The Childbearing Family with Special Needs Flashcards
(27 cards)
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
Birth of an Infant with Congenital Anomalies - Nursing Considerations
* Large emotional component for the parents
* Evokes a grief response; allow families to mourn
* Nursing Considerations:
> Assist with the grieving process
> Promote bonding and attachment
> Provide accurate information
> Facilitate communication
> Participate in infant care
> Provide referrals
Adoption/Relinquishment
* Varying relationships between adoptive parents and birth parents
* Adoption is an act of love, not one of abandonment
* Allow the birth mother any amount of involvement she wishes with the infant at birth
* Prepare to teach adoptive families newborn care
Abuse is more common during pregnancy than is preeclampsia, diabetes, or other commonly screened pregnancy complications, with the greatest risk being after birth
* Intimate partner violence
* Greatest risk is after birth of child
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
___ abuse is controlling the money and making the victim account for any money spent
___ abuse causes the victim to feel shame, loss of self-respect, and powerlessness as the abuser blames the victim for the abuse
___ abuse may involve threats, slapping, or pushing, and may escalate to punching, kicking, and beating that results in internal injuries or wounds from weapons or death
Economic
Emotional
Physical
___ abuse is controlling the victim from where they can go and who they can see
___ abuse, including rape, is often part of physical abuse. Reproductive coercion may also occur
Social
Sexual
Cues Indicating Violence Against Women
Nonverbal: facial grimacing; slow and unsteady gait; vomiting; abdominal tenderness; absence of facial response
Injuries: welts; bruises; swelling; lacerations; burns; vaginal or rectal bleeding; evidence of old or new fractures of the nose, face, ribs, or arms
__ __ __: anxiety; depression; panic attacks; sleeplessness; anorexia
Discrepancy between history and type of injuries: wounds that do not match the woman’s story; multiple bruises or lacerations in various stages of healing; bruising on arms; old, untreated wounds
* 1 in 3 women experience domestic violence by their partners
Vague somatic complaints
