The Childbearing Family with Special Needs Flashcards
Teenage Pregnancy: Global Statistics (World Health Organization)
* Approximately 12 million girls aged 15-19 years and at least 777,000 girls under 15 years give birth each year in developing countries
* At least 10 million unintended pregnancies occur each year among adolescent girls aged 15-19 years and in the developing world
* Complications during pregnancy and childbirth (or postpartum) are the leading cause of death for 15-19-year-old girls globally
* Of the estimated 5.6 million abortions that occur each year among adolescent girls aged 15-19 years, 3.9 million are unsafe, contributing to maternal mortality, morbidity, and lasting health problems
* Adolescent mothers (ages 10-19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20-24 years, and babies of adolescent mothers face higher risks of low birth weight, preterm delivery and severe neonatal conditions
United States Statistics
* In 2018, 17.4 births per 1,000 women aged 15-19 years
> Was 24.2 in 2014 per previous literature
> A 2030 Healthy People goal is to reduce this #
* The birth rate for African-American teenagers was nearly twice as high as that for non-Hispanic white teens, while the rate for Hispanic teens was more than twice that for non-Hispanic white teenagers
* 75% of teen pregnancies are unintended
* 55% of adolescents report they have engaged in sexual intercourse by age 19
* 16.3% of adolescents have had one or more previous births
Implications of Teen Pregnancy
* Socioeconomic Implications
> Children are expensive
> Mothers may not have worked before, had a job; are unable to finish school
> 38% will get a high school diploma but only 2% will get any form of collegiate degree by 30
* Maternal Health Implications
> Increased risk for anemia, labor dystocia, preeclampsia, and preterm labor
> Increased risk of violence and STI’s
> Difference in the level of understanding; provide education
* Fetal-Neonatal Health Implications
> See preterm births, low birth weights, higher infant mortality rates and teenagers are more likely to smoke during pregnancy [→ placental insufficiency, IUGR, low birth weight)
* Implications on the Expectant Teenage Father
* Parenting Implications
Delayed Pregnancy - Disadvantages
* The longer you wait, the increased the risk for complications
* May have less energy
* Decreased peer and family support
* Increased need for time off of work
Delayed Pregnancy - Advantages
* Psychosocial maturity
* Established self confidence
* Better sense of control
* May have financial stability and be better at coping and fighting stressors
Implications of Delayed Pregnancy
* More difficulty becoming pregnant after ___ years old (less eggs available and consider partner complications)
* Increased risk of pregnancy complications as well as chromosomal abnormalities such as ___
* Increased presence of uterine myomas (fibroids) which can increase risk of PPH
* Increased risk of obstetrical complications including SAB, cesarean births, preterm delivery, preeclampsia, placenta previa, placental abruption, and stillbirth
* See women get induced = delivering <40 weeks to reduce stillbirths
35
Trisomy 21
Nursing Considerations for Delayed Childbearing
* Preconception Care
> Identify any risks that may be present
* Clarify Information
> Perform diagnostic testing
* Facilitate the Expression of Emotions
> Concerns for fetal and self well-being
* Providing Parenting Information
> Conserve energy; meal planning
Substance Abuse in Pregnancy
Tobacco
* 7.2% of women in the US smoke during pregnancy
* Cigarettes contain nicotine, tar, and harmful gases such as carbon monoxide - which all contribute to decreased oxygenation of the fetus
* Increased rates of SAB, low birth weight infants, premature birth, placental abruption, placenta previa, PROM, perinatal mortality, and SIDS
Alcohol
* Approximately 1 in 12 women report drinking during pregnancy and 1 in 30 pregnant women reports having five or more drinks on one occasion during pregnancy
* Alcohol passes easily across the placenta (also passes easily through breastmilk)
* Can result in fetal alcohol spectrum disorders
* Leading cause of intellectual impairment, and the only one that is preventable
* NO AMOUNT OF ALCOHOL IS SAFE IN PREGNANCY
Marijuana
* Most commonly used illicit drug in the United States
* Active ingredient tetrahydrocannabinol (THC) crosses placenta and accumulates in fetus
* Conflicting studies exist regarding the effects of marijuana use in pregnancy
* Often used in conjunction with other drugs or alcohol
Cocaine
* Physical effects include cardiovascular stimulation and vasoconstriction, so HTN, tachycardia, arrhythmias, tremors, anemia, and anorexia may occur
* Can cause MI, convulsions, and death in the mother
* Women who use are at increased risk for polysubstance abuse, late/no prenatal care, poor diet, and increased risk of STIs
* Risk of ___, SAB, PROM, preterm labor, and precipitous delivery
placental abruption
Cocaine: Signs & Symptoms of Recent Use
* Diaphoresis, HTN, tachycardia, irregular respirations
* Dilated pupils, increased body temperature
* Sudden onset of severely painful contractions
* Fetal tachycardia
* Excessive fetal activity, late decelerations
> Vasoconstriction at the level of the placenta; are decreasing placental sufficiency
* Angry, caustic, abusive reactions and paranoia
Cocaine: Fetal & Neonatal Effects
* Clearance of the drug in the fetus requires a prolonged period of time
* Fetal effects can include hypoxia, tachycardia, HTN, IUGR (from prolonged placental insufficiency), and limb reduction syndrome
* Neonates who were exposed in utero will exhibit CNS signs such as irritability, lethargy, alternating between sleep and agitation, and a poor response to interaction with others or comforting by caregivers
! Monitor for withdrawal
Amphetamines & Methamphetamines
* CNS stimulants that produce effects similar to cocaine but are longer lasting
* Cause vasoconstriction (poor placental sufficiency = hypoxia), HTN, and tachycardia in mother
* Risk of SAB, IUGR, low birth weight, SGA, preterm labor, placental abruption, preeclampsia, and retroplacental hemorrhage [hemorrhaging behind placenta]
* Neonate may have congenital defects like cleft lip/palate, abnormal sleep patterns, agitation, diaphoresis, poor feeding, and vomiting
Caffeine
* Stimulates the CNS and cardiac function; again causing vasoconstriction
* Half-life TRIPLES during pregnancy
* Crosses placental barrier and stimulates the fetus
* 1 cup/day recommended
Antidepressants
* Prescribed during pregnancy for anxiety and depression disorders
! ___ is no longer recommended for use during pregnancy because of reports of congenital malformations
> Prozac, Zoloft often prescribed
* Neonatal effects include transient respiratory distress, irritability, poor tone, and persistent pulmonary HTN
* Long term effects unknown
Paroxetine (Paxil)
Opioids
* Includes: morphine, ___ (illicit), ___ (prescribed), meperidine, hydromorphone hydrochloride, propoxyphene, and oxycodone
* Many women who use ___ prior to pregnancy begin their pregnancy anemic and malnourished. Also have increased risk of STIs, hepatitis, and HIV
* Episodes of withdrawal cause intermittent hypoxia in the fetus, which increases the risk of ___
! Neonatal Abstinence Syndrome (NAS)
heroin; methadone
heroin
meconium aspiration syndrome
Neonatal Abstinence Syndrome
Signs primarily occur in which 3 systems?
Neurologic, respiratory, GI
! Remember: diarrhea and vomiting are life-threatening in the newborn
Intimate Partner Violence
IPV is seen at all educational levels, within all socioeconomic and ethnic groups, and in all areas of the country and world
