Draft Family (1)

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Nursing

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Nov 24, 2024

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1 Family Assessment Interview N417: Maternity, Newborn, and Women’s Health

2 Introduction My patient is an African- American 17 year-old woman who was admitted to the hospital on February 15. She had a SVD at 37 weeks gestation and she is G2P1101. The mother confirmed having a loss of her baby after preterm delivery. The patient has history of depression, suicidal thoughts, eczema, and chlamydia (2018). She had an uncomplicated vaginal delivery of a 26.9 g baby boy. Her blood loss was 266 ml with first degree laceration. Mother H&H was low after delivery and the provider suggested iron supplements to be administered three times a day. Hearing and metabolic screening were conducted on the boy and found to be normal. The mother practices both breastfeeding and formula feeding, she reported having difficulty in breast feeding and a lactation assistant was assigned to guide her. During postpartum care, the mother reported pain in her abdomen which she rated 4 in a scale of 10. Her baby boy was sleeping and looked relaxed, head to toe assessment was done on him and he was scheduled to be circumcised. During postpartum and newborn care no abnormal finding were noted on both mother and son. Structural assessment This is an extended family. The family is composed of seven people; the patient, her boyfriend, her foster mother and father, her foster sister and brother and the delivered baby. The foster mother is 43 year old, college educated and a high school teacher while the foster father is a 41 year old with college education and is a stay home dad. The patient foster brother is a twelve year old in grade 7 while her foster sister is six years old and in grade three, her boyfriend is a nineteen year old who recently started living with them. He is a high school student with a part time job while the patient is a seventeen-year old high school student and this is her second

3 pregnancy. She lost her first born son few days after a premature delivery. Her recent delivery is a full-term baby boy who is going be a new member of the family. The patient report does not have any external family members or relative thus she does not know her biological parents. The family lives in a four-bedroom house in Middle River, Maryland. The patient explained that they recently moved from the city to the suburbs because it had better affordable housing options for family set up. She explained that there was a park in a walking distance from the house, however, she does not feel safe walking around since crime rate is high in the area. She rated her comfort in the neighborhood to be 5 on a scale of 1-10. She explained that the surrounding has a one grocery store, a clinic and some fast food chain restaurants. Additionally, she pointed out that the community was not diverse and is more dominated by white households. She likes going to the beach during summer which is just a few minutes’ drive. She added that apartments, condos hotels and malls were being constructed in the area. When asked about the future, she responded by saying that she planned to live in Middle River and raise her son and possibly purchase a house there. In regard to their religious affinity, they are Christian Protestants who go to church occasionally. She explained that she prays every day and affirmed that it is her religion that helps her to cope with stress and illness. She believes that God gave her a second chance in life and that is the reason she always give chances to other people. She narrated that her parents did not raise her, it was another family that hosted her and when she lost her son, she felt depressed and sad but God her gave a second chance of having a healthy baby. She is always happy and very grateful. She refused the use of any other community services and did not show any interest in knowing more available services.

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4 She stated of not having friends since she stopped going out when her pregnancy showed. Her foster parents were not supportive of her pregnancy and the relationship at first, they felt disappointed by her. She was afraid when she discovered her second pregnancy because she is from a religious family. However, recently they agreed to support her both financially and emotionally, she relies on the help of her boyfriend and that of her foster parents to give care to the newborn. When questioned about their financial stability, she responded that her foster mum was the bread winner of the family and her boyfriend was not financially stable since he is a high school student. She did not want to rank her social class or financial stability of the family. . She explained that she obtained a health insurance cover through her foster parents and decided to attend this particular hospital to have a better care. She did not have any idea on caregiving role of the new baby. Neither the boyfriend nor any other family member was present during the interview. The patient showed interest in resuming her studies and getting a job to support her young family. Developmental assessment Family life cycle is considered a path members go through. Events like child-rearing, retirement, death, members moving out causes changes. The birth of a baby will bring in new challenges ( Wright, Lorraine M, and Maureen Leahey,2013). The couples are adolescents in high school with no finances thus, her parents are the main care givers. The mother to the new born needs financial help to help her take care of the baby. The family must adjust and create space for the child and the mother’s boyfriend who joined the family. Each family has its own

5 developmental path and the patient and her family are in Stage Three; family with young children. The role of each family member will have to change. Raising a new baby or both young mother and father is a tedious responsibility. The couple must learn to provide care for their child and open communication between them about their responsibilities, role in household task, childcare and financial responsibilities is vital. Each family member will take a new role. For example, her foster parents will become grandparents. The couple must find a balance between childrearing responsibilities and school. Wright & Leahy argues that becoming parents shifts the sense of self and relationship with families of origin becomes stressful. Cohabitating couples with a newborn are a big financial and emotional adjustment for the parents. These changes can affect the relationship negatively. Functional assessment The patient explained that they share house chores. Her foster Dad takes care of transportation and house maintenance, her foster mum does grocery shopping, the patient does cooking and cleaning, her foster brother takes out trash and takes care of their three dogs. In their family, roles are played regardless of the gender. The family is said to have good communication among themselves, her communication with her boyfriend is also said to be smooth. If a misunderstanding arises, she prefers discussing it on time. She frequently video chats with her boyfriend. In the family whenever emotions are high they are expressed, the mother uses both verbal and facial expression to convey her emotions to the boyfriend. The only community service that the family uses is the church, her foster mum reads the bible to her foster sister and brother at bedtime. Dinner gets served after a family prayer and she also explained that they go

6 as a family to farm to pick their Christmas tree. She denied of any cultural or religious beliefs that can influence her health. When asked about diet. She stated that she used to eat fast food and some home cooked food before her pregnancy. However, after her pregnancy she added vegetables and fruits in her diet. She did not show any interest on improving her diet or on additional information on healthy diet. She explained that she occasionally takes a walk though she does not have any specific exercise routine. Summary of the assessment Patient is an adolescent mother who is adapting a maternal role. She stated that she has the necessary help to face the combined demand of adolescent development and her new role as a mother. However, the absence of the father or one of her family members during her delivery and during her stay at hospital might raise some concerns regarding the strong bondage that was described by the patient. In addition, patient stated that there was no communication with her boyfriend on sharing parenting duties and tangible support. This perhaps will pose a caregiver strain. To maintain family harmony and avoid future problem open and realistic expectation should be put in place. The main leading cause of death during delivery is suicide. ( Lewis et al., 2011 ) the patient has history of depression and suicidal thoughts. Adequate assessment is necessary since her psychiatric disorder puts her at a high risk for postpartum depression. Mood swing, sleep regression and increased level of stress may contribute to exacerbating her history of depression and thoughts of self-harm. Family support and proper screening is necessary. Postpartum affects child development negatively, a depressed mother is less likely to respond to baby needs. The other concern regarding patient condition is her ability to adapt to coming changes and resume

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7 her studies. According to CDC, teen pregnancy and birth contributes to high school dropout rates among girls. Consequently, teenage mothers face unemployment and poverty. The patient is a high school student taking online classes. She showed interest in resuming her studies. However, the responsibility and demanding schoolwork may prevent her from going back to school. The patient is an adolescent who is living with her foster family. An article published in 2011 states that adolescents in foster care are more likely to become pregnant (Boonstra HD0,2011). Absence of sex education, absence of dependable family and poor social network contribute to this problem. To prevent repeat pregnancies comprehensive sexual education, family planning and reproductive health service should be provided to patients before discharge. In addition, more teaching on care for infant, nutrition education, mental health services are important. Baltimore city has the third highest teen pregnancy in Maryland and highest nationwide (Baltimore city Heath Department). Many programs and services are in place to support pregnant teen mothers. For example, patient would benefit from enrolling to Laurence G. Paquin Middle-Senior High School. A school that provides academic training, job training center, heath clinic, day crew facility and shelter for Baltimore pregnant student and young mothers. Educating patient on available services within the community can help her generate some money and support her family.

8 Patient Education Both male and female adolescents need education on sexual conduct and birth control options. Contraceptive information is required at this moment thus, education and counseling on contraceptives will be done before discharge. This counseling will prevent other unwanted pregnancies. Open and nonjudgmental approach are key on adolescent teaching and counseling. Assessing patient base knowledge is necessary to personalize the teaching. The teaching will help the mother to understand her options and make a wise decision. If possible, the education must be conducted with her partner present. Step by step teaching on contraceptives will be done. Different types of family planning, method of placement, side effects and their benefits will be addressed, misconceptions about pregnancy will also be addressed. For example, the misconception that breast feeding prevents pregnancy and taking birth control pill protects against STIs must be addressed (Ricci et al., 2017). If the patient decides to have a contraceptive this will help prevent any other unplanned pregnancy. The other patient teaching will focus on postpartum depression. The patient having had unplanned or unwanted pregnancy and loss of a previous baby is at a high risk of falling into postpartum depression. Early recognition of sign and symptoms of postpartum depression will help the patient seek help before the situation gets out of hand. Depression that lasts more than 2 weeks is more intense and needs farther investigation (Ricci et al., 2017). Depression can also affect the child, the mother mood swings will create inconsistent care to the baby. Bonding between mother and child will be affected due to missing response from the mother (2004). After assessing her preferred method of learning, a infographic and a reading material will be provided.

9 References Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans guidelines for individualizing client care across the life span (10 th ed.) . Philadelphia: F.A. Davis. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales . (14th ed.). Philadelphia, PA: F. A. Davis Company. Wright, L. M., & Leahey, M. (2013). Nurses and Families: a guide to family assessment and intervention. F.A. Davis Company. Lewis G, Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife JD, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O’Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG: An International Journal of Obstetrics & Gynaecology. 2011;118:1–203. [ PubMed ] [ Google Scholar ] Boonstra HD. Teen pregnancy among women in foster care: a primer. Guttmacher Policy Review. 2011; 14(2)

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10 Wright, Lorraine M, and Maureen Leahey. Nurses and Families A Guide to Family Assessment and Intervention : A Guide to Family Assessment and Intervention , F. A. Davis Company, 2012. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/hshsl/detail.action? docID=1069220. Created from hshsl on 2019-08-07 15:59:02. Cdc https://health.baltimorecity.gov/node/170 Komoto et al., J Nurs Care 2013, S5 DOI: 10.4172/2167-1168.S5-006 https://www.hilarispublisher.com/open-access/nursing-intervention-in-infant-mental-health- enhancing-mother-infant-interaction-and-self-esteem-2167-1168.S5-006.pdf Ricci , S. S., Kyle, T., & Carman, S. (2017). Maternity and pediatric nursing (3rd edition). Wolters Kluwer. Depression in pregnant women and mothers: How children are affected. (2004). Paediatrics & child health , 9 (8), 584–601. https://doi.org/10.1093/pch/9.8.584 . Depression in pregnant women and mothers: How children are affected. (2004). Paediatrics & child health , 9 (8), 584–601. https://doi.org/10.1093/pch/9.8.584

Draft Family (1)

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