Special-needs

Nursing Care of a Pregnant Family With Special Needs

The Pregnant Adolescent

  • Reasons for High Teenage Pregnancy:

    • Earlier age of menarche (average 12.4 years).

    • Increased rate of sexual activity among teenagers.

    • Lack of knowledge or failure to use contraceptives.

    • Desire by young girls to have a child.

Developmental Task of Adolescent

  • Erikson (1963): Establishing self-worth, body image adjustments, and vocational choices.

  • Adolescents may act as emancipated minors, capable of making their own healthcare decisions.

Prenatal Assessment

  • Health Concerns:

    • Pregnancy-induced hypertension, iron-deficiency anemia, premature labor.

    • Higher incidence of low-birth-weight infants and intimate partner abuse.

  • Methods:

    • Health History and Physical Examination.

Pregnancy Education

  • Key Areas:

    • Nutrition, Activity and Rest, Physiological Changes, Childbirth Preparation.

    • Importance of childbirth education classes and birth decisions.

Assessment Considerations for Pregnant Adolescents

  • Focus Areas:

    1. Conflicting developmental crises.

    2. Hypertension.

    3. Cephalopelvic disproportion (CPD).

    4. Premature labor.

    5. Hemorrhoids.

    6. Iron-deficiency anemia (IDA).

Complications of Adolescent Pregnancy

  • Common Complications:

    • Pregnancy-induced hypertension (PIH): bed rest recommended.

    • Iron-deficiency anemia (IDA) due to poor diet.

    • Preterm labor: educate on recognizing labor signs and vaginal bleeding.

The Pregnant Woman Over Age 40

  • Risks:

    • More susceptible to chronic conditions (e.g., hypertension).

    • Developmental tasks focus on generativity and community involvement.

Prenatal Assessment for Older Pregnant Women

  • Methods:

    • Health History, Physical Examination, Chromosomal Assessment.

    • Triple-screen test at week 15 for fetal abnormalities detection.

Pregnancy Education for Older Pregnant Women

  • Nutrition Considerations:

    • Encourage caffeine-free soft drinks instead of alcohol.

    • Recommend calcium supplementation through yogurt or pudding.

  • Social Integration:

    • Join prenatal exercise or childbirth classes.

Complications of Pregnancy for Women Over Age 40

  • Risks Include:

    • Pregnancy-induced hypertension.

    • Need for increased rest to manage symptoms.

Complications of Labor, Birth, and Postpartum for Women Over Age 40

  • Key Issues:

    • Failure to progress in labor due to less spontaneous cervical dilation.

    • Difficulty accepting the pregnancy reality, increasing emotional stress.

    • Preventing postpartum hemorrhage due to ineffective uterine contractions.

The Pregnant Woman Who is Physically or Cognitively Challenged

  • Preconceptual Care Importance:

    • Evaluate medications and prepare for safe pregnancy care.

Planning Areas for Physically or Cognitively Challenged Women During Pregnancy

  • Areas to Assess:

    • Transportation, health, work, and self-esteem.

    • Involve community agencies for additional support if needed.

Rights of the Physically or Cognitively Challenged Person

  • Legislation Compliance:

    • Access to public buildings and healthcare facilities must be ensured.

    • Women cannot be denied care nor forced to terminate pregnancies against their will.

Modifications for Pregnancy Care

  • Assessment Modifications:

    • Adjust care practices according to disabilities (e.g., visual aids).

    • Ensure prenatal vitamins are taken, especially for housebound women.

Safety Measures for Physically or Cognitively Challenged Women

  • Considerations:

    • Plan for emergency contacts, transportation, and elimination needs.

    • Monitor for Autonomic Dysreflexia in specialized cases.

Autonomic Dysreflexia

  • Responses and Management:

    • Triggered by irritants (e.g., bladder distension).

    • Symptoms can include severe hypertension; immediate intervention required.

Prenatal Care Modifications

  • Adaptations Required:

    • Adjust the examination table for wheelchair accessibility.

    • Provide clear explanations of procedures to prevent distress.

Education During Pregnancy

  • Resource Recommendations:

    • Use tape recordings for important information retention.

    • Limit instructions for cognitively challenged individuals to critical items.

Modifications for Labor and Birth

  • Considerations:

    • Ensure proper communication avenues for hearing-challenged women.

    • Address uterine contractions awareness for women with spinal cord injuries.

Modifications for Postpartum Care

  • Key Points:

    • Assess needs for contraceptive information and breastfeeding support.

Modifications for Planning Child Care

  • Support Considerations:

    • Encourage thinking about baby care equipment that suits their needs.

    • Involve legal mandates for safety before hospital discharge.

A Woman Who Is Substance Dependent

  • Definitions and Risks:

    • Substance abuse defined as failure to meet obligations due to addiction.

    • Increased risk of fetal abnormalities and preterm birth if drugs are used.

Common Substances Abused During Pregnancy

  • Effects of Specific Drugs:

    • Cocaine: Vasoconstriction leading to placental circulation compromise.

    • Methamphetamines: Jitteriness and feeding issues at birth.

    • Marijuana: Causes respiratory infections and reduced milk production.

Trauma and Pregnancy

  • Incidence:

    • 6% to 7% of pregnant women experience trauma, especially in the third trimester.

    • Preventative education on avoiding accidents and trauma is crucial.

Physiologic Effects of Trauma on Pregnant Women

  • Homeostatic Responses:

    • Changes in circulatory, respiratory rates, and blood pressure must be evaluated in context of pregnancy.

Assessing the Effects of Trauma

  • Key Indicators:

    • Monitor for placental dislocation and bladder injuries post-trauma.

Initial Assessment After Trauma

  • Body Systems Evaluation:

    • Focus on respiratory, cardiovascular, nervous, and uterine-fetal systems.

Therapeutic Management Following Trauma

  • Emergency Care Framework:

    • Ensure airway and circulation management; apply rescue breathing and CPR if necessary.

Open Wounds Management

  • Types and Treatment:

    • Lacerations require pressure to control bleeding, possible suturing.

    • Puncture wounds may need tetanus immunization based on vaccination history.

Blunt Abdominal Trauma Management

  • Assessment Protocol:

    • Peritoneal lavage or ultrasound for internal bleeding assessment after trauma.

Gunshot Wound Management

  • Surgical Considerations:

    • Clean and débride wounds, careful monitoring for fetal well-being.

Poisoning and Choking Considerations

  • Emergency Response:

    • Use activated charcoal for poisoning; alternative techniques for choking during pregnancy.

Orthopedic Injuries in Pregnancy

  • Common Injuries:

    • Colles fractures and knee injuries may require support or immobilization.

Burns in Pregnancy Risks

  • Complications:

    • Inhalation injuries increase fetal risks; prognosis worsens with extensive burn areas.

Postmortem Cesarean Birth

  • Indications and Procedures:

    • Guidelines for performing cesarean birth in cases of maternal death.

Key Points for Review

  • Unique Needs in Various Age Groups:

    • Address developmental and psychological needs for adolescent pregnancies.

    • Increased care and precaution for older women and those with disabilities.

  • Substance Dependency:

    • Recognize and support the challenges faced by substance-dependent pregnant women.

  • Trauma Assessment:

    • Consistently evaluate for potential abuse while treating trauma-related injuries.