Case Study on a Pregnant Teenager
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Case Study on a Pregnant Teenager
By applying the principles of the nursing process to the individual, family, and community, the community health nurse can provide services to children and adolescents more systematically and effectively.
Most communities offer a range of preventive services and other important programs that children need. The community health nurse must thoroughly understand the needs of the individual child and family and must be aware of available community resources to help meet the child’s health needs, as this case study illustrates.
Maria Martinez, a community health nurse working for the county health department, received a call from the high school nurse informing her that a 16-year-old high school student named Kaylah M. would come in that afternoon for a pregnancy test.
Kaylah had already missed three menstrual periods and was afraid to talk about it with her family.
She had a long discussion with the school nurse and asked her boyfriend, also aged 16, to take her to the health department clinic after school for the pregnancy test.
Assessment
Kaylah’s pregnancy test result was positive, and she was an estimated 3 months pregnant. She was upset and would not speak with Maria at the health department. With agreement from Kaylah, Maria arranged to make a home visit the next afternoon.
Knowing that she needed to address a number of issues at the first home visit, Maria prepared by developing a list of possible assessment areas that covered individual, family, and community concerns, as follows:
Individual
Medical risk factors
Emotional well-being, including concerns about community safety, domestic violence, and sexual abuse
Cultural beliefs and attitudes toward pregnancy and medical care
Barriers to communication with providers, such as language, hearing, and sight
Understanding and acceptance of pregnancy
Health-promoting and risk-taking behaviors
Understanding the importance of obtaining preventive care services
Health insurance status
Access to transportation
Family
Adequacy of housing structure
Safety of neighborhood
Ability of family members to provide emotional support
Ability of family to provide financial support
Ability and willingness of the father of the baby to provide support
Community
Availability of affordable and culturally sensitive prenatal and pediatric care
Health and social services coordination
Emotional guidance and counseling
Educational opportunities for pregnant and parenting teenagers
Job training
Nutrition services such as WIC and food stamps
Pregnancy and parenting education
Child care availability
Assessment Data
Individual
Kaylah was already in the early second trimester of pregnancy and had not received prenatal care. She also engaged in risk-taking behaviors (i.e., smoking, alcohol use, unprotected sex, and poor eating habits) potentially detrimental to her baby.
During the interview, Kaylah seemed quiet and reserved. She said she was excited to have a baby but feared labor and delivery.
Her boyfriend wanted her to keep the baby but was not committed to supporting Kaylah or the baby. He did not want to involve his own parents.
Kaylah said she did not think about prenatal care much but would probably visit a health clinic sometime before her delivery. Her family did not have health insurance, and she said they could not afford prenatal care.
She wanted to keep the baby and remain in school, yet she did not have a realistic understanding of parental responsibilities.
Family
When Kaylah told her parents she was pregnant, they expressed disappointment. Her mother voiced a willingness to provide emotional support, but her seemingly emotionally distant father expressed anger.
Both parents expressed concern about how the family would manage financially.
After a brief review of the family’s financial situation, it appeared that Kaylah was eligible for Medicaid and WIC.
Her parents wanted her to have no further contact with her boyfriend.
Community
Maria determined that prenatal services were available, but only during school hours. Although the only clinic that accepted Medicaid clients was on the other side of town, a nearby obstetrical practice with a certified nurse-midwife on staff accepted clients with Medicaid coverage. However, their primary clientele consisted of middle-class, married women.
Applying for Medicaid and the WIC program required Kaylah to go to the welfare office and apply during school hours. However, the hospital outpatient department could make a preliminary Medicaid eligibility determination, which might be more convenient.
Although Medicaid would pay for some prenatal classes, those nearby were geared to older, married couples.
Kaylah’s school encouraged her to remain in regular classes until her delivery date and participate in home study for a limited time thereafter.
No parenting classes geared toward adolescents were available.
Child care was not available at the high school, making a return to school more difficult for Kaylah.
Although the community has a lay home visitor program that matches mentors with pregnant and parenting teens and provides health information and encouragement, the project does not serve Kaylah’s neighborhood.
Diagnosis
Individual
Unhealthy lifestyle choices related to the lack of prenatal care and the effect of poor nutrition, smoking, and alcohol use on fetal development
Parenting issues related to unrealistic expectations about parenting responsibilities
Lack of knowledge related to infant and child safety issues, such as the use of child safety seats, advantages of breast-feeding, safe sleep for infants, and use of preventive health care, including immunizations
Family
Disrupted family dynamics related to anger and disappointment over daughter’s pregnancy
Altered financial status resulting from the addition of another dependent to the family
Community
Lack of coordinated, culturally sensitive, accessible prenatal and parenting services for adolescents
Existing lay home visitor program not available
Planning
To ensure the action plan is complete, realistic, and successfully implemented, Maria must thoroughly identify the factors affecting Kaylah’s health and well-being. In addition, Kaylah, her family, and Maria must set mutual goals.
Individual
Long-Term Goals
Pregnancy outcome will be healthy for mother and infant.
Kaylah will demonstrate successful parenting behaviors.
Kaylah will complete high school.
Short-Term Goals
Kaylah will obtain prenatal care.
Kaylah will understand the reasons to change nutrition and substance use habits.
Kaylah and the nurse will plan actions to change poor health habits.
Kaylah will remain in school throughout her pregnancy and will use the home study program until she returns to school after her baby is born.
Kaylah will enroll in parenting class. If classes are not available, she will use age-appropriate reading materials, films, CDs, Internet resources, opportunities for group discussion with other teens, or visits with experienced parents.
Kaylah will breast-feed her baby.
Kaylah will speak with the community health educator to determine methods to protect the health and safety of her newborn.
Family
Long-Term Goal
The family’s ability to handle crises will improve with their ability to discuss problems and engage in mutual problem solving.
Short-Term Goal
Kaylah’s parents will display supportive behaviors, such as accompanying her to prenatal care appointments, helping her engage in healthy behaviors, and helping her arrange child care so she can remain in school.
Community
Long-Term Goal
Accessible, comprehensive, culturally sensitive prenatal and other health care services will be established, including home visiting and parenting classes targeted to adolescents.
Short-Term Goals
The health department clinic will extend evening hours to accommodate students and working families.
A child care facility will open in or near the high school.
Intervention
The nurse, family, and individual must address their immediate, mutual goals to help Kaylah achieve a healthy birth outcome and begin successful parenting.
Interdisciplinary planning among Kaylah’s school health nurse, caseworker, community health nurse, primary pregnancy care provider, childbirth educator, and family planning nurse is critical.
In addition, Maria must be an advocate for community-wide change to ensure that the community is meeting individuals’ needs.
Individual
Maria worked with the school nurse and other health professionals to help Kaylah obtain Medicaid and WIC; she was referred to an obstetrician who saw her regularly.
Kaylah’s pregnancy was also monitored by the school nurse, who had her come to the clinic on a weekly basis to check her weight and blood pressure and to talk with her about pregnancy-related issues.
Working with the school nurse, Maria provided Kaylah with information on childbirth classes and nutrition as well as booklets detailing how to promote a healthy pregnancy. She was counseled to avoid tobacco, alcohol, and all drugs.
Near the end of the pregnancy, Kaylah was encouraged to attend parenting classes with her boyfriend.
Family
Maria and the social worker referred Kaylah’s parents to other social service agencies that might be able to help financially. In particular, they focused on providers who could assist with utilities, job placement, and child care.
The family was also referred to a family counselor who specialized in working with families with adolescent children.
Community
Maria worked with the maternal-child health division of the county health department to help facilitate offering parenting classes at an area high school, targeting the learning needs of pregnant teens.
She and the school nurse also met with school district officials and community leaders to stimulate dialogue about the consequences of dropping out of high school and to facilitate action in policies such as child care for parenting teenagers to help them remain in school.
Evaluation
Evaluation strategies must involve both process and outcome measures on the individual, family, and community levels.
Individual
The school nurse was able to monitor Kaylah throughout her pregnancy and was aware that she finished classes for the term. Kaylah’s pregnancy was unremarkable, and she delivered a healthy boy. Their health care expenses were covered by Medicaid, and the baby was determined to also be eligible for CHIP.
A home-based teacher was assigned to work with Kaylah for 1 month after delivery to ensure that she was able to keep up with her coursework. With the assistance of the social worker, Kaylah was able to place the baby in a subsidized day care facility, allowing her to finish school.
Family
Family counseling helped the family resolve some of their issues. Maria observed that Kaylah’s parents were proud of their grandson and eager to help with his care.
Community
With the help of the school nurse and other interested parties, Maria was able to initiate a collaborative program in which health department nurses and developmental specialists offered parenting classes in high schools on a regular basis.
They were also planning on writing for a Maternal Child Health Block Grant to implement a school-based clinic focusing on the needs of pregnant teens and their infants.
Levels of Prevention
Primary
Primary prevention depends largely on the child’s age. For the youngest children, strategies include encouraging healthy behaviors by girls and women.
Primary prevention also includes the prevention of unwanted pregnancy, which is especially important for adolescents.
Secondary
Once pregnant, the woman must receive early and adequate prenatal care, practice healthy behaviors, obtain necessary social and supportive services, and prepare herself for becoming a parent.
It is incumbent on the community to ensure that adequate preventive health services, such as prenatal care, nutrition and dietary counseling, pregnancy and parent education, and social services, are available.
Tertiary
Initiate programs and services that prevent future unwanted pregnancy among teenagers and help the parenting teenager provide the best possible care to the child.
Establish programs such as parenting classes; support services to help adolescents complete their education; coordination of health and social services for the mother and her child; and well-child care, immunizations, and nutrition services.
Develop strategies to inform parents whose children are uninsured about the availability of CHIP.
Spend a day with a school health nurse and analyze what could help prevent or address the health problems and issues he or she encountered throughout the day.
Communicate with those in policy-making positions by writing letters or holding meetings about children’s needs.
Identify the public health and advocacy organizations in the community that are working to address children’s health needs and identify their strategies for promoting child health within the community.
If your community has a lay home visitor program, meet with a home visitor and, if possible, accompany him or her during home visits.
RUBRIC
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