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.
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.
Inpatient care is not required unless complications develop necessitating hospitalization (refer to appropriate plans of care.)
Nursing diagnosis of teen pregnancy: Body Image disturbance/Role Performance, altered/Personal Identity disturbance/Self Esteem (specify) may be related to situational and maturational crises, fear of failure at life events, biophysical changes, absence of support systems possibly evidenced by self-negating verbalizations, expressions of shame/guilt, hypersensitivity to criticism, fear of rejection, lack of follow-through and/or nonparticipation in care.
1. Identify feelings and methods for coping with negative perception of self/abilities.
2. Verbalize increased sense of self-esteem in relation to current situation.
3. Demonstrate adaptation to changes/events as evidenced by setting of realistic goals and active participation in meeting own needs.
Nursing intervention with rationale:
1. Establish a therapeutic nurse-client relationship.
Rationale: Adolescent client needs a caring, nonjudgmental adult with whom to talk. Important to establish trust and cooperation so that the client is free to hear the information available.
2. Assess use of terms/language used by the client/significant other(s).
Rationale: Terminology may be specific to the adolescent culture, and words may have different meanings for client and nurse.
3. Determine developmental level and needs relative to age as early, middle, or late adolescence.
Rationale: Cognitive development during this period moves from concrete to abstract thinking (formal operations). The younger client may see control of the situation as external and beyond her grasp, and have little ability to understand the consequences of her behavior. With maturity, the abilities to understand possible consequences and to accept individual responsibility develop.
4. Identify client’s self-perception as positive or negative.
Rationale: Helps client become aware of how she views herself and to begin to increase her self-esteem. Until late adolescence, body image is still formative. The client is dealing with adolescent developmental tasks, establishing an adult identity. Low self-worth may lead to feelings of hopelessness about the future and inability to visualize a successful outcome.
5. Elicit the client’s feelings about sexual identity/roles.
Rationale: May have difficulty seeing herself as a mother. The adolescent must make a role transition from child/daughter to adult/mother, which can create conflicts for the client and significant other(s).
6. Discuss concerns and fears about body image and transitory changes associated with pregnancy; discuss personal value system.
Rationale: Establishes a basis for future learning. Conflicts may exist regarding how client has previously seen herself, what her expectations of pregnancy had been, and what the realities of pregnancy are. By midpregnancy, the enlarging abdomen and the increasing size of breasts and buttocks may prompt the teenager to try to control her appearance by dieting, with adverse consequences for fetal health and her own growth needs.
7. Discuss ways to promote positive self-image (e.g., clothing style, makeup) and recognition of positive aspects of the situation.
Rationale: Assists in coping with changes in appearance and presenting a positive image.
8. Discuss appropriate adaptation techniques and the communication skills to implement these techniques.
Rationale: Role playing and active listening can be used to learn skills of communication and adaptation. Helps client learn information necessary to development of improved self-esteem.