Socio-Economic History - Management of the Pregnant and Postpartum Teen - Case Study Example

Case study Name Institution Date Case study My initial encounter with the mother was during her subsequent antenatal visits. During these visits, most women exhibit constant psychological alteration to pregnancy (Koren & Nordeng, 2012). Some of the psychological problems that DB exhibited include inability to institute communication, increased anxiety, inability to deal with stress, failure to prepare and plan for the baby (feeding methods and clothing), and inappropriate actions or responses. These are some of the factors that made me chose this patient for my study because I wanted to learn more about the psychological problems that occur during pregnancy and how care can be provide. With regards to the patient who exhibits this behavior, it is imperative for the nurse to provide ongoing support as well as counseling and refer the lady to suitable professionals where applicable. Socio-Economic History DB is unemployed, she did not provide information regarding her level of education, social class, insurance, and cultural affiliation. She is a Baptist. It is important to be sensitive to spiritual or religious, socioeconomic, and cultural factors because this might influence someone’s reaction to pregnancy, as well as to the expectations of the woman to healthcare system (Pillitteri, 2011). One method of avoiding stereotyping patients is basically to ask her about her pregnancy period. Even though a lot of women’s responses might mirror what are considered to be conventional norms, other women may have distinctly different expectations or views that mirror a blending of cultures or beliefs. During antenatal phase, it is also important to start assessing the woman’s readiness to assume her responsibilities as a parent successfully. Past Medical and Past Obstetrical History DB had Rubella immune, RPR non-reactive. She is gravida 3 para 1 and had 1 abortion. Previous pregnancy delivered via C-section @ 29 weeks gestation, no information about abortion. Present Pregnancy DB’s estimated date of conception was 2/24/14 while the delivery date was 2/17/14. There were no complications and she had an elective C-section. Elective C-section means a caesarean section (CS) that is carried out on a pregnant woman with regards to a medical or obstetrical indication or at non-indicated CS’s maternal request. On the contrary, a CS conducted in the course of labor by necessity is referred to as an emergency CS. The lab results include GBS + 2/14, Trichomonas + 1/8, G/C + 8/27. Adolescents might enter the Intrapartum phase ready for labor and birth or not prepared (Pillitteri, 2011). Most often preparation depends on entry time into prenatal care. It is stated that adolescents who begin prenatal management earlier are more expected to have ample opportunity to take in information associated with labor and child birth. Additionally, more visits to prenatal care give them an opportunity to get some content that relate to labor and child birth. Attendance to prenatal care also raises the possibility that they are encouraged to attend classes of child birth. Childbirth classes’ attendance, even though not frequent among adolescents, widely increases a woman’s capacity to deal with labor and considerably raises her knowledge of what is to be expected in the course of birth process. DB had attended various child birth classes and she was ready for her labor and child birth. There were no complications in the course of her antepartum phase. Her vital signs were as follows: 2/17: 0900 T 34.7, P 94, BP 81/53, SPO2 100%, 1000 T 35.6, R 18, P 78, BP 96/60, SPO2 100%, 1100 P 83, SPO2 100%, BP 95/52, R 17, 1200 LUNCH, 1300 BP 98/51, T 36.6, BP 98/51, R 17, SPO2 100%. Some of the nursing diagnoses for DB include and not limited to anxiety in relation to hospitalization as well as the upcoming process of delivery, risk for deficit of fluid volume in relation to extended lack of oral intake as well as diaphoresis, altered comfort: pain in relation to perineum distention, ineffective pattern of breathing in relation to inadequate expansion of the lung secondary to stillness, risk for deficit of fluid volume in relation to hypovolemia due to excessive loss of blood, altered comfort: pain in relation to trauma to the tissue due to lower abdomen incision, and risk for infection related to impaired integrity of skin due to incision from C/S (Pillitteri, 2011). Labor There are different definitions concerning labor onset, including: regular contractions of uterine at least every 6 minutes with proof of change in cervical effacement or cervical dilation between repeated digital examinations (Pillitteri, 2011). Another definition is that it is regular contractions taking place not more than 10 minutes separately and progressive cervical effacement or cervical dilation. The last definition of labor is at least 3 throbbing regular contractions of uterine during a 10-minute phase, each going for not less than 45 seconds. Labor has a number of stages. The first stage is termed as the latent phase or pre-labor or prodromal labor. This phase is normally classified as starting point where the woman considers regular uterine contractions. On the contrary, Braxton Hicks contractions which might begin around 26 weeks gestation are termed as false labor (Pillitteri, 2011). Another phase in the first stage is termed as active phase. Providers of health care may assess the progress of laboring by carrying out a cervical exam so as to evaluate effacement, cervical dilation, as well as station (Pillitteri, 2011). These factors determine the Bishop score which can be used as a method of predicting the effectiveness of labor’s induction. In the course of effacement, the cervix is incorporated into the uterus lower segment. In the contraction period, muscles of the uterus contract causing upper segment to shorten and lower segment to draw up, in a steady expulsive motion. The second stage starts when there is full dilation of the cervix, and it ends after the baby’s delivery. When there is an increase of pressure on the cervix, a woman may have the pelvic pressure sensation together with the urge to start pushing. When the baby is completely expelled is an indication of the successful of stage two’s completion of labor. Child birth in the second stage will vary due to factors like parity, anesthesia, fetal size, and infection’s presence (Pillitteri, 2011). The third stage is the phase from immediately after expulsion of the fetus until just subsequent to expulsion of the placenta. Delaying umbilical cord’s clamping until at least a minute following birth enhances outcomes provided there is capacity to manage jaundice in case it takes place (Pillitteri, 2011). Expulsion of the placenta starts as a physiological detachment from the uterus wall. Expulsion of the placenta can be actively managed expectantly, facilitating expulsion of the placenta without medical aid. The fourth stage of labor is the phase staring immediately following child birth and extending to nearly six weeks (Pillitteri, 2011). This is also referred to as postpartum period or puerperium which is used less frequently. One of the nursing diagnoses is anxiety in relation to perceived threat on labor’s progress. Another diagnosis is alteration of pain related to labor progression. Difficulty coping or adapting to stress in relation to labor is another nursing diagnosis. There is risk for changed urinary elimination in relation to decreased intake of fluid. With regards to management, drinking or eating in the course of labor is an aspect of ongoing debate. While a number of people argue that eating during labor is safe on outcomes, other still have concern concerning the raised likelihood of an aspiration event in the occurrence of an emergency delivery as a result of the increased esophagus relaxation in pregnancy, uterus upward pressure on the stomach, and the likelihood of general anesthetic during an emergency C/S. A leading challenge for nurses is the creation of a care plan for labor and child birth. This is why a plan that is individualized needs to include the woman’s mechanisms of coping as well as support systems (Pillitteri, 2011). Management of pain during labor is paramount. One of the drugs administered to DB is oxytocin. This drug plays the role of inducing labor. Type of delivery that DB had a C-section and there were no notable complications. In several situations and with rising frequency, childbirth is accomplished via C/S or induction of labor. Policy makers in the medical profession contend that before 39 weeks elective cesarean and induced births can be detrimental to the neonate and the mother, and have certified guidelines for elective C/S and induced births that are non-medically indicated before 39 weeks (Pillitteri, 2011). Medical conditions that may necessitate C/S or induced labor delivery include chronic or gestational hypertension, eclampsia, preeclampsia, diabetes, severe restriction of fetal growth, post-term pregnancy, and premature membranes’ rupture (Nigro, G., et al., 2011). C/S may be advantageous to both baby and mother for particular indications including fetal abnormality, fetal distress, maternal HIV/AIDS, breech positions, maternal health conditions which may be worsened through labor, and multiple gestations (Nigro, G., et al., 2011). The baby’s delivery presentation was vertex. In obstetrics, a fetus presentation about to be delivered refers to the anatomical component of the fetus is heading, indicating, is nearest to the inlet of the pelvis (Pillitteri, 2011). With regards to the heading section, this is recognized as a breech, shoulder, or cephalic presentation. A malpresentation is considered as any other presentation other than a vertex appearance (with the head’s top first). The baby was female weighing 3.130 g, 45.5 cm long, 31 cm head circumference, SGA, Apgar 9/9. Apgar for the baby at one and five minutes was a 9. The baby did not have any complications noted. The Apgar scale is established through evaluation of the newborn baby on 5 easy criteria on a scale from 0 to 2, then summarizing the 5 values hence obtained. The consequential Apgar score varies from 0 to 10. The 5 criteria are summed up using words that form Appearance, Pulse, Grimace, Activity, and Respiration. The baby’s score is 9 which is regarded normal since score above 7 are considered normal. Postpartum There are various expected physiological changes that occur during puerperium. One of them is involution which is the reduction in uterus size following delivery to prepregnant size brought about by uterine contractions that tighten and occlude underlying vessels of blood at placental region (Pillitteri, 2011). Some factors enhance involution while some slow it. Those that enhance involution include early ambulation, breast feeding, and complete placenta and membranes’ expulsion. Factors that slow involution include anesthesia, prolonged labor together with difficult delivery, grand parity, full urinary bladder, retained placental membranes or fragments, infection, and uterus’ overdistension (Pillitteri, 2011). With regards to patient’s examination, the uterus was firm, 1 FB below umbilicus, Lochia scant rubra, no clots, no odor. The second physiological change occurs in the fundus. The uterus top portion is a palpable sign of involution. In case uterine muscle’s contractions are interrupted, a marshy uterus results and is expected to bring about hemorrhage. The third physiological change is lochia. This is the blood and debris discharge after delivery (Pillitteri, 2011). The types include lochia alba, lochia serosa, and lochia rubra. This discharge should not entail large clots. The entire volume is 240 to 270 mL, and day to day volume decreases gradually. Amount might be raised by breast feeding or exertion. While reclining, pooling in vagina or uterus may take place, with raised bleeding upon arising. Unexplained raise in quantity or lochia rubra’s reappearance is abnormal. Another physiological change is afterpain that is brought about by irregular uterine contractions after delivery (Pillitteri, 2011). The cervix becomes irregular, edematous, and soft. It may also seem bruised with various small lacerations. The vagina’s walls become smooth, edematous with several small lacerations. This will not be the case in the case study because DB underwent a C/S which does not involve delivery via the vagina. There is low level of estrogen in postpartum that result in reduced lubrication of the vagina. The abdominal wall is also affected. The wall becomes flabby and soft with reduced muscle tone. Stretch marks or striae, remain darker in women that are dark skinned. The cardiovascular system goes back to the prepregnant condition within two weeks. Blood pressure ought to remain steady with the baseline of pregnancy (Pillitteri, 2011). Bradycardia of 50-70 bpm is frequent during the initial 6 to 10 days; tachycardia is connected with temperature elevation, increased loss of blood, or prolonged, difficult labor and birth. With regards to gastrointestinal changes, thirst and hunger are common after birth (Pillitteri, 2011). With regards to endocrine changes, progesterone and estrogen levels drip quickly following placenta delivery. Related medications and treatments include Toradol PRN for pain, Morphine PCA, Benadryl PRN for itching. Treatments: TCDB, incentive spirometer, SCD’s, wound care for low transverse abd incision. One of the nursing diagnoses include the risk for infection related to site for invasion of microorganism secondary to C/S. Another nursing diagnosis is effective breast feeding related to maternal-infant dyad satisfaction. The patient did not want to hold baby at first due to pain and itching. Once symptoms alleviated, she interacted well with baby. There were no signs and symptoms of Baby Blue. The sign of postpartum depression was observed when the mother did not want to hold her baby. Support was provided by the nurse through administration of pain relievers and soon the mother-infant interaction became effective. Bonding, occasionally termed as attachment, between infants and mothers is influenced by various factors like family history, support systems, role models, socioeconomic status, birth experiences, and cultural factors (Koren & Nordeng, 2012). Nurses are generally encouraged to put in mind these variables when evaluating the bonding process between infants and mothers. It is also significant to acknowledge that women start to display behaviors of attachment not just during the postpartum phase but during pregnancy as well. Hence, healthcare providers have various opportunities to evaluate how pregnant patient will possibly bond with their babies following delivery (Pillitteri, 2011). Exercise and rest are imperative for the healing process (Pillitteri, 2011). However, one needs to take it easy at first. Pt was educated on proper positioning of baby while feeding, proper preparation of formula, activity restrictions at home, lift restrictions. She was also informed no driving for 2 weeks, to check on s/s of infection, follow up physician as ordered, breast care. Infant feeding method: bottle feeding, taught proper handling of formula and bottles, proper position of baby while feeding, breast care to discourage milk let-down, s/s of mastitis. Breast feeding is highly recommended because it boosts the baby’s immunity (Stuebe & Schwarz, 2010). Having bowel movement might be painful for some days following childbirth. Hence a careful diet that has a lot of fiber aids in keeping stool soft. The pt wt was 74.38 kg. NPO, then clear liquids, if tolerated, Regular Diet_indwelling cath 2/17, voiding spontaneously 2/18, BS x4, notified primary nurse of no flatulence or BM, encouraged pt to walk. Conclusion Management of the pregnant and postpartum teen is related to the one provided for an adult woman. On the other hand, adolescents frequently require extra support as well as teaching in the course of pregnancy as well as in postpartum. Adolescents might have less life experiences compared with adult women, thereby making them less able to deal with life transformations that they go through in relation to pregnancy and child birth. I have learnt that nonjudgmental care together with easy instructions is vital to management of a pregnant teen in the course of the reproductive cycle. Reference Pillitteri, A. (2011). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. New York: Lippincott Williams & Wilkins. Nigro, G., et al., (2011). Role of the infections in recurrent spontaneous abortion. Journal of Maternal-Fetal and Neonatal Medicine, 24, 983-989. Stuebe, A.M. & Schwarz, E.G. (2010). "The risks and benefits of infant feeding practices for women and their children". Journal of Perinatology 30: 155–162. Koren, G. & Nordeng, H. (2012). Antidepressant use during pregnancy: The benefit-risk ratio. American Journal of Obstetrics and Gynecology. Read More