle of Violence

1.) Although intimate partner violence may be random, there is often a pattern. 2.) The violence occurs in a cycle that consists of three phases: → Tension building. → Battering incident. → Honeymoon. 3.) Being aware of the behaviors that accompany each phase will enable the nurse to counsel the woman.

The Sound of Silence

1.) And no baby cried... 2.) Haunting silence. 3.) Overwhelming emptiness. 4.) The quest for answers. 5.) Why did this happen? Only one quarter to one half of losses can be explained. 6.) Why did this happen to me?

Rape Trauma Syndrome/Violence: Signs/Symptoms

1.) Anxiety or fear, feeling in danger again. 2.) Anger or aggressive feelings and feeling the need to defend oneself. 3.) Trouble controlling emotions because reminders lead to sudden anxiety, anger, or upset. 4.) Feeling shaky and sweaty. 5.) Having your heart pound or having trouble breathing. 6.) Trouble concentrating or thinking clearly. 7.) Trouble falling or staying asleep. 8.) Feeling agitated and constantly on the lookout for danger. 9.) Getting very startled by loud noises or something or someone coming up on you from behind when you don't expect it.

Pregnancy in Special Populations: Substance Abuse (1)

1.) Approximately 1 in 10 women in the US (regardless of socioeconomic status or ethnic background) is currently abusing a substance. 2.) 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. 3.) 1 in 10 infants is exposed to one or more mood altering drugs during pregnancy.

Sexual Assault: The Offenders (1)

1.) Approximately 2/3 of rapes were committed by someone known to the victim. 2.) 73% of sexual assaults were perpetrated by a non-stranger. 3.) 38% of rapists are a friend or acquaintance. 4.) 28% are an intimate. 5.) 7% are a relative.

Pregnancy in Special Populations: Substance Abuse (2)

1.) 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). 2.) Healthcare providers attitudes towards substance abuse & pregnancy?

Adolescent Pregnancy: Risk to Infant & Child

1.) 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. 2.) Children of 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).

Someone's personal story...

1.) Being abused physically isn't what really hurts someone; bruises heal and the pain fades away. 2.) It's knowing that someone you love would hurt you intentionally. 3.) You know that you would never intentionally hurt someone you love, so how could someone you love intentionally hurt you? 4.) So you think that it must be something you do that sets them off, you must be the one creating this anger. Now you think that you've figured it out, you know that you just need to change. You just need to change that one thing you do that makes them so hurt that they lose control and hit you. 5.) So you change...and you change and change and change and change again; you change so much that your friends constantly ask you what's wrong. 6.) Naturally you say nothing and smile. You change so much you become miserable, but it doesn't matter because all you want to do is make your spouse happy. 7.) They take advantage of this knowing that you don't want your relationship to fail and that you'll do whatever it takes to make them happy. 8.) You still refuse to admit to yourself that they don't love you, or that you're being abused. 9.) You become obsessed with trying to make your partner happy. 10.) That's their tool, the abuse was just a way of getting you into that vulnerable state so they can manipulate you emotionally. 11.) You have no confidence in yourself and no faith in your judgment; they make you rely on them to let them to let you know if you're being normal or acting acceptable. 12.) You become withdrawn because you feel that you don't understand people; they try to make it so that you rely on them to function. 13.) They make you believe that you need them so you won't ever leave them. 14.) You trust them completely and believe everything they say because they earned that trust knowing that later they can use it to manipulate and exploit you.

Infant and Child Outcomes

1.) Child (increased risk for). → Neglect and abuse. → Chronic cognitive defects. → Developmental delays. → Chronic behavioral problems. → School failure/withdrawal. → Chronic runaway. → Foster/alternative placement. 2.) Teenager. → Repeat cycle. → Poor school performance. → More likely to be incarcerated.

Adolescent Psychosocial Development

1.) Concrete and abstract thinking occurs over time. 2.) Age parameters for reaching cognitive tasks are for guide only. → Concrete thinking (first): Focuses on the present with little thought to later consequences. → Abstract thinking (second): Ability to connect separate events and understand later consequences. 3.) Adolescents from age 12-14 cannot comprehend the negative consequences that can result from sex. 4.) Adolescents of ages 15-17 think that negative consequences are not likely to happen to them.

Signs and Symptoms of Recent Cocaine Use

1.) Diaphoresis, hypertension, tachycardia, irregular respirations. 2.) Dilated pupils, increased body temperature. 3.) Sudden onset of severely painful contractions. 4.) Fetal tachycardia, excessive fetal activity. 5.) Angry, caustic, abusive reactions; paranoia.

Sample Interview Questions

1.) During any pregnancy were you ever pushed, shoved, slapped, hit, kicked, or otherwise physically hurt by anyone? 2.) During this pregnancy have you been pushed, shoved, slapped, hit, kicked, or otherwise physically hurt by anyone? 3.) Before you were pregnant, had anyone ever forced you to engage in sexual activity? 4.) Since this pregnancy began, has anyone forced you to engage in sexual activity?

The Grieving Family (1)

1.) Families need a chance to grieve separately as well as together. 2.) Some researchers have noted that one person does a lot of "grief work" on his/her own, the family system can be thrown out of balance. 3.) Families need some time to grieve in privacy-some time and space to process their loss without a constant stampede of visitors. 4.) This needs to be balanced with the need for care and support from the community. 5.) Maybe we need to think about having a "family moon" whenever there is a milestone event in our family's lives - kind of like the "honeymoon" or the "baby moon".

Stillbirth Facts

1.) Fetal demise occurs in 1 in 160 deliveries in the US. 2.) 50% occur before the onset of labor. 3.) 24% occur between 20-28 weeks. 4.) Risk factors: → Maternal race. ⤷ African American woman 2X higher than Caucasian. ⤷ Native Americans 26% higher. ⤷ Hispanics 10% higher. ⤷ Adolescent & AMA. ⤷ Obesity. → Multiple gestation. → # of pregnancies (nulliparasat highest risk). → Maternal conditions. → Infections.

The Grieving Family (2)

1.) First-time parents who experience a stillbirth may not have their support networks in place. 2.) Convenient if have a religious affiliation. 3.) They may be new to a community. 4.) Issue of involving the children... 5.) Thoughts???

Primary Care of Abused Women

1.) Forensic nursing provides clear, precise, detailed descriptions of the abuse that occurred. 2.) Oral, vaginal, anal swabs, external, and internal exams. 3.) Inspect for pubic hair, skin surfaces for sperm.

Sexual Assault Reporting

1.) Health care providers are mandatory reporters of all forms of abuse, including sexual abuse. 2.) Immediate medical attention provides the best medical protection and legal evidence. 3.) Evidence will be collected and other injuries will be documented. (Pt may have to return 2X as bruising is most evident 24 hours after the event). 4.) Medical attention is confidential and extremely important. 5.) Advocates are available for support through medical procedures.

Adolescent Pregnancy Rates

1.) In 2011, birth rate for adolescents fell to a historic low level. 2.) Why? More teens using contraceptives at time of first intercourse 3.) US teenage birth rate still the highest of any industrialized nation.

Behaviors Associated with Drug Abuse

1.) Inadequate nutrition. → Poor weight gain. 2.) Inadequate prenatal care. → Late entry or no prenatal care. 3.) Noncompliant. 4.) Often deny use. 5.) Increased incidence of sexually transmitted diseases. → Hepatitis, HIV. 6.) Injuries to the expectant mother and fetus.

Pregnancy in Special Populations: Advanced Maternal Age (5)

1.) Increased risk for: → Trisomy 21 (Down Syndrome). → Low birth weight infant. → Preterm birth. → Miscarriage. → Perinatal morbidity & mortality. 2.) 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.

Major Contributing Factors to Stillbirths in Developed Countries

1.) Infection (10-25%). 2.) Malformations and genetic abnormalities (7-20%). 3.) Placental abruption (15-20%). 4.) Placental insufficiency/IUGR (3-22%). 5.) Often, cause unknown (25-60%).

Safety Planning

1.) Is it safe for the woman and her children to go home? 2.) Are there weapons in the home? 3.) Has there been an increase in the frequency or severity of the violence 4.) Has the woman been hospitalized in the past as a result of the intimate partner violence. 5.) Has the abuser threatened to kill the woman or himself? 6.) Has the woman thought of committing or tried to commit suicide? 7.) Does the abuser hurt the children? 8.) Has the woman attempted or is she planning to leave the relationship.

Clinical Therapy

1.) It usually starts with a report of decreased fetal movement. 2.) IUFD (intrauterine fetal demise) confirmed with lack of fetal heartbeat on ultrasound. 3.) Without intervention, most women will have a spontaneous labor within 2 weeks (risks & complications). 4.) Prompt birth helps with identifying cause of death. 5.) Induction scheduled. 6.) After delivery, the baby and placenta are examined carefully to determine why the death occurred. 7.) Tests to determine cause of death: → Fetal blood tests, x-rays, autopsy, placental studies, chromosome studies.

Attributes of Adolescence (2)

1.) Lack of commitment. → Frequent change of interests. 2.) Peer groups. → Peers often define what is acceptable behavior and what is not acceptable. ⤷ Pregnancy. ⤷ Drug and alcohol use. ⤷ School attendance. ⤷ Physical appearance. ⤷ Extracurricular activities at school or church or in community. 3.) Media. → For many adolescents, the media serves as their primary source of sexual education.

The Loss

1.) Life changes when you see a pair of pink lines on a pregnancy test strip. If it's good news, your life becomes a 38-40 week countdown to holding your future, safely swaddled in your arms. You read books, you post sonogram pictures on the fridge, you make plans for a nursery, you put your name on child care center waiting lists. 2.) You don't plan for the doctor to tell you your future has no heartbeat. You don't plan to deliver a baby who will never open his eyes. You don't plan on coming home with an urn of ashes instead of a bag of diapers.

Adolescent Fathers

1.) Most teen fathers educationally disadvantaged. → High school drop outs. 2.) More of these fathers suffer from. → Behavior problems. → Academic problems. → Drug abuse problems. → Low paying job.

Trauma in Pregnancy

1.) Most trauma during pregnancy is cased by accident, assault or suicide. 2.) Blunt (MVA) or penetrating (gunshot wound). 3.) Most common cause of fetal death due to trauma is maternal death. 4.) Therapeutic management. 5.) Care for life threatening injuries of mother. 6.) Nursing Considerations. 7.) Maternal stabilization then fetal stabilization.

Grief

1.) Mother's Grief. 2.) Father's Grief. 3.) Children's Grief. 4.) Grandparent's Grief.

Myths & Realities of Violence Against Women (2)

1.) Myth: → Women "like" it or they would leave. → Couples counseling is a good recommendation for abusive relationships. → Battered women will be safer when they are pregnant. 2.) Realities: → Women are threatened with severe punishment or death if they attempt to leave; many have no resources and are isolated, and they and their children depend on the abuser. → Couples counseling is ineffective for the couple. It can be dangerous for the abused woman. → Battering may occur for the first time during pregnancy or may escalate in intensity if the woman is already being abused. Why?? Many researchers and advocates believe that batterers are threatened by a pregnancy because the fetus interferes with the abuser's ability to maintain power and control within the relationship.

Myths & Realities of Violence Against Women (1)

1.) Myths: → It only affects a small percentage of the population. → Violence against women occurs only in lower socioeconomic classes and minority groups. → The problem is really "partner abuse," couples who assault each other. → Alcohol and drugs cause abusive behavior. → The abuser is "out of control." → The woman "got what she deserved." 2.) Realities: → Battering is the single major cause of injury to women (1.5 million women each year). → Violence occurs in families from all social, economic, educational, racial and religious backgrounds. → Approximately 95% of serious assaults are male against female; violence against women is about control and power. → Substance abuse and violence against women are two separate problems. Substance abuse is a disease but violence is a learned behavior that can be unlearned. → He is not out of control. He is making a decision, because he chooses who, when and where he abuses. → No one deserves to be beaten. No one has the right to beat another person. Violent behavior is the responsibility of the violent person.

Intimate Partner Violence: Assessment Findings Suspicious of Abuse

1.) Nonverbal cues. → Facial grimacing, vomiting, abdominal pain. 2.) Injuries. → Welts, bruises, swelling, lacerations, burns. → Multiple injuries often at different stages in healing. 3.) Somatic complaints. → Anxiety, depression, panic attacks. 4.) Discrepancy between history and injury type. 5.) Other cues. → Unwilling to make eye contact with health provider. → Unwilling to remove clothing in front of health provider (may be due to embarrassment or may be an attempt to hide injuries).

Nursing Role in Adolescent Pregnancy (2)

1.) Nurses are in a good position to assist teenagers by providing information and by teaching problem solving skills. 2.) Try to provide consistency in care givers (getting used to different providers may be a barrier for them to utilize available services). 3.) Education: → Body changes. → Development of infant in utero and after birth. → Breastfeeding and bottle feeding education.

Substance Abuse and Pregnancy: Tobacco

1.) Occurs during 20 - 30% of pregnancies. 2.) Causes vasoconstriction of vessels & reduces placental blood flow. → Resulting in reduced oxygen to the fetus. 3.) Increases risk for: → IUGR/Prematurity/low birth weight. → Placenta previa. → Abruptio placenta. → PROM. → Delayed neurological functioning. → High risk for ADD/ADHD. → 2x risk for SIDS. 4.) Second hand smoke around children increases risk of: → Ear infections, respiratory tract illnesses. 5.) About 50% of women quit for pregnancy, but 60-80% resume smoking within 1 year.

Substance Abuse in Pregnancy: Heroin

1.) Opiate derived from morphine. 2.) CNS depressant. 3.) Risk for STI's, HIV, and Hepatitis. 4.) Maternal effects: → Poor appetite. → Anemia/poor health. → Increased risk of preeclampsia, preterm labor, PROM & meconium staining. 5.) Fetal Effects: → Hypoxia → Prematurity → IUGR → Risk for stillbirth 6.) Neonatal/Newborn: → Neonatal abstinence syndrome. ⤷ Restlessness. ⤷ Lack of habituation. ⤷ Shrill, high-pitched cry. ⤷ Irritability. ⤷ Fist sucking. ⤷ Vomiting. ⤷ Seizures. 7.) Developmental/Learning delay. 8.) Prone to abuse & neglect by parent.

Grief & Loss in the Childbearing Family

1.) Please be aware that there are pictures of infants who have died. 2.) You may be excused if the experience is too much.

Care of the Grieving Family in Hospital (1)

1.) Provide the family with an private, quiet place in which to reflect on their loss and view their infant. 2.) Give opportunity to see, hold, and touch their infant at any time before, during, and after death. 3.) Allow family to verbalize feeling of emotion and use important listening skills. 4.) Offer quiet condolence or, just BE THERE (physical presence). 5.) Have photographs taken with their baby. 6.) The family may not wish to have these photos or mementos right away so keep them for a time in case the parents come back for them.

Intimate Partner Violence (1)

1.) Referred to as intimate partner abuse, domestic violence, domestic abuse, spouse abuse, or wife battering. 2.) Controlling behavior is often seen in intimate partner violence. → Examples of this? 3.) 1 in every 4 women has been physically assaulted or raped by an intimate partner at some point in her life. Women eight times as likely to be abused than men.

Abuse

1.) Remember that abuse includes physical as well as emotional abuse. 2.) Men are also in abusive relationships. 3.) Male/male & female/female relationships may be abusive as well. 4.) The focus here is on the male as the abuser to the woman.

Pregnancy in Special Populations: Advanced Maternal Age (4)

1.) Reproductive system efficiency declines with older age. → 95% decrease in fertility in women age 40-45. 2.) Increased frequency of diseases with older age. → Diabetes, hypertension, obesity. 3.) If the woman has no existing health problems, her risk during pregnancy is not appreciably higher than that of the general population (Davidson, et al, 2016).

Teen Pregnancy and Parenting

1.) Risk for poor parenting. → Cause undetermined. ⤷ Premature births attribute to poor parenting. ⤷ Low socioeconomic status. ⤷ Status of home environment. 2.) Less sensitive to infant cues for care. 3.) Less interaction with infant. 4.) Disillusioned about infant care, time and difficulty. 5.) Are not instrumental in seeking out ways to gain information about infant care. 6.) Teen mothers do not do as well parenting if father is not involved.

Substance Abuse and Pregnancy: Nursing Care Management

1.) Screen all pregnant women. 2.) Be matter-of-fact & nonjudgmental. 3.) Assess woman's understanding of impact of use on pregnancy. 4.) Focus on ongoing assessment & patient teaching. 5.) Discuss strategies to help quit & treatment options. 6.) Postpartum: → Tox screen the baby. → Collect first urine "bag" the baby. → If positive, refer to social services.

Phases of Bereavement

1.) Shock & Numbness. → "This is all a bad dream." → Parents have difficulty making choices. → Usually lasts about 2 weeks. 2.) Searching & Yearning. → 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. 3.) Disorientation. → Usually seen as depression. → During first week, but may last months to years. → Intensifies and subsides. → Regrieving may happen especially during holidays & birthday anniversaries. 4.) Reorganization. → Numbness wears off, reality of loss. → 18 mo to 2 years.

Substance Abuse and Pregnancy: Cocaine (1)

1.) Short-acting CNS stimulant. 2.) Causes vasoconstriction. 3.) Increased heart-rate. 4.) Increased blood-pressure. 5.) Increased oxygen consumption. 6.) Maternal risks. → Preterm labor. → Abruptioplacenta. → High incidence of spontaneous abortion. → PROM, Stillbirth. → Precipitous delivery. 7.) Fetal risks. → IUGR. → Marked irritability. → Microcephaly. → Increased risk of SIDS.

Teen Pregnancy and Fetal/Neonatal Wellbeing

1.) Teen mothers more likely to smoke while pregnant → Resulting in IUGR, preterm birth, low birth-weight (25% of LBW infants born to teen moms who smoke). 2.) Why IUGR, prematurity, low birth weight? → Poor placental perfusion caused by preeclampsia. → Underdeveloped vasculature of the uterus in the young, teen mother.

Sexual Assault: The Offenders (2)

1.) The average age of a rapist is 31 years old. 2.) 52% are white. 3.) 22% of imprisoned rapists report that they are married. 4.) Juveniles accounted for 16% of forcible rape arrestees in 1995 and 17% of those arrested for other sex offenses. 5.) In 1 in 3 sexual assaults, the perpetrator was intoxicated. 6.) 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. 7.) 84% of victims reported the use of physical force only.

Rape Aftermath (1)

1.) The trauma of rape is associated with extreme distress. 2.) Highly-qualified doctors and nurses would provide forensic examinations. 3.) Will be given the morning-after pill. 4.) Testing for sexually transmitted infections. 5.) Psychological support extremely important.

Remind victim of sexual assault not to ...

1.) Wash. 2.) Shower. 3.) Change clothing. 4.) Douche.

What is Stillbirth?

1.) When fetal death occurs after 20 weeks of pregnancy, it is referred to as stillbirth, or a fetal demise. 2.) A fetal death prior to 20 weeks is a miscarriage, or spontaneous abortion.

Adolescent Psychosocial Development: Normal Tasks of Adolescence

1.) When pregnant as a teen, physical development as well as developmental tasks of adolescence are interrupted. 2.) Developmental tasks: → Identity formation. → Sexual identity. → Vocational identity. → Developing intimacy in relationship. → Developing a sense of achievement. → Gaining independence. 3.) Cognitive development tasks: → Development of intellectual reasoning. → Being able to reason from concrete to abstract thinking. → According to Piaget, consistent problem solving skills and abstract thinking is not seen until age 18.

Adolescent Pregnancy (2)

1.) Why is this population considered "special?" 2.) 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. 3.) Pregnancy does motivate some teens to stay in school and do well for the baby/become more goal oriented ("old 16").

Pregnancy in Special Populations: Advanced Maternal Age (1)

>35 years of age

#3 Sample Question

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?"

Intimate Partner Violence: Significance in OB

Abuse increases risk for: 1.) Spontaneous abortion. 2.) Placenta abruption. 3.) Premature labor. 4.) Low birth weight. 5.) Fetal death. 6.) Increased rates of maternal depression and suicide.

Remember...

As nursing student and nurses, we are mandated reporters of any type of violence against adults or children ... no one deserves to be abused.

Pregnancy in Special Populations: Families with a Child with Congenital Anomalies

Birth of an infant with congenital anomalies: 1.) Timing and manner of being told. 2.) Prior knowledge of the defect. 3.) Type of defect. 4.) Grief and mourning. 5.) Promoting bonding and detachment. 6.) Providing accurate information. 7.) Facilitating communication. 8.) Preparing for discharge.

Nursing Role in Adolescent Pregnancy (4)

Communication Techniques. 1.) Asking open-ended questions: → What are your concerns? → What is the worst thing you have heard about. 2.) Adolescents should be asked about what their friends or kids at school are doing (direct questions about themselves can make them uncomfortable). 3.) Nurses can teach adolescents problem solving skills that include how to deal with social pressures, how to negotiate and refusal skills.

Nursing Role in Adolescent Pregnancy (3)

Counseling: Must be sensitive to feelings, concerns, & needs of teenager. 1.) Provide community resources to teen parent(s). 2.) Support to the teen parents and their parents. 3.) Assess teen parents plan for the future of the infant and living arrangements. 4.) Assess teen parents plan for themselves if they have not finished school.

Factors Contributing to Adolescent Pregnancy (4)

Debate about teaching about birth control in sex education classes. 1.) 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. 2.) 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).

Pregnancy in Special Populations: Advanced Maternal Age (2)

Delayed Childbirth: 1.) Advantages. → Financial resources. → Psychosocial maturity. → Self-confidence. 2.) Disadvantages. → Anxiety about antepartum testing. → Pregnancy complications. → Exhaustion.

Pregnancy in Special Populations: Advanced Maternal Age (3)

Dramatic increase in this pregnant age group: 1.) Reasons. → 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.

Nursing Role in Adolescent Pregnancy (1)

Education for Safe Sex Practices: 1.) Many adults are hesitant to discuss contraception with teenagers that are not sexually active. 2.) Studies show that talking about contraception DOES NOT cause teenagers to engage in sexual activity 3.) Studies have shown that early education about contraception actually DELAYS the first sexual encounter. 4.) Studies show that early adolescence (11-years-old) is the best time to teach safe sex practices, well before the onset of sexual activity.

Care of the Grieving Family in Hospital (2)

Give the family mementos of their infant/save mementos even if family does not want them at the time of infant death. 1.) Photos. 2.) Blankets. 3.) ID bracelets. 4.) Lock of hair. 5.) Ultrasound pictures. 6.) Foot and hand prints. 7.) Crib card. 8.) Tape measure.

Factors Contributing to Adolescent Pregnancy (5)

High-risk Behaviors: 1.) Younger adolescents unable to foresee consequences. 2.) Take more risks because they don't think they will become pregnant. 3.) Have a sense of invulnerability "it won't happen to me." 4.) Peer pressure. 5.) Nearly ½ of all new cases of STIs in ages 15-24. 6.) Inconsistent use of contraceptives.

Substance Abuse in Pregnancy: Infant Characteristics

Infants born to substance abusers often have the following characteristics: 1.) Poor feeding. → Cant coordinate suck, swallow. 2.) Poor sleep. 3.) Difficulty handling physical stimulation (holding). 4.) Hyperactive reflexes. 5.) High-pitched cry.

The Grieving Family (3)

It is particularly important for friends, family members, and health care professionals working with these parents to help them to tap into both formal and informal supports in the community.

Factors Contributing to Adolescent Pregnancy (1)

Knowledge (deficit): 1.) Many have little knowledge about their own anatomy & physiology. 2.) Often are misinformed by other teenagers. 3.) Intercourse often unplanned/not prepared with contraception. 4.) Many adolescent girls have irregular periods, so they think they can't become pregnant. 5.) Many do not understand contraception techniques & can become pregnant due to lack of information. → Examples of this?

Factors Contributing to Adolescent Pregnancy (2)

Misinformation: 1.) Many think they can't become pregnant the first time they have intercourse. 2.) Use of douching after intercourse-sperm may enter cervix soon after ejaculation. 3.) Coitus interruptus - requires control over timing of ejaculation than most adolescent boys have. 4.) 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.

Substance Abuse and Pregnancy: Cocaine (2)

Newborn/neonatal effects: 1.) Low birth weight. 2.) Tremors. 3.) Tachycardia. 4.) Irritability. 5.) Muscle rigidity. 6.) Poor response to outside stimuli such as noise or voice. 7.) Hyperactive reflexes especially Moro reflex. 8.) Poor feeders. 9.) Frequent diarrhea. 10.) Continued developmental delays throughout life. 11.) Learning difficulties. 12.) Delayed motor and language.

Pregnancy in Special Populations: Advanced Maternal Age (6)

Nursing Care of Older Women: What's different? 1.) Prenatal testing. 2.) Genetic counseling (possibly if advanced paternal age as well; associated with increased risk of learning disorders & autism). 3.) Prescreening (before pregnancy) for physical and psychological problems. 4.) Education: → Related to risks to mother and infant. → About the birth process to alleviate fears. 5.) Refer to support groups of women in same age group.

Implications of Teenage Pregnancy for Maternal Health

Pregnant teens are at increased risk for: 1.) Preterm birth. 2.) Low birth weight babies. 3.) Pre-eclampsia. 4.) Anemia. 5.) High weight gain or low weight gain. 6.) High incidence of STI's. → Increases risk to fetus. 7.) Being in an abusive relationship. 8.) Substance abuse.

Factors Contributing to Adolescent Pregnancy (6)

Psychosocial Factors: 1.) Family dysfunction. 2.) Poor self-esteem. 3.) In pregnancy in the very young, suspect incest or sexual abuse. 4.) Physical, emotional & sexual abuse are risk factors increasing likelihood of adolescent pregnancy. 5.) Many don't seek prenatal care, or are noncompliant.

Pregnancy in Special Populations: Adoption

Relinquishing the newborn to the care of another family for adoption. 1.) A painful decision that can produce long-lasting feelings of ambivalence and sorrow. 2.) An act of love, not one of abandonment. 3.) Nurses must be prepared for and respect any special wishes the mother may have about the birth.

Intimate Partner Violence (2)

Significance in OB: 1.) Violence may start or increase in frequency during pregnancy. 2.) Incidence during pregnancy is between 1 & 20%. 3.) In more than 50% of homes where the woman is abused, the children are also injured.

Factors Contributing to Adolescent Pregnancy (3)

Socioeconomic & Cultural Factors: 1.) Poverty. 2.) Lack of economic opportunity. 3.) Social marginalization. 4.) Higher teen birth rate among African American & Hispanic teens.

Nursing Role in Adolescent Pregnancy: Communication

Techniques: Research has shown that the most effective methods of communication with adolescents are frequent, brief, informational chats during teachable moments using interactive communication techniques. 1.) Contraceptive counseling should focus on practical advice instead of repeated education on why contraception is important.

#7 Sample Question

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.

#5 Sample Question

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

#4 Sample Question

The nurse would take which action as part of nursing care for the infant experiencing neonatal abstinence syndrome? A.) Place stuffed animals and mobiles in the crib to provide visual stimulation. B.) Position the baby's crib in a quiet corner of the nursery. C.) Avoid the use of pacifiers. D.) Spend extra time holding and rocking the baby.

#6 Sample Question

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.

#1 Sample Question

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.