NCM 109 - Module 1 Lesson 4 PDF

NCM 109 - MODULE 1 LESSON 4 PRENATAL BARRIERS ➔​ Denial NURSING CARE OF A PREGNANT FAMILY ➔​ Lack of knowledge of the importance of WITH SPECIAL NEEDS...

NCM 109 - MODULE 1 LESSON 4 PRENATAL BARRIERS ➔​ Denial NURSING CARE OF A PREGNANT FAMILY ➔​ Lack of knowledge of the importance of WITH SPECIAL NEEDS prenatal care ➔​ Transportation issue TEENAGE PREGNANCY. ➔​ Feeling awkward on prenatal settings ➔​ Earlier age of menarche in girls ➔​ Fear of pelvic exam ➔​ Rates of sexual activity among teenagers ➔​ Difficulty relating to authoritative figure ➔​ Lack of knowledge about ( or failure to use) contraceptives or abstinence THE PREGNANT ADOLESCENT. ➔​ Desire by young girls to have a baby HEALTH HISTORY ➔​ Take a detailed health history and best THE PREGNANT ADOLESCENT. done without a parent present ➔​ Erickson’s Theory ➔​ Be alert to the possibility of pregnancy ◆​ Identity vs. Role confusion when an adolescent describes symptoms ◆​ Intimacy vs. Isolation that are vague and hard to define “ ➔​ DEVELOPMENTAL TASK weight gain and feeling tired all the time” ➔​ To establish a sense of self-worth or a value ➔​ Be certain for press for the responses needed system to allow you to assess them safely ➔​ To emancipate from parents ➔​ Ask for the reason for delayed first ➔​ To adjust a new body image prenatal visit ➔​ To choose a vocation ➔​ Ask the parent separately if there are any concerns he or she wishes to discuss THE PREGNANT ADOLESCENT. ➔​ If the baby’s father attends prenatal care PRENATAL ASSESSMENT ◆​ Help him to feel welcome HIGH RISK PREGNANCY ◆​ allow him to offer support in the ➔​ Iron deficiency anemia current pregnancy ➔​ Premature labor ◆​ be sure he receives compassionate ➔​ Abortions education on preventing further ➔​ PIH pregnancies until he is more mature ➔​ Low birth weights infants ➔​ Teach adolescent common pregnancy ➔​ Cephalopelvic disproportion symptoms and reassure her they are part of ➔​ Hemorrhoids a normal pregnancy ➔​ Conflicting development crises ➔​ Listen for signs of “nest-building” behavior ➔​ Intimate partner violence ➔​ Role- playing or simulation may be an effective technique to help them tell their PRENATAL parents about the ➔​ Ensure optimal maternal and fetal ➔​ pregnancy outcomes ◆​ Early and consistent prenatal care is THE PREGNANT ADOLESCENT. essential to their health and health of FAMILY PROFILE their baby ➔​ Living arrangement ➔​ Prevent pregnancy-related complication ➔​ Source of income ➔​ Family dynamics ➔​ Pregnancy plans  ➔​ School attendance THE PREGNANT ADOLESCENT. ➔​ Nutritional practices ACTIVITY & REST ➔​ Hygiene ➔​ No contact sports ➔​ Use of illicit drugs ➔​ Join alternative activities ➔​ Social support ➔​ Plan for adequate REST without compromising social relationship THE PREGNANT ADOLESCENT. PHYSICAL EXAMINATION THE PREGNANT ADOLESCENT. ➔​ Obtain baseline VS: Blood pressure CHILDBIRTH PREPARATION ➔​ Obtain FHT (doppler) ➔​ Join a class of pregnant adolescents ➔​ Assess fundal height ➔​ BIRTH DECISIONS ➔​ Routine laboratory: CBC, blood typing, ◆​ Pelvic measurements should be taken Urinalysis, STD screening early and carefully because CPD is real because of the girls’ incomplete They need to know a great deal more about her pelvic growth body and her ability to monitor her health ◆​ Information on cesarean birth must → Focus on hemorrhoids, striae gravidarum and be scheduled is shared with the girl chloasma and her parents → Suggest cover makeup and offering reassurance ➔​ PLANS FOR THE BABY the pigmentation will fade after pregnancy ◆​ Breastfeeding → Teach adolescent that a healthy weight gain is ◆​ Child care/teaching practices important for fetal growth and this weight can be ➔​ Be certain they know all the options lost afterward available to them when the baby is born ( keeping the baby, placing the baby in a THE PREGNANT ADOLESCENT. temporary foster home, adoption) NUTRITION RISK THE PREGNANT ADOLESCENT. ➔​ preterm births - lack of nutritional stores PREGNANCY-RELATED COMPLICATIONS ◆​ The girl should have an intake that IRON DEFICIENCY ANEMIA both allows for growth of the fetus ➔​ ssx: chronic fatigue, pallor, low hemoglobin and her own growing body level ➔​ Iron deficiency anemia ➔​ Iron and folic acid supplements ➔​ Low-birth-weight newborns NUTRITIONAL NEEDS Low iron intake cannot compensate for iron lost ➔​ Calorie: 1800-2400, additional CHON during menstrual flow. ➔​ Supplement: Iron, folic acids, Vitamins ➔​ Symptoms include: A,C,D ◆​ Chronic fatigue ◆​ They may need to gain more weight ◆​ Pale mucous membranes than a mature woman to supply ◆​ Hemoglobin (hgb) level < 11 g/dL adequate pregnancy nutrients ◆​ Associated with pica (craving ◆​ Overweight and obese adolescents non-food items) should not actively restrict nutrients ➔​ Treatment: during pregnancy , their body may ◆​ Iron and folic acid supplements. be deficient in proteins and vitamins ◆​ Review of iron-rich foods for daily consumption.  ➔​ Follow-up: ➔​ Prevent postpartum depression ◆​ Reticulocyte count may be scheduled LACK OF KNOWLEDGE ABOUT INFANT after 2 weeks of supplement use. CARE ◆​ Stool swab to check for black tinge ➔​ Spend time with the girl, observing how she (indicating iron supplementation). handles her infant ◆​ Reassessment of serum iron level. ➔​ Demonstrate bathing and changing the baby ➔​ Model good parenting behaviors PRETERM LABOR ➔​ Education about the importance of ➔​ Report any vaginal bleeding breastfeeding ➔​ Their uterus is not fully grown ➔​ Select a feeding method that is satisfying to ➔​ Review the signs of labor by the third month them and safe for the baby of pregnancy ➔​ Stress labor contractions usually begin as PREGNANT WOMAN OVER AGE 40 YEARS only a sweeping contractions no more ISSUES intense than menstrual cramps ➔​ Feel ambivalent during pregnancy ➔​ Work-life balance CEPHALOPELVIC DISPROPORTION ➔​ Health-related conditions ➔​ prolonged labor, dystocia ➔​ Chromosomal anomaly ➔​ Suggested by lack of engagement at the ➔​ Financial burden beginning of labor, prolonged first stage of Advanced maternal age is the label for pregnant labor and poor fetal descent women 35 years and older at delivery the ➔​ Be certain an adolescent has a support developmental challenge is to expand their person with her in labor awareness or develop GENERATIVITY POSTPARTUM HEMORRHAGE PREGNANT WOMAN OVER AGE 40 YEARS ➔​ Uterus not fully developed ASSESSMENT ➔​ Because a girl’s uterus is not fully HEALTH HISTORY developed, it becomes overdistended by ➔​ document symptoms of pregnancy pregnancy , not likely to contract as readily, ➔​ Attitude/feeling about pregnancy bleeding will occur ➔​ Lifestyle changes ➔​ May have more frequent and deeper perineal ➔​ Ask if she has been taking any medication or and cervical lacerations because of the size herbal remedies of the baby FAMILY HISTORY ➔​ Social/emotional support POSTPARTUM DEPRESSION ➔​ Finances - SOURCE OF INCOME ➔​ Provide social/emotional support ➔​ Plans to become pregnant immediately ➔​ She finds herself making many adjustments KNOWLEDGE DEFICITS RE: INFANT CARE at once ( new life partner, house or ➔​ Model good parenting behavior apartment and community and also to a ➔​ Breastfeeding pregnancy ) ➔​ Infant safety PRENATAL INABILITY TO ADAPT POSTPARTALLY ➔​ Dietary needs ➔​ Immediate postpartum period almost an ➔​ Exercise program unreal time ➔​ Use of drugs/alcohol/smoking ➔​ Urge her to talk about labor and birth PREGNANT WOMAN OVER AGE 40 YEARS ◆​ graphing labor is a good method PHYSICAL EXAMINATION ◆​ may need CS ➔​ Thorough Physical examination ◆​ encourage women to verbalize how ➔​ Assess: FHT, fundal height she is feeling and allow for ➔​ Routine diagnostic examination reassurance and prompt intervention ◆​ Genetic screening ➔​ Postpartum depression ◆​ Ultrasound ➔​ Postpartum hemorrhage ◆​ Amniocentesis/Chorionic villi ◆​ The uterus may not contract as sampling readily ◆​ Quad test ◆​ More prone to perineal-anal tears ➔​ Check for varicosities because her perineum is less supple, ➔​ Obtain a urine specimen and test it for check for amount of lochial flow or specific gravity. Glucose, and protein potential perineal bleeding ➔​ Assess breast for any abnormalities ◆​ Respect for need for independence ➔​ Assess carefully for fundal height and fetal ➔​ Difficulty accepting the event movement at prenatal visits ◆​ Review plans for child care and postpartum rest PREGNANT WOMAN OVER AGE 40 YEARS ◆​ Help women learn how to balance NUTRITION their lives ➔​ Obtain detailed nutritional history ◆​ Help making child care arrangement ➔​ Nutritional changes ◆​ Calories: 1800-2400 PREGNANT WOMAN WHO IS PHYSICALLY ◆​ Iron, folic acid supplement OR COGNITIVELY CHALLENGED. ◆​ Substitutes: caffeine-free soda, milk AREAS OF CONCERN or juice ➔​ Transportation ➔​ Pregnancy counselling PREGNANT WOMAN OVER AGE 40 YEARS ➔​ Support person COMPLICATIONS ➔​ Health ➔​ Gestational hypertension ➔​ Work ◆​ Take adequate supply of protein and ➔​ Recreations obtain adequate rest each day ➔​ Self-esteem ​ Preterm or post term birth RESPECT THEIR RIGHTS ​ Cesarean birth ➔​ Hospital cannot deny care to a person with ◆​ Because the circulatory system may disability not be as competent as when she was ➔​ She has full rights to her child, so the baby younger can not be taken from her at birth without ◆​ Her body tissues may not be as her full consent elastic as they were once ➔​ She cannot be forced to terminate a ➔​ Gestational DM pregnancy or undergo sterilization unless ➔​ Preterm/post term birth that is her informed decision ➔​ C-section MODIFICATIONS FOR PREGNANCY ➔​ Failure to progress in labor ➔​ Safety measures to explore ◆​ labor may be prolonged because ➔​ Emergency contacts cervical dilatation does not seem to ➔​ Transportation occur spontaneously ➔​ Mobility  ➔​ Elimination ◆​ C-section, assisted birth ➔​ Autonomic responses ➔​ Hearing challenged ◆​ directly face the client when giving PREGNANT WOMAN WHO IS PHYSICALLY information OR COGNITIVELY CHALLENGED. ➔​ Visually-impaired PRENATAL CARE MODIFICATIONS ◆​ identify sounds of birthing rooms ➔​ Clear instruction is needed for pelvic examination MODIFICATIONS FOR POSTPARTUM CARE ➔​ Secure a ramp for wheelchair ➔​ additional support for breastfeeding ➔​ Sexually abused: talk and work through ➔​ arrange for follow-up care experience ➔​ Contraception decision ➔​ Visually-impaired; use demonstration aid ➔​ Hearing-impaired; stand by the head of the MODIFICATIONS FOR PLANNING CHILD table where they can see your lips and repeat CARE instructions or questions as necessary ➔​ Explore Social support ➔​ Dorsal recumbent position may be required ➔​ Social Services referral for pelvic examination for woman with a spinal cord injury or cerebral palsy PREGNANCY AND SUBSTANCE ABUSE. SUBSTANCE ABUSE PREGNANT WOMAN WHO IS PHYSICALLY ➔​ inability to meet major role obligations OR COGNITIVELY CHALLENGED. ➔​ an increase in legal problems HEALTH EDUCATION ➔​ or risk-taking behavior, HEALTH-TEACHING MODIFICATION ➔​ or exposure to hazardous situations because ➔​ Cognitively-impaired of an addicting substances ◆​ instructions given to her care provider SUBSTANCE DEPENDENT ➔​ Visually-challenged ➔​ when he or she has withdrawal symptoms ◆​ pamphlets to support person to read following discontinuation of the substance , to pregnant woman ➔​ with role-abandonment of important ➔​ Hearing-impaired activities , ◆​ Interpreter ➔​ spending increased time in activities related ➔​ Health education to the substance use ◆​ Nutritional counseling ➔​ substance for a longer time than planned ◆​ Activity/rest ➔​ continued use despite worsening problems ◆​ Childbirth because of substance use ◆​ Use of illicit drug/smoking/alcohol RISK PREGNANT WOMAN WHO IS PHYSICALLY ➔​ Blood-borne infections OR COGNITIVELY CHALLENGED. ➔​ Sexually transmitted diseases MODIFICATION FOR LABOR AND ➔​ Illicit substances tend to be of small DELIVERY molecular weight , they cross the placenta , MODIFICATIONS FOR LABOR AND BIRTH : can lead to fetal effects, fetal abnormalities, FEW ADAPTATIONS or preterm birth ➔​ Spinal cord Injury ➔​ The risk for hepatitis B or HIV infection ◆​ unaware of presence of contractions increases  ➔​ The risk for STI poses threat to the fetus ➔​ Fetal abstinence/withdrawal syndrome ➔​ SGA, meconium aspiration PREGNANCY AND SUBSTANCE ABUSE. ➔​ Neonatal respiratory depression COCAINE ➔​ extreme vasoconstriction INHALANT ➔​ compromised placental circulation ➔​ Fetal respiratory depression ➔​ Risks: abruptio placenta, preterm labor, fetal ➔​ Refers to sniffing or huffing of aerosol demise, fetal ICH substances ➔​ Gestational hypertension ➔​ They contain freon as a propellant which can lead to severe respiratory and cardiac Extremely harmful during pregnancy because of irregularities extreme vasoconstriction , severely compromised ➔​ Have similar effect to alcohol dependency placental circulation leading to premature ➔​ Respiratory depression can cause limitation separation of the placenta, preterm labor and fetal of fetal oxygen supply to a serious level death Infants can suffer immediate effects of intracranial ALCOHOL hemorrhage and an abstinence syndrome of ➔​ FAS tremulousness, irritability, and muscle rigidity. ➔​ Fetal alcohol spectrum disorder , a Learning and social interactions defects as long syndrome with recognizable facial features , term effects possible cognitive challenges and memory deficits occur AMPHETAMINES ➔​ Women are advised not to drink alcohol ➔​ maternal blackened and infected teeth during pregnancy ➔​ Newborn jitteriness, poor feeding, IUGR ➔​ Discuss alcohol ingestion with late adolescents, mention about binge drinking ( MARIJUANA AND HASHISH 5 or more alcohol drinks on one occasion ) ➔​ maternal tachycardia, euphoria is not safe during pregnancy ◆​ Associated with loss of short-term memory and increased incidence of respiratory infections in adults ➔​ Reduced milk production and the risk to the newborn from excretion of the substance in breast milk PHENCYCLIDINE ➔​ It creates a sense of euphoria and causes irritation and possibly long-term hallucination ➔​ Tends to leave the maternal circulation and concentrate in fetal cells it may particularly injurious to a fetus NARCOTIC AGONISTS ➔​ Risks: gestational HTN. phlebitis, endocarditis, Blood-borne infection