The Pregnant Woman with Special Needs

A pregnant woman who has a special need needs more attention and care than an average woman warrants. Caregivers must understand that pregnancy for them is much more challenging, and they need every bit of guidance from us. With thorough assessment and an extra amount of care given, we could ensure that the pregnancy would be safe and less risky of them.

The Pregnant Adolescent

Teenage pregnancy is rampant nowadays. Since adolescent girls are not yet fully mature physically and emotionally, they need special care and education from their caregivers so they can have a safe and worry-free delivery.

• Adolescents have higher incidences of iron deficiency anemia, pregnancy-induced hypertension, premature labor, a low birth weight infant, disproportionate size between fetus and pelvis, and a high rate of intimate partner abuse.
• During the prenatal period, the adolescent can be more comfortable with primary nursing or case management approach because she is less exposed to a number of healthcare providers.
• Health history taking during the first prenatal visit is best done without the girl’s parents so a detailed history could be taken.
• The adolescent should be encouraged to continue with her prenatal visits, especially if she sought for prenatal care late in her pregnancy because she is protecting the pregnancy.
• If a parent accompanies their child, ask them separately about their concerns regarding their daughter, as they may be anxious too about hr health during pregnancy.
• The baby’s father may also accompany her during the pregnancy diagnosis, but he does not have a legal right to participate in the girl’s decisions regarding abortion and adoption because he is not married to her.
• Allow the father to offer support in the pregnancy so he will know more about himself and have education on how to prevent further pregnancies until he is more mature.
• Educate the adolescent about the common signs and symptoms associated with pregnancy and reassure her that they are part of a normal pregnancy so she would not attempt to treat the symptoms with drugs that could potentially harm the fetus.
• Some adolescents may have difficulty in telling their parents about the pregnancy, so involving them in role-playing or simulation might help them prepare to do this.
• Health teaching is compulsory for pregnant adolescents because they may not know the care measures that older women have gleaned through experience.
• Encourage the adolescent to eat a sufficient diet full of nutrients and minerals to accommodate the growth of the fetus and also her growing body.
• Also, teach her how to construct quick, healthy meals especially if she still attends school or how to buy nutritious cafeteria lunch at school.
• Remind the girl of the importance of taking her vitamins and supplements as adolescents may not be too compliant with medication taking.
• Assess the adolescent’s level of activity and participation in sports to determine what should be discontinued during pregnancy.
• Suggest alternative activities so they do not suffer from the loss of companionship, and also encourage them to plan their rest periods.
• The adolescent also needs substantial education on the physiologic changes during pregnancy and also with labor and delivery to help her gain more knowledge and treat the pregnancy as a growth experience.
• Encourage the adolescent to breastfeed like the average pregnant woman and assure them that their breast tissue would mature enough for them to be able to breastfeed.

The Pregnant Woman over the Age of 40

The dangers of getting pregnant over the age of 40 are mostly due to the complications and previously diagnosed conditions that these women may have. However, as long as prenatal care is done early in pregnancy, the serious complications in older pregnant women seem to decrease gradually.

• Women over the age of 40 may already have adequate information regarding the importance of early prenatal care and may already have an adequate insurance.
• Ask the woman about the present symptoms she is experiencing and how it fits into her lifestyle to ensure that she is not taking medicines to help relieve these symptoms.
• Assess the woman’s source of income and if stopping work because of the pregnancy could greatly reduce the family income to ascertain if the woman needs extra emotional support for feeling responsible for so many people.
• Assess the woman’s job, her recent diet, and exercise programs to determine if there should be any modifications for her pregnancy.
• Ask about personal habits such as cigarette smoking and alcohol consumption to determine if counseling is needed to halt or decrease these habits.
• A thorough physical examination should be performed on the first prenatal visit to identify any health problems especially those circulatory disturbances.
• Assess the woman’s breasts, the fetal heart sounds, and fetal movements during the prenatal visits because H-mole is also more common in women over 40.
• Obtain a urine specimen to check for the specific gravity, glucose, and protein to evaluate her renal function and the possibility of developing gestational or type 2 diabetes.
• Assess the woman’s number of meals especially those eaten outside her home or in restaurants to give her suggestions on how to adjust pregnancy nutrition so she can still obtain the same amount of nutrients when she eats at home or outside.
• Suggest attending prenatal classes where she could feel that she is one of the group, and makes sure that she plans to set aside time to do breathing exercises in preparation for her labor.
• Encourage the woman to undergo a triple screen testing (AFP, hCg, and unconjugated estriol levels) to detect any chromosomal defect or open spinal cord in the fetus.

Practice Quiz: The Pregnant Woman with Special Needs

Quiz time!

1. When planning a teaching strategy for the pregnant adolescent, the nurse should do which of the following?

A. Inform the teen that she should consider the needs of her baby first when eating or planning activity.
B. Omit information related to minor pains of pregnancy to prevent the adolescent from developing hypochondria.
C. Explain how healthy eating and exercise habits will help the teen look and feel better.
D. Emphasize the importance of frequent urine and blood testing to ensure that she is drug-free.

2. Bonnie, 16 years old and seven months pregnant, has been diagnosed with early symptoms of pregnancy-induced hypertension. An outcome that would be appropriate for Bonnie would include which of the following?

A. Bonnie regularly performs knee-chest exercises three times daily to strengthen her vascular system.
B. Bonnie verbalizes a plan for obtaining schoolwork while resting at home until her baby is born.
C. Bonnie states her intention to watch for pale mucous membranes and note any cravings.
D. Bonnie verbalizes her understanding that she is ill and must remain in bed to get well.

3. Sheila, 43 years old, is pregnant and has been scheduled for a serum alpha-protein level. The nurse would explain which of the following?

A. The test is to determine whether a chromosomal defect is present.
B. An amniocentesis will not provide the fetal serum specimen needed for the test.
C. Conditions like open spinal cord cannot be diagnosed through this test.
D. The test must be performed before the 12^th of pregnancy to prevent fetal damage.

4. When providing care for a 42-year old pregnant woman, the nurse must be alert for signs of which of the following?

A. Pregnancy-induced hypertension
B. Preterm birth
C. Rapid labor
D. Iron-deficiency anemia

5. Women over the age of 40 are at increased risk of developing pregnancy-induced hypertension. The reason for this is:

A. Many are overweight before they enter pregnancy.
B. They drink more fluids daily than younger women.
C. They do not exercise much, so fluid accumulates easily.
D. Their blood vessels are not as elastic as those of younger women.

Answers and Rationale

1. Answer: C. Explain how healthy eating and exercise habits will help the teen look and feel better.

• C: The adolescent needs to comply with healthy eating habits and because she is still at the age where she is conscious of her looks, incorporating it in the teaching could greatly increase her compliance.
• A: Both the fetus’ and the adolescent’s needs should be addressed when it comes to eating or activity planning.
• B: Information should not be withheld from the adolescent.
• D: Urine and blood testing is necessary but should not be done frequently.

2. Answer: B. Bonnie verbalizes a plan for obtaining schoolwork while resting at home until her baby is born.

• B: Bonnie needs complete rest especially late during her pregnancy to avoid exacerbating PIH.
• A: Bonnie would be unable to perform knee-chest exercises due to her growing belly.
• C: The symptoms mentioned are not signs of PIH but of iron-deficiency anemia.
• D: Complete bed rest is not necessary for Bonnie.

3. Answer: A. The test is to determine whether a chromosomal defect is present.

• A: The purpose of the test is to detect any chromosomal defect.
• B: An amniocentesis can also be used as a fetal serum specimen for the test.
• C: Open spinal cord could be diagnosed through this test.
• D: The test is performed at the 15^th week of pregnancy.

4. Answer: A. Pregnancy-induced hypertension

• A: most women who get pregnant over the age of 40 is previously diagnosed or develops PIH.
• B: Preterm birth occurs commonly in pregnant adolescents.
• C: Rapid labor is common among multigravidas.
• D: Iron-deficiency anemia is common among teenage pregnancies.

5. Answer: D. Their blood vessels are not as elastic as those of younger women.

• D: Women over the age of 40 develop PIH possibly because of blood vessel in elasticity.
• A: Obesity is not a factor in the development of PIH.
• B: Drinking more fluids could actually decrease the viscosity of blood leading to decrease possibility of developing PIH.
• C: Fluid accumulation and edema do not contribute to PIH.

These women who need an extra ounce of care should be given complete attention to help them achieve a positive pregnancy experience. Despite the difficulties that they may encounter due to their age, with the aid of her caregivers, they would be able to go through the experience feeling confident and well-informed about all the processes.