Online Class Day 3

thanks rai, angel and lauren for the additional post.

Postpartum:

Risk for impaired parent/infant attachment r/t birth of infant with physical defect

Delayed growth and development r/t congenital defect

Parental role conflict r/t birth of a child with birth defect

I think somehow she may be regretful, disappointed about what she had done and like what many said she may blame herself and her partner about the consequences of their actions.

Just to add for to the possible diagnosis for postpartum.. She could also be at risk for Postpartum psychosis...

In addition, Risk for Fetal Injury related to maternal complications/susceptibility (maternal age)

Good job guys. Now, let’s continue our enthusiasm for discussion for our second case.



Case Study # 6: Pregnant woman at risk for preterm labor
Martha is a 24-year-old unmarried multigravida (4-0-1-2-1) woman. She is 15 weeks pregnant and has finally come to the reproductive clinic for her first prenatal visit since she’s is afraid she will have another premature baby. Her first two pregnancies resulted in miscarriages at 13 and 14 weeks. Her third pregnancy resulted in the birth of her 4-year-old daughter at 30 weeks’ gestation. Martha smokes one pack of cigarettes every 1 to 2 days. Her health history reveals that she has been hypertensive since 20 years of age and often experiences bladder infections. Her stress level has increased since her boyfriend, the father of the baby, has started to ”pick fights with her and hit her.” She cannot understand why he is doing this since he never hit her before when he would get angry.

Questions:

1. What risk factors associated with preterm labor and birth does Martha’s history reveals?
2. You recognize that violence has become part of Martha’s relationship with her boyfriend. How would you address this problem with her? Why is he “picking fights” with her when she is pregnant?
3. Martha asks you what to look for in terms of signs that preterm labor is occurring, “With my daughter, everything seemed to happen so fast without any warning.” What should you teach Martha about the signs of preterm labor and what to do if she detects them? Her obstetrician did a fetal fibronectin test and it was positive. What does this mean?
4. Martha goes into labor at 24 weeks’ gestation. Conservative measures fail to suppress labor, necessitating admission to the hospital. Tocolytic therapy with magnesium sulfate is successful and Martha is discharged to home care. Home uterine monitoring and nursing telephone consultation has been arranged. How would you prepare Martha

summary of possible diagnosis:


risk for violence
self-directed r/t symptoms of depression or expreesses desire to hurt oneself.
Disturbed body image r/t physiological changes occurring in pregnancy
Interrupted family process r/t role confusion secondary to adolescent pregnancy
Delayed growth and development r/t disruption of normal psychosocial development in adolescence
Anticipatory Grieving r/t having a neonate with congenital defect
Anxiety

Since the mother have an idea what is happening to her baby,ANXIETY could be an appropriate nursing diagnosis when looking at it in a psychological manner.

Prenatal/Postnatal dxs:
>Disturbed body image r/t physiological changes occurring in pregnancy
>Interrupted family process r/t role confusion secondary to adolescent pregnancy
>Delayed growth and development r/t disruption of normal psychosocial development in adolescence
>Anticipatory Grieving r/t having a neonate with congenital defect
>Health seeking behavior r/t lack of knowledge on neonatal management
>Knowledge deficit r/t management of a newborn with congenital anomaly.

Intranatal:
>Pain r/t CS incision
>Other dx depends on the client's condition

i agree with jenny and yogi

in q3 some of us pointed out that the mother may go into blaming herself or the anomaly presented once she gets ahold of the reality of the situation. she may go into depression hence, an important diagnosis in this situation would be risk for violence, self-directed r/t symptoms of depression or expreesses desire to hurt oneself.

they should really be given the support they need so that they do not go into this state.

nice one yogi and jenny.

now, lets proceed to the last question.

in addition to yogi's response, and if this guilt feeling of causing the problem persist. eventually, the mother may entertain other forms of intervention. In a literature, elective abortion may be associated with feelings of guilt and anger that abortion was necessary and varying degrees of depression are common.

aun lng!

>> i found this literature but it is not specific to the case of an adolescent mother...
common emotional reactions of mothers with atypical infants are anxiety, shock, or dismay in facing the unexpected crisis. this overshadowed the satisfaction normally accompanying birth. (typical and atypical infant by Martin Herbert, Google Ebook)

i agree with angel on the psychological aspect...

very good guys. the developmental tasks of erikson for these adolescents really overlap with the new role and responsibilities and expected tasks of pregnancy/motherhood.

I believe the initial reaction of the child is not to believe the diagnosis of her baby’s condition maybe because she does not know what it was all about or maybe because she was not yet prepared for such kind of a fetal problem as she was still adapting to the early pregnancy. Looking into the psychosocial development of this pregnant mother, her primary task is to achieve positive role identity (Erikson, 1963; Gross, 1987; Rasmussen, 1964).

In a study conducted, all female respondents know that getting pregnant is a big problem (Reproductive Health and Risk Behavior of Adolescents in Northern Mindanao, Philippines. Magdalena C. Cabaraban and Maria Teresa Sharon C. Linog) and if this is a pregnancy is a problem that they consider, having congenital defective baby will also add up to the problem that hinders them to achieve a positive role identity.

At this age, the mother in this scenario is at the identity versus role confusion developmental level. Her task should be finder her identity. This is compromised by the new role she is thrust into by becoming a young mother.

She may not be ready. Her first task would be to accept the reality. Judgment from others, disowning behaviors from parents would not help her accept her situation because she would be routinely reminded of her “mistake.” What she needs to see is that there are people around her giving her the encouragement and support.

Being pregnant of a fetus with congenital anomalies further complicates her situation. She could go into blaming herself in the situation. I agree with Yogi on this one. I have seen mothers who were not even adolescents blame themselves when something went wrong with their newborn.

I agree with Angel, about the teenage mother being guilty and in the end blaming themselves as well as their partners.

>supposedly, this patient is in the identity vs. role confusion,,.. normally, it is difficult for this age group to be pregnant since it is not part of the what they should really be experiencing. Maybe, the pregnancy itself will be a short of shock with feelings of unpreparedness and doubts for the adolescent mother. Anxiety will be part of the picture since as a first time mom, she is not sure of how to perform her roles well. These feelings I think will be coupled by the fact that the fetus has a congenital anomaly.... Since this age group is sort of idealistic.. having in mind of a normal and perfect newborn, to find out that the pregnancy will not produce a normal newborn can make her depressed at some point.. Just as like what the others said.. (this can also answer no.4)

since she is a teenage mother and her first baby (i assume) have abnormalities, i think she will be perceive that it is her fault that's why the baby has abnormalities. And by having that, there's a higher chance that she will be having a hard time going back to school...

Among teenage mothers, going back to school has been a problem for them especially if the support system is not encouraging them

In our case the mother is 16 years old which means that her developmental stage is Identity vs. Role Confusion. In this stage, adolescent’s life is getting more complex that they find their own identity, struggle with social interactions and grapple with moral issues.

The mother may feel guilty and blame herself for what happened to her baby which could trigger some psychological effects on her such as denial and rejection. She may have periods of withdrawal from responsibilities, which Erikson called a “moratorium”. And if she will be unsuccessful in navigating that stage, she will experience role confusion.

Harder. 1994. The Developmental Stages of Erik Erikson. Available at: http://www.learningplaceonline.com/stages/organize/Erikson.htm

I had patients who were pregnant at this age. To me they looked so fragile and weak to become mothers. They really do not look ready or prepared for motherhood.

Sometimes, at the back of my mind I forget my role as a nurse and become judgmental.

At this point, judging them on their "mistake" would not help at all. People around would really tend to judge. This is still a SOCIAL STIGMA. But intstead of hiding them, I think the focus should be on giving them support and acceptance.

Thea looked on the psychological view of the matter at hand. She stated that the experiences (expectations) of adolescent mothers led them to be at risk for postpartum depression.

The discussion is becoming more interesting as everyone look at the situation at different angles.

MY INTERNET IS RUNNING SO LOW