NCP The Pregnant Adolescent

Statistics for 1995 reveal that 56.9 babies were born for every 1000 females between the ages of 15 and 19. Although these rates appear to be dropping, pregnant adolescents are at risk physically, emotionally, and socially. The impact of adolescent pregnancy on the individual has far-reaching consequences, which may restrict or limit future opportunities for the adolescent and the child(ren). Educational goals may be altered or eliminated, thus limiting potential for a productive life. The client frequently may be of lower socioeconomic status, with the pregnancy perpetuating financial dependence and lowered self-esteem. Statistically, the obstetric hazards for adolescents and their infants include increased mortality and morbidity rates. Therefore, individualized prenatal nursing care for the adolescent client/family/partner that incorporates developmental needs and health education with prenatal needs has the potential to contribute positively to prenatal, intrapartal, and postpartal outcomes. In addition, neonatal outcomes associated with better Apgar scores, lower incidence of resuscitation, and fewer LBW infants can also be expected.

(Refer to CPs: First Trimester, Second Trimester; Third Trimester, for discussion of usual/expected pregnancy needs.)

CLIENT ASSESSMENT DATA BASE

(In addition to Prenatal Client Assessment Data Base)

Circulation

Elevated blood pressure (risk indicator of PIH)

Ego Integrity

Pregnancy may or may not be wanted by client; may be result of abuse.
Varied cultural/religious responses to pregnancy out of wedlock; or as a stressor on teen marriage (note whether client’s mother was a teenage mother).
Expressions of worthlessness, discounting self.
Decision making varies from abdicating all responsibility to extreme independence.
May or may not be involved with father of child by own/partner’s choice, family demands, or question of paternity.
May feel helpless, hopeless; fear family/peer response.
Emotional status varies; for example, calm, acceptance, denial, hysteria.
History of limited/no financial resources.

Elimination

Proteinuria (risk indicator of PIH)

Food/Fluid

Weight gain may be less than optimal.
Dietary choices may not include all food groups (adolescent eating patterns; presence of eating disorder).
Edema (risk indicator of PIH).
Hb and/or Hct may reveal anemia and hemoconcentration, suggesting PIH.

Hygiene

Dress may be inappropriate for stage of gestation (e.g., wearing restrictive or bulky clothing to conceal pregnancy).

Respiratory

May be a cigarette smoker

Safety

History/presence of STDs.
Fundal height may be less than normal for gestation (indicating IUGR of fetus).
Ultrasonography may reveal inappropriate fetal growth, low-lying placental implantation.

Sexuality

Lack of/incorrect use of contraception.
Pelvic measurements may be borderline/contracted.

Social Interactions

May report problems with family dynamics, lack of available resources/support
Little or no concept of reality of situation; future expectations, potential responsibilities
History of encounters with judicial systems

Teaching/Learning

Level of maturity varies/may regress; barriers of age and developmental stage.
Experimentation with substance use or abuse.
Lack of achievement in school.
Lack of awareness of own health/pregnancy needs.
Fantasies/fears about childbirth.

NURSING PRIORITIES

1. Promote optimal physical/emotional well-being of client.
2. Monitor fetal well-being.
3. Provide information and review the available options.
4. Facilitate positive adaptation to new and changing roles.
5. Encourage family/partner participation in problem-solving.

DISCHARGE GOALS

Inpatient care is not required unless complications develop necessitating hospitalization (refer to appropriate plans of care.)