eenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female under the age of 20. Pregnancy can occur with sexual intercourse after the start of ovulation, which can be before the first menstrual period (menarche) but usually occurs after the onset of periods.
2. *
*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.
3. *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
4. *
*Socioeconomic and Cultural Factors
*Poverty, Race
*Low educational achievement
*High-Risk Behaviors (CDC Stats)
*Sense of invulnerability
*46% of all teens 15-19 years have had sex, 62% of HS seniors
*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
5. *
*Physiologic: preterm births, LBW babies, pre-
eclampsia/eclampsia, iron deficiency anemia, CPD. Early
and consistent prenatal care is essential to safe care,
early detection, 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
6. *
*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.
7. *
*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.
8. *
*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
9. *
*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.
10. *
*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—27mg of iron/day indicated to prevent anemia
*Adequate Calcium (1300mg/day) 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.
12. *
*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.
13. *
*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
