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COLLEGE OF NURSING

Silliman University
Dumaguete City

Resource Unit: Care of Adolescent Pregnancy and
Pregnancy 35 years and above

Second Semester, SY 2007-2008
Level III

Submitted by:
Divinagracia, Eden Mae
Javier, Johanna
Nodado, Judee
C4

Submitted to:
Mrs. Kathleah S. Caluscusan

COLLEGE OF NURSING
Silliman University
Dumaguete City

RESOURCE UNIT:

Vision: As a leading Christian Institution committed to total human development
for the well-being of society and environment.

Mission:
• Infuse into the academic learning the Christian faith
anchored on the gospel of Jesus Christ; provide an
environment where Christian fellowship and relationship
can be nurtured and promoted.
• Provide opportunities for growth and excellence in
every dimension of the University life in order to
strengthen character, competence and faith.
• Instill in all members of the University community an
enlightened social consciousness and a deep sense of
justice and compassion.
• Promoted unity among peoples and contribute to national
development.

COLLEGE OF NURSING
Silliman University
Dumaguete City

Resource Unit: Care of Adolescent Pregnancy and
Pregnancy 35 years and above

PLACEMENT: NCM-102 - C4 Ward Class
TIME ALLOTMENT: 2 HOURS
TOPIC DISCRIPTION: This topic deals with the care of adolescent pregnancy. This tackles on its developmental tasks,
causes of adolescent pregnancy, and the preventive measures and nursing care management. Also, this
topic entails the care of pregnant women over the age of 35. It embarks the various complications
associated with this pregnancy and the necessary nursing care interventions.
CENTRAL OBJECTIVE: At the end of 2-hour presentation, the learners shall be able to acquire comprehensive knowledge,
develop competent skills and transpire positive and desirable attitudes and values toward the care
of adolescent pregnancy and pregnancy over 35 years old, thereby promoting optimal well-being.

SPECIFIC CONTENT T-L EVALUATION
OBJECTIVES ACTIVITIES
At the end of
the discussion
PRAYER
and activities,
the learners
shall: INTRODUCTION:

• Be able to Socialized Able to
define at I. Definitions Of Related Terms discussion define the

and exercise. Other serious consequences include an increased understandin likelihood of late or no prenatal care. Pregnancy Over the Age of 35 Pregnancy at ages 35 and above with potential complications. 4.5 and 4. It usually goes away after the baby is born. Once you have type 2 diabetes. Women who have had gestational diabetes are more likely than other women to develop type 2 diabetes later on. Placenta Previa The placenta is implanted in the lower portion of the uterus. 2. most women with gestational diabetes are able to control their blood sugar and give birth to healthy babies. . But with treatment. The normal range of weight at birth is between 2. eat healthy foods. usually occur on the 24th weeks of gestation. Your baby may also be born with low blood sugar. with dark red bleeding. Your baby may grow too large. and decreased employment opportunities. 3. painless uterine contraction.Birth Weight Infants born weighing significantly less than normal are considered to be premature. Low.least 8 of the related related terms 1. unattended births. You may be able to prevent type 2 diabetes if you stay at a healthy weight. 6. Infants of teenage mothers are at greater risk of low birth weight and increased infant mortality. you always have it. which can cause problems during delivery. rather than being breast-fed or fed normal infant formula.5  kg. reduced g with 75% educational attainment. High blood sugar can cause problems for you and your baby. Adolescent pregnancy terms basing in their own Teen pregnancy is one serious consequence of early initiation of on ones words sexual activity. their chances of survival and normal development are considerably improved if they are fed special formula preparations to meet their needs. Gestational Diabetes If your blood sugar level is too high when you are pregnant. competency. you have gestational diabetes.

the only cure is delivery of the baby. any time throughout your pregnancy. It can appear suddenly.7. This disease is characterized by swelling. your care provider will occasionally want to prolong your pregnancy. If you are diagnosed with pre-eclampsia before your baby's due date. Pre- eclampsia. But. and it is unlikely that you will suffer any long-term effects of the disease. without warning. Iron. no matter how ill you become with this disease. your care provider will most likely prepare you and the baby for delivery. and toxemia are essentially interchangeable terms used by your care provider for this disease. This disease can also be chronic. There are medications and treatments to keep you from becoming more ill with the disease. It may be mild or severe.deficiency Anemia Iron deficiency anemia occurs when your body doesn't have enough . Occasionally. but no medications will make the disease go away entirely. early treatment can prolong a pregnancy and lessen complications for both mother and baby. labor. 8. whether it's sudden or gradual. pregnancy-induced hypertension (PIH). Sometimes. the disease eventually goes away. gradually becoming worse over a period of time. there are complications that will require medical attention for a time after you deliver. If you are close to your due date. Pregnancy Induced Hypertension Pre-eclampsia is a disease that only occurs during pregnancy. Your care provider will begin to look for signs of pre-eclampsia during your second trimester and continue through your postpartum period. After delivery. high blood pressure. and the presence of protein in the urine. This may include taking blood pressure medication and frequent follow-up visits with your care provider. or in the early postpartum period. Pre-eclampsia occurs in 5 to 10 percent of all pregnancies.

body type. Changes in the appearance of their bodies may make adolescents feel shy and awkward. and you cannot get enough oxygen. Adolescent Pregnancy Puberty begins between the ages of 9 and 14. Although the sequence of events is universal. Adolescent Pregnancy Socialized • Be able to discussion Able to discuss the A. Hemoglobin carries oxygen through your body. II. from the hypothalamus trigger the secretion of the hormones in the pituitary gland. Preterm labor is also called premature labor. an unfavorable presentation fetal position. In labor. Iron is important because it helps you get enough oxygen throughout your body. Review of the Different Developmental recall the different Task different developmental development task of 1. The first sign of puberty is the growth spurt. Cephalopelvic Disproportion Matching Game A condition in which the fetus is unable to pass safely through the / Picture pelvis during labor because of pelvic contraction. your body makes fewer and smaller red blood cells. . genes. or a large fetal head in relation to pelvic size. A full-term pregnancy lasts 37 to 42 weeks. Physiologic Development task. Hemoglobin is a part of your red blood cells. 10. Your body uses iron to make hemoglobin. 9. such as sex. iron. nutrition and health. Pituitary hormones increase the production of estrogen and progesterone by the ovaries. Then your body has less hemoglobin. This is the first stage of childbirth. the onset of puberty is influenced by many factors. when the hormones thoroughly. Preterm Labor Preterm labor is the start of labor between 20 and 37 weeks of pregnancy. continues over 3-year period. If you do not have enough iron. the uterus contracts to open the cervix. This accelerated growth. which occurs approximately 2 years earlier in females than in males.

These physiologic changes enable the adolescent to reproduce. 2. stimulation of the hypothalamus leads to the secretion of the gonadotropic-releasing hormone (Gn-RH). Egocentric thought prompts adolescent to create imaginary audiences that allow them to think that other people are watching them. the adolescent begins to look inward and discussion become more egocentric.The development of secondary sex characteristics. Gn-RH stimulates the anterior pituitary to release gonadotropins. The first menstrual cycle is usually anovulatory. thus leading to reproductive maturity. with regular ovulation not occurring for about a year. As the brain matures in the pubescent girl. Adolescent egocentrism is a stage of cognitive development in which teens consider their own experiences to be unique. which stimulates the gonads to mature and release ova in the female and to produce sperms in the males. Cognitive Development Socialized As the body changes. The creation of the imaginary audience explains the common feeling of self-consciousness among adolescents. has an impact on the adolescent’s new body image. Menarche occurs in adolescent females about 3 years after the growth spurt and occurs in about half of all girls about age 12 1\2 years. Primary sexual characteristics include maturation of the female ovaries and male testes. The invisibility fable that “It can’t happen to me” is and extension of adolescent egocentrism. adolescents who exhibit a high degree of egocentrism . Generally. Maturation of the ovaries and testes is marked by menarche in girls and first ejaculation in boys. but it may occur as early as 10 years or as late as 16 years. such as breast and pubic hair.

they develop their own personal moral code (post conventional morality). Piaget maintains that maturation of the adolescent’s brain and body makes formal operational thought possible. most young adolescents follows rules for the purpose of gaining approval from other or to be a good citizen (conventional level of morality). Psychological Development . 4. Thus many adolescents continue to use concrete operational thought and cannot imagine the future consequences of their actions. Cognitive and psychosocial development allows adolescents to think more abstractly and to question the moral views of their parents. However. whereas women are more concerned with the needs of others. Social development exposes them to various ethical values. As late adolescents mature cognitively and gain experiences with right and wrong. According to Kohlberg. and imagine possibilities. have not yet mastered formal operational thought. However. Personal experiences force adolescents to make decisions on their own and to consider moral questions more broadly than before. so does moral reasoning. Social interactions and education are essential factors in enabling an individual to attain formal operational thought. who intend to see moral dilemmas differently than men. form hypotheses. The logical and abstract reasoning involved in formal operational thought allows adolescents to speculate. men view moral dilemmas in terms of the rights of others. but not inevitable. 3. Moral Development As thought processes mature. According to Gilligan. Kohlberg’s theory has been criticized for being biased against women.

47% of high school students had ever had sexual pregnant intercourse.2 • In 2002. Others experience identity diffusion with few commitments to goals. a process Erikson calls foreclosure. Some adolescents. Although adolescents strive to achieve individuality. or society. both as an individual and as a member of the larger discussion / community. In addition to the search for independence.2 . • Clearly B.1 • In 2005. and oral intercourse place young people at risk for Socialized Understand on STD’s and HIV infection and other sexually transmitted diseases (STDs). values. Some adolescents achieve identity prematurely. STD’s HIV in Adolescents verbalize understanding Vaginal. 3% of males aged 15-19 had had anal sex with a male. 11% of males and females aged 15-19 had engaged in anal sex with someone of the opposite sex. The primary developmental task of adolescence is the search for Lecture- identity. The ultimate goal is identity achievement. Vaginal Discussion the causes HIV in intercourse carries the additional risk of pregnancy. rebel and adopt a negative identity and become the opposite of what is expected of them. 55% of males and 54% of females aged 15-19 had engaged in oral sex with someone of the opposite sex. unable to find alternative roles. and 14% of high school students had had four or more woman sex partners during their life. they have self- doubts and seek acceptance from their peers. Some adolescents postpone career and marriage decisions (declaring a moratorium on identity formation) by attending college or serving in the military. In the United if STD’s HIV Adolescents States in and its causes adolescent • In 2005. anal.1 • In 2002. which occurs Matching game when adolescents develop their own belief system and career goals. 34% of currently sexually active high school students did not use a condom during last sexual intercourse. adolescents also depend on their parents for financial and emotional support.

an estimated 4. no protective method is 100% effective. representing about 13% of the persons diagnosed that year. and almost half of them are among youth aged 15 to 24. and pregnancy. when they are under the influence of drugs or alcohol. 23% of high school students who had sexual intercourse during the past three months drank alcohol or used drugs before last sexual intercourse. and condom use cannot guarantee absolute protection against any STD or pregnancy.000.1 Abstinence from vaginal. In 2005. Causes of Adolescent Pregnancy different Socialized Cited the .883 young people aged 13-24 in the 33 states reporting to CDC were diagnosed with HIV/AIDS. The correct and consistent use of a male latex condom can reduce the risk of STD transmission. occurred among adolescents aged 15-19. while ensuring that all youth are provided with effective education to protect themselves and others from HIV/STD infection now and lifelong. other STDs.6 Adolescents are more likely to engage in high- risk behaviors. young people in the United States use alcohol and other drugs at high rates. It should address the needs of youth who are not engaging in sexual intercourse and youth who are currently sexually active.4 • In 2000. anal. and oral intercourse is the only 100% effective way to prevent HIV. including HIV infection.3 • Each year. 13% of all pregnancies.5 In addition.8. • Cite the C. HIV/STD prevention education should be developed with the active involvement of parents. be locally determined. • In 2004. there are approximately 19 million new STD infections. and consistent with community values. or 831.9 However. such as unprotected sex.

the United States has the highest rates of pregnancy. • Adolescents today are growing up in a culture in which peers. much of the "sex education" that adolescents receive filters through misinformed or uninformed peers. condoms. Therefore. music. In fact. the birth rate among girls ages 10-14 has fallen to pregnancy the lowest level in almost 50 years. . accepted. • Education about responsible sexual behaviour and specific.causes of Discussion different adolescent The rate of adolescent pregnancy has steadily declined since reaching causes of pregnancy an all-time high in 1990. despite similar or higher rates of sexual activity in the other countries. clear information about the consequences of sexual intercourse (including pregnancy. When compared with other industrialized nations. and childbirth among teenagers. and psychosocial effects) are frequently not offered. Suggested reasons include: • Adolescents become sexually mature (and fertile) approximately 4- 5 years before they reach emotional maturity. A sexually active teenager who does not use contraception has a 90% chance of becoming pregnant within a year. TV and movies. mostly due to an increase in the use of adolescent correctly. through oral questioning. abortion. Since no form of contraception is completely effective. abstinence (not having sexual intercourse) is the only sure way to prevent pregnancy. sexually transmitted diseases. and do so without effective methods of contraception. and even expected. is a topic of debate. Why teenagers have sex. and magazines transmit subtle and obvious messages that unmarried sexual relationships (specifically those involving teenagers) are common.

The proportion of Caucasian the adolescent women who had ever had sexual intercourse steadily assessment.and and the increased to 58. increased between 1980 and 1988. Although African – plan of .7 years for males. matching game about Adolescent Sexual Behaviour preventive measures that The average for initiation of sexual intercourse is 16.6% in diagnosis.2 years for focuses on females and 15. family. 1988.The proportion African-American women having ever had outcomes sexual intercourse was 58. Teens are more likely to become pregnant if they: • Begin dating early (dating at age 12 is associated with a 91% chance of being sexually involved before age 19.43.1991 a.The trend for adolescent African-American women was somewhat expected different .and 59.declined to 55. including tobacco products • Drop out of school • Have no support system or have few friends • Lack involvement in school.1% in 1980.1991 b). or community activities • Think they have little or no opportunity for success • Live in a community or attend a school where early childbearing is common and viewed as normal rather than as a cause for concern • Grow up in poverty • Have been a victim of sexual abuse or assault • Have a mother who was 19 or younger when she first gave birth • Be able to Socialized correctly Discussion identify the B. with 41. Primary Prevention of Adolescent High Risk Sexual Behaviour participate Nursing care and Pregnancy in the Management.. Preventive Measures and Nursing Care Management preventive Actively measures and 1.4% reporting having had nursing premarital sexual intercourse in 1980.1% in 1985. and dating at age 13 is associated with a 56% probability of sexual involvement during adolescence) • Use alcohol and/or other drugs.4% in 1985.8% in 1988(CDC.

Yawn and Yawn . Able to cite 3 or more .1991).1992). other demographic and physiological factors have been linked with adolescent premarital sexual intercourse .In one study investigating the relationship between sexual abuse the adolescent pregnancy . In every young sexually experienced adolescent . The father of the baby is often an adult.1993) lows educational goals (Dry foots.low socioeconomic status (Rabin and Hayward .1995. young 1990 ) have been correlated with an increased incidence of adolescent premarital sexual intercourse .researches found that 66% of the 535 pregnant of parenting adolescent females had experienced no voluntary sexual intercourse (Boyer and fine .1992).cabin and Hayward. American girls tend to initiate sexual intercourse at younger ages care and than do European –American girls.but others have found no relationship (Pirkens. racial differences are beginning implementat to narrow because of the increased in ion Premarital sexual intercourse among Caucasian teens (AGI.Demographic factors such as older age (Lock and Vincent . 1994. Perceptions that their friends are sexually active (Lock and Vincent . In addition to racial differences.most researches have not found a consistent relationship (Yawn and Yawn . 1993).1993 .1991.1995. `1993).1995 .single –parent family (lock Vincent .1994).Newcomer and Baldwin .sexual abuse must suspected .National institute of child health and human Development .Leigh et all .the influence of parent – adolescent communication is a strong predictor of sexual intercourse .1990)have been also associated premarital sexual intercourse .

a. such as “sexual intercourse. Physical examination A thorough physical examination is essential.body image .An unhurried . i. The nurse should be use direct language.In addition . and support systems is essential .g.then health history interview should be conducted in a quite . cognitive –development stage .self-concept ).the health is needed to identify learning and care needs . The nurse should be aware of culturally unacceptable verbal non verbal responses. sexual identity . nursing Nursing Care Management assessment. The nursing process can be used to accomplish this competency. heavy menstrual bleeding or other abnormal bleeding in adolescent may be related abortion . Assessment A thorough health history interview (including menstrual. more sensitive question may be asked.private room the adolescent fully clothed .assessment of the psychosocial (e. the and adolescent is a risk for virus health problems.The interview with no threatening question.”not” making love “. non-judgemental attitude will facilitate patient relaxation . The nurse can work evaluations affectivity with the sexual experienced adolescent to achieve optimal at 75% health outcomes.complete physical examination (including breast and pelvic examination ).trauma endocrine diseases . interventions When adolescent choices include engaging in sexual activity. After rapport is established with the patient. sexual and dietary factors )with review of systems . and laboratory test should be conducted . The nurse should be alert possibilities Of sexual abuse of the young adolescent because the young adolescent has little experience with what normal body functions are. STDs may go unnoticed and unreported to health care providers to treatment.. goal.

Therefore it is more vulnerable to irritation and infection . Although true breast disease is uncommon in adolescent girls . -Decisional conflict related to unclear personal values or beliefs regarding premarital sexual intercourse. sprays.contact vagina can result from performed soap.such as taking oral contraceptives incorrectly or even correctly (Hilliard and Rebar . Adolescent girls are modest and usually tense during the pelvic examination. and tight jeans or other garments. Lidocaine ointment may be used as a lubricant . A pelvic examination is recommended for any teenage woman who sexually active for those considering oral contraceptives. physical examination. Examples of nursing diagnoses that may apply include the following : -Body-image disturbance related to puberty. .Breast examination findings in teens commonly b..the anxious adolescent client may feel more comfortable using a mirror so she can participate in the examination too painful and is truly unable to cooperate. Powders.infection.1990). an examination under anesthesia may be necessary (Hilliard and Rebar .1990). Nursing Diagnosis After a review of assessment findings from the interview. or other causes . Instruction in relaxation techniques is helpful. anxiety about symptoms such as welling is common . and laboratory /diagnostic test. appropriate nursing diagnoses are formulated. -Lack of experience with sexual decision making. During puberty the vaginal epithelium is thin .

7. Health-seeking behaviours: contraceptive use related to desire to avoid pregnancy. 2. Verbalize alternatives to sexual intercourse for expressing feelings. Verbalize /demonstrate correct method of using contraceptive of choice. .. mutually determined by the adolescent and the nurse.Not become pregnant. Not contract an STD. Verbalize that she and her partner are practicing safer sexual behaviour. . Demonstrate acceptance of changes in body as a result of puberty (e. Expected outcomes A nursing care plan is based on the adolescent’s health care needs. posture.-Lack of relevant information. safer sexual practices related to desire to avoid sexual transmitted diseases. 5. 8. Verbalize consequences associated with unsafe sexual practices. grooming. The expected outcomes for care. c. and dress). Verbalize personal values and beliefs about premarital sexual intercourse . Examples of possible excepted outcomes include the following.Health-seeking behaviour. adolescent will: 1. 6. 4.g. Non-compliance: contraceptive regimen related to lack of information on correct contraceptive regimen unplanned sexual encounter side effect of contraceptives. 3. are stated-centered terms.

and (3) adolescent may be un comfortable when parents find it difficult to acknowledge that their ‘child ‘is a sexual person with sexual feelings and behaviours . National survey of parent reveal greater support for inclusion of comprehensive sex education in school curricula and at earlier ages for today’s youth (CDC. Plan of care and Implementation i. d. Early evaluation of HIV/AIDS education programs have indicated an increase in knowledge. and development of decision-making and not accelerate or delay the initiation of sexual intercourse .Those who were concerned that sexuality education be value-free developed abstinence-only programs. Parental refusal to discuss sexual behaviour may cause the adolescent to keep sexual activity secret and may interfere with the adolescent’s efforts to seek help. More recently. Sexuality education programs should begin before puberty (some . sexuality education programs focused on knowledge about Ricks and consequences of pregnancy. Evolution of abstinence –only programs has shown that they are effective in changing attitudes about premarital sexual intercourse but have had little effect on sexual behaviour. Kirby (1992) described the evolution of sexuality education programs. sexuality education programs have been based on theoretical models such as social learning theory. Initially. 1991a.(2) they may be uncomfortable with the topic of sex . In review of school-based sexuality education programs. but few studies have measured the effect on sexual behaviour (Kirby et al . values clarification.1994). 1991b). Preliminary evaluation of programs based on social learning theory suggests that they are effective in delaying sexual intercourse and reducing unprotected sexual intercourse. Parents may not involve themselves in sexuality education for several reasons (1) they may not have adequate information. Sexual education Sexuality education.

Younger mothers than older mothers live in families with annual incomes near the poverty level.suggest As Early as kindergarten ) and provide adolescent with experience in personal decision making practice in applying the information to their lives . low SES. Education should be appropriate for low-risk groups. Leaving school early is associated with unemployment and poverty. Health education strategies needs to be creative and developmentally. and dependency on public welfare. educationally. and parent or partners of low. churches. Health education to the primary prevention level includes providing information about good hygiene. 1993). with peer providing information and counseling to other adolescent. nurses should take a more active role in training sexuality concepts in school. Teenager pregnancy remains the major reason female adolescents terminate their education prematurely. focus on both females and males . g. and language appropriate. In addition. and society. child. high-risk groups.and involve parent to enhance parent adolescent communication and to strengthen family ties. Culturally. since teachers report a lack of training sexuality education (cabins and Hayward. Nurses should promote school-based sexuality education for early ages. Nurse can Facilitate the development of peer counseling groups. have fewer opportunities for employment and career advancement.risk groups..Programs should address how to handle peer pressure. Secondary Prevention with Pregnant Adolescents Teenage childbearing has been associated with unfavourable consequences for mother. 2. Community institutions (e. local lay groups . Thus adolescent parents often fail to complete their basic education. prevention of STDs contraceptive use.and professionals groups) should also be involved to lend financial or volunteer support to the programs. . After the birth of a child the mother is at high risk for low educational attainment. and have limited earning potential.

The very young pregnant adolescent is at higher risk for each of the confounding variables associated with poor pregnancy outcomes and for those conditions associated with first pregnancy. including low level of education. Pregnancy puts the adolescent and her baby at risk nutritionally. Late entry into prenatal care may result from late recognition of pregnancy. to encourage early and continued prenatal care and second. which can help reverse a negative socioeconomic . denial of pregnancy. infant mortality. this family instability is related to other variables. or confusion about available. Pregnancy adolescents are also at increased risk for iron deficiency anemia. low level of employment. and lack of support systems. The Very Young Pregnant Adolescent The pregnant adolescent younger than 15 years of age is most at risk for problems I pregnancy and childbirth. In addition to the stress of the transition to marriage. to refer the adolescent. abuse. separated. Late presentation for care may result in inadequate time before the birth to attend to correctable problems. When prenatal care is given early and consistently and confounding variables are accounted for. The incidences of LBW infants. The role of the nurse in reducing the risk and consequences of adolescent pregnancy is thus twofold: first. mother younger than 15 years old are twice as likely to deliver preterm or low. and abortion are 2 to 3 times higher in this age group than for women older than 25 years. The very young adolescent is at particular risk because she enters prenatal care later than do older adolescents and women. very young pregnant adolescent are at no greater risk than older pregnant women. In additional. Poor nutritional status can lead to inadequate weight gain during pregnancy. which contributes to low birth weight in the infant. if necessary social support services.birth. The incidence of abandonment. which has been associated with prematurity and low birth weight.weight infants. and divorce is 2 to 4 times higher among adolescents married in their teens than among those married in their 20s.

young adolescent parents have limited life experiences. It id 75% over the age common for teens to diet and wear constricting clothes to hide their competency. healthy baby to dress up and play with like a doll. 2Accepting the reality of the unborn child. happy. their own need to grow and develop. environment. and capable of providing the nurturing care an infant needs. These tasks include the following: pregnant developmental 1Accepting the biologic reality of pregnancy. • Properly discuss and Identified establish Development Tasks of Pregnancy the deeper developmental knowledge of The pregnant adolescent faces the same development tasks of pregnancy tasks of the as the pregnant adult. and little ability to cope with abstractions and to solve problems. Although there usually is the desire to be a good mother. of 35. The amount and type of support available to adolescent can significantly influence the accomplishment of these tasks. concerned. Most adolescent do not clients above task of expect to become pregnant. Being a parent implies being loving. They may deny it until the signs are 35 years at pregnant woman so obvious they can no longer be ignored by family members. condition and to succeed in concealing the pregnancy until it is quite high. . The adolescent may accept only the fantasy of having a cute. The idea of the infant’s growth and development into an older child may not be a reality to the adolescent. 3Accepting the reality of parenthood.

Her mother usually is the first to find pregnancy / out and may attempt to prevent the adolescent’s father from 35 years old discovering his daughter’s pregnancy. Nurses must be aware of differences in cultural beliefs if open communication is to occur. Satisfactoril y discussed the suitable .places these individual at high risk for pregnancy. In addition. and mothers at sorrow. The usual initial reactions of pregnant grandparents-to-be to the news are shocks. Poverty and societal racism have a harmful affect on family and community life. anger.coupled with fewer opportunities to accomplish social and educational goals. The availability of social support varies across ethnic groups. The lack of social and family support. more effective programs for pregnancy prevention may result and more appropriate care may be provided. The adolescent may not talk about her of adolescent pregnancy until it is obvious.Culture Influences The pregnancy rate for poor and low-income minority adolescents is high. other options). When these beliefs are assessed and incorporated into a plan of care. The nurse must assess any disharmony that is occurring in the 75% family and assist family members in adapting to the pregnancy (or competency. nurturance. guilt. cultural differences exist in adolescent’s knowledge of sexuality and in their beliefs about pregnancy and prevention. Cited 3 or Family Reactions to Adolescent Pregnancy more risks and One of the most difficult tasks of the pregnant adolescent is telling complications he parents that she is pregnant. shame. and supervision of the adolescent (as may occur in single-family household).

with a review of systems and sexual history. such as cognitive-development level. obstetric. psycho logic immaturity. Except for very young teens. Assessment i. such as parity. life-style. Cultural considerations should be aware that before pregnancy the very young adolescent usually has received care only from a pediatric health care provider and may be apprehensive about an unfamiliar health care provider. and these in turn are influenced by the pregnant preconception. The clients above adolescent and her offspring are particularly vulnerable to the risks 35 years of inherent in pregnancy and parenthood. and smoking. and lack of political power and influence. Nutrition assessment id essential and includes the following components: history (medical. there id little evidence that maternal age influences weight gain when other factors are controlled.Nursing Care Management nursing Many interacting biologic and social factors affect the quality of management to human reproduction. delayed medical care. physicians. alcohol use. registered dietitians. and social workers a. ii. anthropometric measurement. Dietary assessment. and clinical evaluation. ethnicity. Inadequate weight gain early in pregnancy is linked to small-for- . In addition to obtaining a health history from the pregnant adolescent. characteristic of her age group. is warranted. Interview The interview for the initial prenatal visit for the pregnant adolescent is similar to that for an adult pregnant woman. The effect of maternal age on gestational weight gain is unclear because most studies have not controlled for other factor influencing gestational weight gain. the nurse should elicit information about the health of the baby’s father. psychosocial). prep regnant weight for height. A through health history. The multifaceted and complex needs of the adolescent are most effectively addressed by means of a multidisciplinary team of nurses. laboratory testing. This result from circumstances age. maternal. economic dependency. Nutritional assessment . and neonatal care that is made available.

dependency. Availability of nutrients to the fetus depends on whether the teenager mother continues to grow while pregnant.gestational-age (SGA) infants. process of labor and delivery. problem-solving ability. Basic knowledge of these factors is important to help the pregnant adolescent understand more readily the additional changes that occur during pregnancy. body changes associated with pregnancy reflect growth and survival of the infant. In addition to body changes associated with puberty. The nurse should also assess the adolescent's cognitive-developmental level. Pregnant teens may be ambivalent about the pregnancy. poor prepregnancy nutritional status. reliable procedures for obtaining and recording weight and height and should them consistently in classifying women according to weight for height. Late inadequate weight gain is linked to preterm birth and SGA infants. For adult women. Assessment of perceived learning needs reveals valuable information that may be used as the basis for planning and intervention. and poor diet during pregnancy. Fetal growth restriction in teens still growing may result from competition for nutrients. and monitoring weight gain over the course of pregnancy iii. prenatal development. Knowledge base and perceive need The adolescent is assessed for her knowledge of sexuality and reproduction. setting weight gain goals. the body image. she may have an increased rate of growth for a longer period of time post menarche. . They may deny the pregnancy. and pain management during labor. iv. and peer and partner relationships. The nurse should refer the pregnant adolescent to childbirth classes to prepare for labor and birth. literacy. Psychosocial status Psychosocial screening includes assessment for response to pregnancy. or suicide. Health care provider should use specific. depression. Early weight gain may be difficult because of body image. which can have a negative influence on body image and may lead to decreased nutritional intake to limit weight gain. time orientation. If the teenage woman experienced early menarche. body image.

v. Support systems
Emotional support, particularly from the family of origin, is
extremely important to the pregnant adolescent. Persons in the support
system, particularly the parents, boyfriend, or husband, can
significantly influence pregnancy outcome. The nurse must assess how
the pregnant adolescent perceives her role and the roles and level of
support from others in her support from others in her support system.
Many pregnant adolescents come from socially and economically
deprived families. Appropriate use of health care resources and
compliance with preventive health care measures may not be part of
their health value system. The nurse can assist those adolescents at
risk to begin to change their own behaviour so that use of the health
care delivery system and its resources enhance health and well-being

vi. Physical examination

Physical assessment is the same as for the pregnant woman. Careful
determination of baseline blood pressure is necessary because
adolescents have lower systolic and diastolic pressures than do older
women. An adolescent could be in serious jeopardy for eclampsia with a
blood pressure reading of 140/90 mm Hg.

vii. Laboratory tests
Screenings are similar to those for the adult pregnant woman and
should include hemoglobin and hematocrit level., white blood celland
differential count, blood type, RH factor, and antibody screen;
rubella titer; serologic test for syphilis; urinalysis and urine
culture; Papsmear; and vaginal or rectal smear for Neisseria
gonorrhoeae, B-streptococcal, and chlamydial infections, A 1-hour
glucose tolerance test should be obtained at 28 weeks' gestation to
screen for gestational diabetes. HIV testing, tuberculin skin testing,
and sickle cell screening may also be recommended for patient at risk.

b. Nursing Diagnosis
The information gathered during the assessment, along with laboratory
data, is analyzed and provides the basis for formulating nursing
diagnoses. Nursing diagnoses relevant to the pregnant adolescent might
include the following:

- Body-image disturbance related to pregnancy
- Post-trauma response related to Physical or sexual abuse
- Altered family processes related to Birth of infant to teenage mother
-Risk for altered nutrition: less than body requirements related to
Combined nutritional demands of teenage pregnancy and growth in
the very young adolescent. Low socioeconomic
- Altered growth and development related to
Loss of independence and disruption of peer relationships
secondary to pregnancy.
- Decisional conflict related to
Parenthood
Adoption
Abortion
- Altered health maintenance related to
Low socioeconomic status
Lack of access and availability of health care services
- Noncompliance with therapeutic regimen related to
- Inadequate knowledge
- Lack of social support
- Knowledge deficit: ante partum, intrapartum, postpartum, newborn
care related to
- Lack of experience

c. Expected outcome

The plan of care reflects the adolescent mother’s need increased
surveillance with health care measures, and feeling of personal and
social integrity. The care begins as early as possible in the prenatal
period and extends through the formative period of the new family.
Whenever possible, expected outcomes for care mutually
determined. These expected outcomes may include the following. The
adolescent will:

1. Demonstrate acceptance of changes in the body as a result of
pregnancy (e.g, posture, grooming, dress)
2. Demonstrate clear communication with her family and will
effectively resolve problems
3. Express her fears, anger, and guilt about previous sexual abuse
and will identify and will identify and contact appropriate
support persons/resources
4. Have adequate weight gain with hemoglobin level >11.0g/dl
5. Seek prenatal care in the first trimester
6. Demonstrate behavior appropriate to her developmental level.
7. Keep appointments for prenatal and postpartum care
8. Give birth to an infant whose birth weight is appropriate for
gestational age
9. Identify and contact support system in her community
10.Verbalize understanding of teaching related to antepartum,
intrapartum, postpartum, and newborn care
11.Demonstrate appropriate self-care and newborn care

d. Plan of Care and Implementation
Health care professional who work with pregnant adolescents must
come to terms with their own sexuality so they can maintain a non
judgment approach. They should be genuinely interested in the
adolescent- enthusiastic, warm, caring individuals able to view
adolescent as young people worthy of respect and dignity. Nurses must
be able to listen and respond with honest answer.

Nurses must be adept in using various teaching strategies. Group
discussions meet the adolescent’s strong need for peer contact and

and at times. Teens who were referred to a special teenage clinic initiated prenatal care earlier and have more visit than teens who attended a traditional clinic. charts. the use of visual models. i. to have negative attitudes toward physicians. educational sessions should be short-15 minutes or less. For example. The comic book format may appeal to the very young adolescent. Written instructional materials such as brochures and visual teaching aids should be attractive. ego strength. such as pre-eclampsia and poor nutritional status. Because young adolescents have short attention spans. direct language. It is important to use simple. In addition. and role playing helps to reinforce learning and fits with the concrete cognitive style of young adolescents. Prenatal education requires creativity.acceptance. humor. Using correct terminology for body parts and giving direct answer to questions communicates respect. and to rely on their families for prenatal advice. In addition of more than one of the senses by using multimethod approaches and active participation by the adolescent are helpful. the teenage mothers who received inadequate prenatal care placed more importance on an “adolescent only” clinic than did other teens. and contain more pictures than words. bright in color. Flexibility. Maternal adaptation during pregnancy should be discussed. using concrete examples of “what to do” and “what not to do”. films. Those who received inadequate care were also more likely to think that prenatal care was unimportant. to have late recognition of pregnancy. concrete. The nurse should avoid treating the adolescent as a child . have been linked with inadequate prenatal care. Adolescents are likely to obtain more adequate care if the prenatal site is attractive and inviting and if special efforts are made to register and retain them in care. Prenatal care Risk factors. Attracting teens to prenatal care may improve maternal and infant outcomes. Anonymous question and pre-tests can be used to identify knowledge deficits or beliefs in myths. Demonstrations by the nurse with return demonstrations by the teen facilitate assessment of the adolescent’s abilities.

fruits and juice. various self-help groups are available for pregnant teens and their families. and thiamine. Nutrients found in many of the snacks eaten by adolescent females contribute approximately half the RDA of riboflavin. The programs vary in structure and content. and support groups for parents (of the pregnant adolescent) who learn how to cope and adapt to the experience. and after pregnancy. vitamin C. and prepare optimally nutritive foods for herself and her family (table 12-1). iii. Newborn feeding . Additional amounts of vitamins.1990). iv. In addition to these services. select. The nutritional needs of the mature (15 years and older) pregnant adolescent approach those pregnant adults. Example of group types include those that focus on the pregnant adolescent and her self-care. Support and information group The prenatal care services already discussed are offered predominantly in clinics or in hospitals. cheese. minerals. Snacks contribute more than “empty calories”. Nutritional counselling The purpose of nutrition counseling is to increase the adolescent’s knowledge of nutrients and ability to plan. those addressing teenage parenting (which teens and their infants may attend together) . with a range of one to seven. depending on the organization or agency sponsoring the program. ii. during. Iron supplements are needed to provide for the growing muscle mass and blood volume increase in the pregnant adolescent (story. Most adolescent females consume at least one snack per day. and calories are needed to meet the growth needs of the pregnant adolescent and her fetus and to correct deficiencies resulting from inadequate intake of nutrients before. Pregnant adolescent should be encouraged to eat nutritious snacks such as peanut butter crackers.

or nurse many teenage women come to labor lacking preparation. and a lack of role models all contribute to the failure to choose breastfeeding as an option. especially after leaving the hospital. The nurse may help the adolescent weigh the realities of breastfeeding. and birth rooms. vi. Single. Fear of permanent alteration in the breasts. When identified counseling needs are beyond the nurse’s scope. the adolescent is trusting and will follow suggestions. against the realities of continuing her education. Labor and birth The very young adolescent may be frightened of needles. The adolescent in labor should have the support of a knowledgeable coach. Adolescents are usually responsive to staff members sharing in their delight about the infant. For successfully breastfeeding the adolescent’s family and school must work together. such as 24-hour commitment. The adolescent may be more concerned with how the baby will get out than with fetal well-being. pelvic examination. v. the adolescent is referred to a counselor who deals effectively with adolescent. they are fearful and often alone. teaching about relaxation with contractions. ambulation. Even though she may show an intense response to the contractions. a view of breastfeeding as “dirty”. Anticipatory guidance and explanation of all procedures before they are administered should always be a component of the nurse’s care. efforts to promote parent-child attachment are particularly important. Thus bottle-feeding is often the feeding method chosen. If they are admitted early in the first stage. private rooms should be provided when possible. other misconceptions. Postpartum care . noises from other women in labor or from equipment. All teens needs much support for breastfeeding. Peer reactions or negative responses from the spouse or boyfriend are other factors. and comfort measures can be accomplished. side-lying positions. parent.Many adolescent initially respond negatively to the idea of breastfeeding. friend. perhaps her husband. For these young parents.

child injuries. parent. Neutral language such as “arranging for an adoption”. The adolescent may experience grief brought to a preterm infant who may be in the intensive care unit. The nurse can help the birth mother move through the grieving process. Outreach programs concerned with self-care. and instances of failure to thrive. The need for continued assessment of the new mother’s parenting abilities during the postbirth period is essential. Phrases such as “put up for adoption” and “give up for adoption” imply a callous. as well as those that provide prompt and effective community intervention. Neither should the terms “real or natural parents” be used exclusively for generic parents. In addition.12-4) or other family members through home visits and group session for discussion of infant care and parenting problems. that is. The adoptive parents are the “real parents” because they care for the child. Intensive teaching and continuous support programs are essential if the young mother and her vulnerable infant are not to be estranged. viii. or the death of the infant.Physically the adolescent mother requires the same care as any woman who has given birth. Most adolescent view the care of the infant as their primary area of concern. “biologic parents” or” birth mother” and” adoptive parent” are preferred.child interactions. Evaluation The nurse can be reasonably assured that care has been effective if the expected outcomes have been achieved. uncaring. Adoption The adolescent will need to support if she is contemplating adoption for her child. if the adolescent: • Demonstrates acceptance of changes in body as a result of . Explicit directions for self-care and infant care are required. continued support should be provided by involving grandparents (Fig. Health professionals must avoid using phrases that give negative connotations to the adoption process. insensitive biological parent. prevent more serious problems vii.Grief Grief result from change or actual or perceived loss.

. Assessment Assessment of Parenting abilities include the following: • Ability to emphasize with the child • Her self-concept • Her definition of an identification with the maternal role • Ability to solve problem and consider the child within the context of the future • Support system • Ability to perform care giving task b. a role that is best assumed by the adults who are financially and educationally secured.posture. They are exposed to many stresses as they undertake the task and responsibilities of parenthood. Nursing Diagnosis • Altered family process related to Adaptation to teen parenthood • Risk for altered parent/infant attachment related to decreased communication with the infant • Altered role performance related to lack of knowledge of maternal role c. dress) • Demonstrates behaviour appropriate to developmental level • Give birth to an infant whose birth weight is appropriate for gestational age 3. a. pregnancy (e.g. Tertiary Prevention with Adolescent Parents Adolescent’s ability to function in mothering role is affected by the level of stress she is experiencing. grooming. Expected Outcome • The adolescent’s family will communicate effectively and provide .

social life and allow her to discuss feelings and responses to the labor and birth • The nurse physical assessment skills can be taught to the adolescent parent so that she becomes more knowledgeable about her child’s needs. the nurse should inquire about the adolescent and her friend. Pregnant Woman Over the Age of 35 complications of pregnant woman above 35 years satisfactorily . school. • Discuss the different III. Plan of Care and Implementation • Nurse must demonstrate to the adolescent that she is still important • Before discussing about the care of the infant. support • The adolescent will demonstrate the appropriate interactions with the baby • The adolescent will demonstrate appropriate role performance d.

What you need to know: Healthy women from age 35 into their 40s usually have healthy pregnancies. they can usually be successfully treated. such as diabetes. a condition in which the placenta is in the wrong place and covers the cervix • Cesarean section • Premature delivery • Stillbirth • A baby with a genetic disorder Because of these increased risks for women over 35. see your health care provider. . see your health care provider before trying to get pregnant. If problems do arise. some medical conditions can cause risks for you and your baby. What you can do: No matter what your age. This is especially important if you: • Have a chronic medical condition. a seizure disorder or high blood pressure • Are on long-term medication If not under control. prenatal care is especially important. Women over age 35 have an increased risk of: • Fertility problems • High blood pressure • Diabetes • Miscarriage • Placenta previa. If you are older than 35 and don�t get pregnant after trying for six months.

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see your health care provider. In many cases. they can usually be successfully treated. Good prenatal care and healthy habits can help you reduce certain risks. If you are older than 35 and don’t get pregnant after trying for six months. Most women over 35 are in good health. see your health care provider before trying to get pregnant if you: • Have a chronic medical condition. If problems do arise for women over 35. such as diabetes. A Mommy After 35 Most healthy women from age 35 into their 40s have healthy pregnancies. No matter what your age. a seizure disorder or high blood pressure • Are on long-term medication If not under control. infertility can be treated. Older women may find it harder to get pregnant than younger women because fertility declines with age. Prenatal Care Is Important Prenatal care is especially important for women over 35 because: • They�re more likely to get high . some medical conditions can cause risks for you and your baby.

by definition. because it disappears after pregnancy. no known theory accounts for all symptoms. Pregnancy Induced Hypertension *Pregnancy induced hypertension is a hypertensive state that appears during pregnancy and disappears after the birth of the fetus. . The following observations have been made: --. after 20 wks. as with twins or a hydatiform mole.It is known that PIH is related to physiologic changes of pregnancy. --. --. or previous PIH.PIH seems to be a disease of the extremes . It occurs.weight (underweight or overweight). It is defined by the presence of an increase in blood pressure of 30 mm Hg systolic or 15 mm Hg diastolic or greater over baseline levels on two occasions at least 6 hours apart. Gestation. ** The cause of PIH is still the subject of much research. Complications Pregnant woman over 35 years A. age (adolescents or the elderly primigravida) --.IV.PIH occurs most frequently in women who have a predisposition to hypertensive disease (family history).PIH is much more likely to develop in the woman exposed to chorionic villi for the first time (primigravida ) or in those who are exposed to a superabundance of chorionic villi. Hypertensive disease in pregnancy is one of the major causes of maternal death and is responsible for a large number of perinatal deaths. or is defined by the presence of blood pressure of 140/90 mm hg or greater.

E. hemoconcentration within the circulatory system as the plasma content is decreased. thus reducing uteroplacental blood flow--.decreasing platelets (< 50.This vascular constriction in various parts of the body leads to : A. H. D. prematurity). scotomata. elevation in blood pressure--. I.visual disturbances: blurred vision. blood pressure elevation. thus compromising the fetus (IUGR. sudden weight gain. thrombocytopenia--. C. F. spilling of protein into the urine due to a loss of efficiency in the filtering process of the kidney.hyperactive reflexes/clonus. This results in hypoalbuminemia and is an important indicator of severity of the disease. .000).edema.elevated or rising hematocrits. irritation of the central nervous system--. spasm of the blood vessels with small hemorrhages in the capsule covering the liver---epigastric pain (RUQ)-a late symptom.The basic pathophysiologic alteration that occurs in preeclampsia is widespread vasospasm in the body. B. resulting in a decreased intravascular volume--. increased risk for intracranial hemorrhage.convulsions. headache.PATHOPHYSIOLOGY IN PIH . shift of fluids (especially plasma) from inside the circulatory system to the tissues. spasm of the blood vessels and edema in the brain or the optical vascular bed--. large. decreased delivery of oxygen and glucose to all tissues of the body. which is thought to be the result of an abnormal sensitivity of the woman's vascular smooth muscle to blood vessel constrictor hormones produced in her body.inadequate placental growth and function. decreased blood supply to the placental vascular bed. fetal distress. G. dizziness. --- proteinuria.

Anemia may cause severe maternal and fetal complications. pregnant Anemia may be an indicator of nutritional. followers of fad diets. The incidence of small for gestational age babies and stillbirths are increased with severe anemia due to the limited amount of oxygen available for fetal oxygenation. The hemoglobin level of 35 years at most iron-sufficient pregnant women is usually 11 g/dL or higher. social. depending on whether supplemental iron or other supplements are taken. ice cubes). clay. or women whose pregnancies are closely spaced. FOLIC ACID DEFICIENCY. SICKLE CELL ANEMIA fitting information’s * Anemia is a decrease in circulating red blood cells and consequently to the care a decrease in the capacity to carry oxygen to vital organs in the of adolescent mother and the fetus. Those especially at risk 15-item Quiz include adolescents. or it may be a preexisting condition such as sickle-cell woman and anemia. starch. affecting at least 15-30% of pregnant women. Assessment of iron deficiency anemia begins with health and nutritional histories. poorly nourished clients. IRON DEFICIENCY Iron deficiency anemia is a common medical disorder of pregnancy. women with multiple gestations. and/or woman above environmental problems that affect pregnancy. About 25% of women with anemia practice pica (The ingestion of non food items with no nutritional value such as dirt. The 75% incidence of all types of anemia during pregnancy is variable competency. THE ANEMIAS OF PREGNANCY recall and supply IRON DEFICIENCY. Women with anemia have a higher incidence of infection than women with normal hematological values. The causes of pica are attributed to a variety of reasons and may be engaged in by children as well as . Anemia may be caused by pregnancy. Able to B. as with iron pregnant deficiency.

Additional doses up to 3x a day are prescribed when the Hgb falls below 10-11 mg. The total daily iron requirement for the pregnant woman is usually not met by the usual American diet or by existing iron stores of many women. the body's response to needed nutrients or a response to hunger. weight loss. the demands of the fetus and placenta. Parenteral iron may be prescribed in severe cases. 2. that blood component which transports oxygen to all living cells. enriched cereals and grains and molasses. 3. seafood.Ideally nutritional status should be improved prior to pregnancy. dark green leafy vegetables. Increase iron intake by daily supplements . Research findings have shown that interference with absorption of necessary nutrients occurs when clay is eaten. Iron absorption is enhanced . and iron tends to further aggravate nausea and vomiting which is a problem for a large portion of women.pregnant women and other adults. complaints of being tired and feeling listless. Pica may be a psychologic response. a cultural phenomenon. This is pseudoanemia. GOALS OF NURSING CARE: 1. and the blood losses during childbirth. Prevention of anemia . The hematocrite decreases by 7%. Controversy exists as to whether the iron deficiency is the cause or effect of the anemia. Modification of the diet to increase foods high in iron content . The recommended dosage is 300 mg of supplemental iron during the second half of pregnancy.The primary function of iron is to combine with protein to produce hemoglobin. dried fruits. Iron is usually not given in the first trimester because the effects on the fetus are not known. There is an increased need for iron during pregnancy because of the maternal expanding blood volume. Iron enhances the quality of the blood and thereby increases an individual's resistance to stress and disease. A physiological anemia exists in early pregnancy due to the increase in plasma volume.Foods rich in iron include organ meats. Physical signs of anemia include pallor (although this may not be the case due to hyperemia of the skin during pregnancy). especially liver and egg yolks.

Folic acid deficiency . milk. C. and a folate level less than 5 mg/mL. become enlarged and are fewer in number. .Nutritional assessment . vomiting.Overcooking destroys as much as 80% of available folic acid in food. Stress the labor contractions no more . usually accompanies iron deficiency. The increased red blood cell production during pregnancy and fetal demand for iron can result in folic acid or folacin deficiency. and legumes. fish.Nausea. . when present. pallor. megaloblastic anemia beginning during pregnancy almost always results from folic acid deficiency.Laboratory values . soreness of the tongue. * Treatment of folic acid deficiency includes an oral folic acid supplement of 1 mg daily and nutritional counseling. and stomatitis. eggs. . Review the signs of labor with them by the 3rd month of pregnancy. In the absence of folic acid.Signs and symptoms . Folic acid deficiency is usually found in pregnant women who consume neither fresh vegetables nor foods with a high content of animal protein. FOLIC ACID DEFICIENCY * In the United States.Mean corpuscular volume is elevated. Megaloblastic anemia is a disorder of the red blood cell production that demonstrates as an alteration in cell morphology. meat. smears indicate macrocytes (immature form of red blood cells). Good sources of folic acid are green leafy vegetables. poultry. * Folic acid deficiency may be assessed by using various methods. Preterm Labor Adolescents are high risk for preterm labor. anorexia.in the presence of vitamins C and E. red blood cells fail to divide. probably because their uteruses are not fully grown.

Many women in this age may need a caesarean birth both if labor is becoming is overly prolonged and places the fetus at risk. Postpartum Hemorrhage More prone than the average woman because if a girl’s uterus is not fully developed. Cephalopelvic Disproportion They are prone to cephalopelvic disproportion because their own development is still immature. Encourage a woman to verbalize how is she feeling about her progress throughout labor to allow for reassurance and prompt intervention should problem arise. An over distended uterus does not contract as readily as a normally distended uterus in the postpartum period. a prolonged first stage of labor. vaginal bleeding is suspicious of the labor and should be reported. young adolescents are generally healthy and have supple body tissue that allows more adequate perineal stretching. This is suggested by lack of engagement at the beginning of the labor. Gestational Diabetes The risk to your baby from gestational diabetes is not as severe as the risk to your baby if you have diabetes prior to getting pregnant. and poor fetal descent. Failure to Progress in Labor Labor in older primipara maybe prolonged because cervical dilatation may not occur as spontaneously as in younger women. D. G.intense than menstrual cramps. On the other hand. F. E. Adolescent may have more frequent or deeper perineal and cervical lacerations than the older women because of the size of the infant in relation to their body. probably because of elasticity in cells. Because your baby is done forming by the time gestational diabetes . it becomes over distended by pregnancy. Also.

and breathing problems. and children who develop type 2 diabetes as adults. V. As glucose can go through the placenta to the baby it gives an excess energy supply to your baby. the WIC . Prenatal Health teaching What you need to know: Prenatal care is the care you get while you are pregnant. During prenatal visits. midwife or other health care professional.begins. The goal of prenatal care is to monitor the progress of a pregnancy and to identify potential problems before they become serious for either mom or baby. birth defects are not probable. It can also lead to overweight children. This care can be provided by a doctor. and are less likely to have other serious problems related to pregnancy. Women who see a health care provider regularly during pregnancy have healthier babies. All mothers-to-be benefit from prenatal care. Having an overweight baby at birth can lead to problems when it travels down the birth canal. including possible shoulder injuries. are less likely to deliver prematurely. Since your baby doesn't need the extra energy. the energy from the glucose is changed into fat. Nursing Interventions / Health Education A. but there are other problems that may occur. which results in a large birth weight for your baby. the health care provider: • Teaches the woman about pregnancy • Monitors any medical conditions she may have (such as high blood pressure) • Tests for problems with the baby • Tests for health problems in the woman (such as gestational diabetes) • Refers the woman to services such as support groups.

and are less likely to have other serious problems related to pregnancy. Make sure you go to all your prenatal care appointments. Women who see a health care provider regularly during pregnancy have healthier babies. make getting prenatal care a priority. Ideally. This visit can address concerns and issues before you get pregnant. are less likely to deliver prematurely. This is called a preconception visit. even if you’re feeling fine. it's best to see your provider before you become pregnant. A typical prenatal care schedule for a low-risk woman with a normally progressing pregnancy is: • Weeks 4 to 28: 1 visit per month (every 4 weeks) • Weeks 28 to 36: 2 visits per month (every 2 to 3 weeks) • Weeks 36 to birth: 1 visit per week A woman with a chronic medical condition or a �high-risk� pregnancy may have to see her health care provider more often. For the sake of your baby. even if you’re feeling fine. During your pregnancy. program or childbirth education classes What you can do: As soon as you think you are pregnant. All women need prenatal care. though. . call your health care provider to find out when you should come in for your first prenatal care appointment. make sure you attend all of your prenatal care appointments. Sometimes getting to an appointment may be difficult or it may seem like a waste of time.

. • Check your blood pressure. You will be asked if you want a test for HIV. • Do a physical exam and a pelvic (internal) exam. • Make sure you're taking a prenatal vitamin with folic acid. feet and face for swelling. • Measure your belly to see how the baby is growing (middle and late pregnancy). your partner’s health and the health of your close family members. • Check your blood pressure. • Check your hands. Most babies are born within two weeks (before or after) their due date. • Do some blood tests to check for anaemia and see if you have had certain infections. • Discuss with you any medications you are taking. the virus that causes AIDS.What Happens at a Prenatal Care Visit? During your first prenatal care visit. At the first visit your health care provider will: • Ask you about your health. • Check a urine sample for infection. Most of your other visits will be much shorter. • Weigh you. • Identify medical problems. • Listen for the baby’s heartbeat (after the 12th week of pregnancy). Don’t worry if you don’t know all the answers. During later prenatal visits your provider will: • Weigh you. • Do a pap smear to check for cervical cancer and other tests for vaginal infections • Figure out your due date: an estimate of the day your baby will be born. your provider will ask you a lot of questions and do some tests.

But we do know it works. And watch your portions’ you may be eating more than you think! Avoid too much sugar and fat in your diet. . • Do any tests that are needed. • Ask you if you have any questions or concerns. What you can do: Follow the serving recommendations. such as blood tests or ultrasound. It’s a good idea to write down your questions and bring a list with you so you don’t forget. • Feel your abdomen to assess the baby’s position (later in pregnancy). B. or if your partner hurts or scares you. That means that he or she can’t tell anyone else what you say without your permission. the things you tell your health care provider are confidential. No one knows exactly why women who get early and regular prenatal care have healthier pregnancies and healthier babies. So don’t be afraid to talk about issues that might be uncomfortable or embarrassing. Nutrition What you need to know: You don’t have to give up all the foods you love when you’re pregnant. Your provider needs to know all about you and your lifestyle so that he or she can give you and your baby the best care. You may even want to see your dentist more often than usual. So go. You only need 300 extra calories per day to support your baby’s growth and development. be sure to have a dental checkup early in pregnancy to help your mouth remain healthy. Remember: In addition to prenatal care. drink alcohol or take any drugs. It’s OK to tell your provider if you smoke. Remember. Do it for yourself and your baby. You just need to eat smart and make sure that most of your choices are healthy ones.

One grain serving is: • 1 slice bread • 1 cup dry cereal • 1/2 cup cooked rice. apple. frozen or canned fruit • 1 medium whole fruit (orange. How much should you eat each day when you're pregnant? Follow these food guidelines. banana) • 3/4 cup fruit juice (avoid unpasteurized juices) Vegetables Eat 3 to 5 vegetable servings each day. pasta or cereal • 1 small pancake • 1 small tortilla .Your Healthy Diet During Pregnancy Eating healthy foods can help you have a healthy baby. Fruit Eat 2 to 4 fruit servings each day. One vegetable serving is: • 1/2 cup raw or cooked vegetables • 1 small baked potato • 3/4 cup vegetable juice (avoid unpasteurized juices) Grains Eat 6 to 11 serving each day. This article will help. But sometimes it's hard to know what foods to eat. One fruit serving is: • 1/2 cup fresh.

listen to the March of Dimes Podcast with Marion Nestle. see Food-borne Risks in Pregnancy. You may not be very hungry during the first months.) One milk serving is: • 1 cup milk • 1 cup yogurt • 2 1-inch cubes cheese (Avoid soft cheeses such as feta. Camembert. The 12 ounces can include: .Proteins Eat 2 to 3 protein servings each day. Roquefort. The important thing is to eat healthy foods that you like all during your pregnancy. blue-veined. (Low-fat or skim is best. poultry or fish (For more information on fish. One protein serving is: • 2 ounces lean meat.) You may find that your interest in food changes during pregnancy. professor of nutrition Don't Eat That! The articles Food Safety and Food-borne Risks in Pregnancy provide information about foods that are not safe to eat during pregnancy. But you may want to eat all the time during the later months! Every woman is different. queso blanco. Not Too Much You can eat up to 12 ounces a week of fish that have small amounts of mercury. To learn more about healthy eating during pregnancy. queso fresco or Panela.) • 2 tablespoons peanut butter • 1/2 cup dried or cooked beans • 2 eggs Milk Products Eat 2 to 3 milk servings each day. unless the cheese is label as made with pasteurized milk. brie.

depending upon the type of coffee. So check with your health care provider before you start an exercise program. Pick things you think you will enjoy. the amount of caffeine in coffee varies. • Albacore (white tuna). C. drinks and medicine to know how much caffeine you're getting. Remember. decide what type of exercise you will do. it’s important that you discuss your exercise plans with your health care provider. Caffeine can also be found in soft drinks. and you don’t need to join a health club or buy any special equipment. Next. if you like. and the amount of coffee used. For example. Activity and Rest Before you go out and run a marathon. catfish and canned light tuna. hike or dance. such as heart or lung disease. Not all pregnant women should exercise. Drink no more than one 12-ounce cup of coffee each day. salmon. Don't eat more than 6 ounces of this tuna in one week. how it is prepared. Try coffees and teas that are decaffeinated (they don't have caffeine in them). medications and other foods. • Shrimp. The water simultaneously supports the weight of your growing body and provides resistance that helps bring your heart rate up. Swimming is another sport that is especially good for pregnant women. You can also look around for aerobics and yoga classes designed specifically for pregnant women. brisk walking for 30 minutes or more is an excellent way to get the aerobic benefits of exercise. pollock. especially if they are at risk of preterm labor or suffer from any kind of serious ailment. . Read labels on food. You may want to try several things. You may find that a variety of activities helps keep you motivated to continue exercising throughout your pregnancy and beyond. You could also run.

Don’t overdo it try to build up your level of fitness gradually. you can still put your feet up after you’ve come back from your walk. • Heart disease • Lung disease • Incompetent cervix: The cervix is the narrow. outer end of the uterus. You’ll feel and look better. do not exercise. So with a little bit of caution. and yes. If it is weak. kickboxing or soccer. dizziness. Lying on your back can restrict the flow of blood to the uterus and endanger your baby. because this sport may result in the dangerous formation of gas bubbles in the baby’s circulatory system. chest pain. pregnant women should also stay away from sports in which you could get hit in the abdomen. pay attention to your body and how you feel. such as horseback riding or downhill skiing. stop exercising and contact your health care provider immediately. Finally. you can achieve or maintain a level of fitness that would shock your grandmother. When you exercise. it is important to avoid exercises that require you to lie flat on your back. • Preterm labor (before 37 completed weeks of pregnancy) . headaches. Check with your health care provider. decreased fetal movement or contractions. You do need to be careful when choosing a sport. such as ice hockey. such as vaginal bleeding. it cannot hold the fetus in the uterus. Conditions That Make Exercise Dangerous During Pregnancy If you have any of the conditions below. If you have any serious problems. Similarly. pregnant women should never scuba dive. Especially after the third month. Avoid any activities that put you at high risk for injury.

The Lamaze Method Lamaze teaches simple coping strategies for labor. Other childbirth education techniques include the Alexander technique. Two of the most popular are Lamaze and Bradley. Most childbirth education classes use one of these two approaches. • Hypertension D. There are several kinds to choose from. Many borrow elements from each. moving and positioning. Both approaches encourage the woman�s partner to participate in the labor and delivery process. visit the Lamaze Web site. • Multiple pregnancy (twins. Women receive information about medical procedures and pain relief during labor so that they can make informed choices. This can block the baby’s exit from the uterus. named after their developers. The Bradley Method Bradley teaches natural childbirth in the absence of medical . Both Lamaze and Bradley teach women how to cope with labor pain. massage. and labor support. it is an unborn baby’s lifeline. including focused breathing. For more information. HypnoBirthing. Childbirth preparation /Childbirth Educational Class Childbirth classes help expectant parents learn about and prepare for labor and birth. and Birthworks. relaxation techniques. Attached to the mother’s uterus. Birthing From Within. Learn as much as you can about each technique until you find an approach that seems right for you. triplets or more) at risk for preterm labor • Frequent bleeding from the vagina during months 4-9 of pregnancy • Placenta previa: The placenta connects the baby’s blood supply to the mother’s blood. Placenta previa is a low-lying placenta that covers part or all of the cervix.

It emphasizes exercise. Topics covered include where you want to deliver. VI. and the pain medications you want (if any). nutrition and deep-breathing techniques. be sure to share it with your provider ahead of time. visit the Bradley Web site. Giving of Prizes VIII. He or she needs to be aware of your wishes and discuss them with you well in advance.complications. This is a written document in which you express your preferences about labor and delivery. Educational Game VII. If you do create a birth plan. Creating a Birth Plan Some childbirth education classes help women create a birth plan. who your support people will be. Open Forum . For more information.

). (2nd ed. Smeltzer. Philadephia: Lippincott Williams & Wilkins. Kozier. . IX. (2nd ed). Brunner & Suddarth’s textbook of medical surgical nursing. (2007). A. et al. (1998). Fundamentals of nursing concepts. Upper Saddle River. (2004). B. & Perry. The Merick manual of medical information. Inc. Wong. Maternal and child health nursing: Care of the childbearing and childbearing family. (2003). Evaluation BIBILIOGRAPHY Beers. D.). M. S. Maternal child nursing care.(2007). New Jersey: Pearson Education Inc. Philadelphia :Lippincott Willimans & Wilkins. Pillitteri. (5th ed. (7th ed. S.). New York: Simon and Schuster. Louis.). (11th ed. process and practice. St. Missouri : Mosby -Year Book Inc. et al.