Adolescent pregnancy,

Elderlyprimi,Unwedmot
her,Sexual abuse, and
Substance abuse
SINDHU SEBASTIAN
LECTUER
FMCON2014

ADOLESCEN
T
PREGNANCY
SINDHHU SEBASTIAN
LECTRER
FMCON

INTRODUCTION
Child marriages are still prevalent today in
India the results of which are girls becoming
mothers in their teens.
In addition to that, the recent incidents of rape
on minors and the rising levels of promiscuity
among teenagers are also a cause of great
concern as they lead to teenage pregnancies.
Average age of menarche (first menstrual
period) is 12 years.

DEVELOPMENTAL TASKS OF
ADOLESCENCE

Seeking economic & social stability.

Developing a personal value system
Building meaningful relationship with

others
Becoming comfortable with their

changing bodies
Working to become independent.

It is a Global Issue- why

Approximate Pregnancy Rate

Per 1,000 girls < 20-years-old

Information in table was generated from data gathered from cited resources (Guttmacher
Institute, WHO, CDC)

Most men have sex

before age 20.

Copyright: The Alan Guttmacher Institute

Worldwide

In Their Own Right-

Worldwide, women
bear a greater burden
of sexual and
reproductive ill-health
than men. More than
half a million women
die in pregnancy and
childbirth in resource
constrained settings.

Source: WHO (2006)

Adolescent Pregnancy Leads

to Unsafe Abortions
In developing countries, the risk of

death following unsafe abortions is

several hundred times higher than
one performed professionally in safe
conditions.
Almost 14% of all unsafe abortions
occur in adolescents under the age
of 20.
The rate is higher in Africa than any

Chile
More than 30,000 adolescents

between the ages of 15 and 19

give birth every year.

Source: Health-Chile (2007)

South Africa
One in three girls has had a baby by the age

of 20.

16 percent of pregnant women under the

age of 20 tested HIV positive.

30 percent of girls in South Africa said "their

first sexual experience was forced or under

threat of force".

Source: IRIN Africa (2007)

Afghanistan
57% of marriages are by girls

under the age of 16 years old

which has led to an increased
maternal mortality rate.

Source: Guttmacher Institute (2006)

Ghana
More than half marry in their teens.
12% aged 15-19 have had a child.
25% report sexual coercion that leads to

an unintended pregnancy.

39% aged 12-24 state that the last

abortion they were involved in took place

at home.

The Alan Guttmacher Institute (2004)

United
States

One million teenagers become pregnant

annually.

The United States has the highest rate of teen

pregnancy, childbirth and abortion among

developed countries.
63% give birth, and 22% have abortions.

Source: Adolescent Pregnancy and Childbirth in the U.S. (1999)

The 2005 Youth Pregnancy Risk

Behavior Survey

47% of high school students

had sexual intercourse at

least once.
37% of sexually adolescent
students had not used a
condom.
Source: Branson (2006).

Adolescent Maternity
Threatens Achievement of the Millennium
Development Goals (MDGs) by 2015
Adolescent pregnancy leads to an

increased infant and maternal mortality

rate, achievement of the following goals
will not be met if current trends
continue:
Reduce the maternal mortality rate -109/1

lakh live birth (5th )

Reduce the cild mortality rate 28/1000 live
birth)(4th Goal )

Source: Millennium Project (2005)

MDG 4 :Reduce Child Mortality

Target:
Reduce by two-thirds the under five mortality
rate by 2015.
Present Status (India):
Indias under Five Mortality (U5MR) declined
from 125 per 1000 live births in 1990 to 53 per
1000 live births in 2013

Reduce Child Mortality

Indicators:
1.Under-five mortality

rate (UNICEF-WHO).
2.Infant mortality rate
(UNICEF-WHO).
3.Proportion of 1 yearold children
immunized against
measles (UNICEFWHO

Target:
Reduce by two-thirds the

under five mortality rate

by 2015.

Improve Maternal Health

Indicators:
1. Maternal mortality ratio

(UNICEF-WHO).
2. Proportion of births
attended by skilled health
personnel (UNICEFWHO).

Target:
Reduce by three-quarters

the maternal mortality

rate between 1990 and
2015
Achieve by 2015,
universal access to
reproductive health

MDG 5 :Improve Maternal Health

Present Status(India):
The Maternal Mortality Rate (MMR) of India was 437 per
100,000 live births in 1990-91 and the target of 2015 is
109 per 100,000 live births.
The present MMR is 178 per 100,000 live birth as
compared to 1990.
By 2015, India is expected to ensure only 62 percent of
births in institutional facilities with trained personnel.

TARGET BY 2015
Goal
NO

Goals

Reduce infant
mortality

Infant
28
Mortality Rate
(IMR)

Reduce child
mortality

Under 5
42
Mortality Rate
(U5MR)

Improve maternal
health

Maternal
Mortality
Ratio (MMR)

Indicators

Targets
by 2015

109

Since in many parts of the world,

pregnant girls are not allowed to

remain in school, achievement of
this goal will also not be met:
Eliminate gender disparity in all

levels of education(2nd

Healthy People 2010

In an attempt to decrease adolescent pregnancy,
Healthy People 2010 recommended the goal of

.increasing the proportion of sexually active,

unmarried adolescents aged 15 to 17 years who use
contraception that both effectively prevents
pregnancy and provides barrier protection against
disease

Source: Healthy People 2010

Definition
Adolescent pregnancy

is pregnancy in girls
age 19 oryounger.

Adolescent pregnancy and

Causes, incidence, and risk factors

babies born to adolescents have

dropped since reaching an alltime high in 1990.
This is mostly due to the
increased use ofcondoms.

Incidence
Worldwide about
14 million
adolescent girls
give birth, while
about 4.4 million
have abortions.
Source: Peoples Daily (2007)

INCIDENCE
Save the Children found that, annually, 14

million children are born to women under

age 20 worldwide, more than 90% in
developing countries.
Complications of pregnancy and childbirth
are the leading cause of mortality among
women between the ages of 15 and 19 in
such areas

Risk factors
Adolescent pregnancy is a complex issue with

many reasons for concern.

Kids age 12 - 14 years old are more likely than
other adolescents to have unplanned sexual
intercourse .
They are more likely to be talked into having
into sex.
Up to two-thirds of adolescent pregnancies
occur in teens aged 18 - 19 years old.

Risk factors
Younger age
Poor school performance
Economic disadvantage
Older male partner
Single or teen parents

Early menarche
Peer pressure to become sexually

Risk factors contd

active
Sexual abuse as a child
Lack of information regarding
contraception
Poverty
Culture / ethnicity
Low self esteem
Strong need for someone to love
Early dating without supervision

CAUSES

The lack of education on safe sex

Peer pressure
Drugs and alcohol
Unprotected intercourse. A sexually

active teenager who does not use

contraception has a 90% chance of
becoming pregnant within one year.
Poverty is associated with increased
rates of teenage pregnancy.

Potential behavior patterns for

a teenage girl becoming
pregnant
*

Early dating behaviour

* High-risk behaviours (smoking, alcohol and substance abuse)

* Lack of a support group or few friends
* Unhealthy environment at home
* Stress and depression
* Delinquency / criminal behaviour
* Living in a community where early childbearing is common and
viewed as the norm rather than as a cause for concern
* Exposure to domestic or sexual violence
* Most important, financial constraints

Symptoms
Pregnancy symptoms include:
Abdominal distention
Breast enlargementandbreast tenderness
Fatigue
Light-headednessor actualfainting
Missed period
Nausea/vomiting
Frequent urination

Symptoms
Irregular vaginal spotting or

bleeding
Stomach cramping
Increased drowsiness and
moodiness

Signs and tests

The adolescent may or may not admit to

being involved sexually.

If the teen is pregnant, there are usually
weight changes (usually a gain, but there may
be a loss if nausea and vomiting are
significant).
Physiological changes in pregnancy
Examination may show increasedabdominal
girth, and may be able to feel the fundus (the
top of the enlarged uterus).

Pelvic examination may reveal bluish or purple

coloration of vaginal walls, bluish or purple

coloration and softening of thecervix, and
softening and enlargement of the uterus.
Apregnancy testof urine and/orserum
HCGare usually positive.
Apregnancy ultrasoundmay be done to
confirm or check accurate dates for pregnancy.

IMPACT OF PREGNANCY ON
ADOLESCENTS
Negative impact in terms of health &

social impact.
Affect one's education
7 out of 10 adolescents will drop out of
school.
Greater psycho-social impact

employment and social class.

IMPACT OF TEENAGE PREGNANCY ON THE CHILD

Children of adolescent mothers are at a greater risk of
preterm birth,
LBW,
Child abuse,
Neglect, Poverty & Death.

Early

motherhood
can
affect
the
psychosocial development of the infant
developmental disabilities
behavioral issues is increased in children born to teen
mothers.
Poor academic performance

Treatment
All options made available to the pregnant teen

should be considered carefully, including

Abortion,
Adoption,
Raising the child with community or family

support.

Discussion with the teen may require several

visits with a health care provider to explain all

options in a non-judgmental manner and
involve the parents or the father of the baby as
appropriate.

Early and adequate prenatal care, preferably

through a program that specializes in teenage

pregnancies, ensures a healthier baby.
Pregnant teens need to be assessed for
smoking, alcohol use, and drug use, and they
should be offered support to help them quit.

Adequate nutrition can be encouraged

through education and community

resources.
Appropriate exercise and adequate sleep
should also be emphasized.
Contraceptive information and services are
important after delivery to prevent teens
from becoming pregnant again.

Pregnant teens and those who have recently

given birth should be encouraged and helped to

remain in school or reenter educational
programs that give them the skills to be better
parents, and provide for their child financially
and emotionally.
Accessible and affordable child care is an

important factor in teen mothers continuing

school or entering the work force.

Prognosis

Having her first child during

adolescence
Makes a woman more likely to have
more children overall.
About 2 years behind their age
group in completing their education.
More likely to live in poverty

 History of substance abuse

are more likely to start abusing

by about 6 months after
delivery.
More likely than older mothers

to have a second child within 2

years of their first child.

Infants born to teenage

mothers are at greater risk

for developmental
problems.
Girls born to teen mothers
are more likely to become
teen mothers themselves,
and
Boys born to teen
mothers have a higher
than average rate of being
arrested and jailed.

Complication
s

Higher Risk with Adolescent Pregnancy,

Birth and Postpartum Complications
Hypertension
Eclampsia
Anemia
Difficult labor and childbirth as a result of

cephalopelvic disproportion
Increased maternal mortality
Low Birth Weight: 2 - 6 times more likely to have
low birth weightthan those born to mothers age
20 or older.
Source: IRIN-Africa (2007)

Pregnancy induced hypertension

Placenta praevia
Iron- deficiency Anemia
Preterm Labor
Cephalo- pelvic Disproportion
Difficult labor
Postpartum Hemorrhage
Inability to adapt Post-partum
Knowledge Deficit about Infant care.
Increased maternal mortality

Prematurity

Intrauterine growthretardation:Teen

mothers are more likely to have

unhealthy habits that place the infant
at greater risk for inadequate growth,
infection, or chemical dependence.
The younger a mother is below age
20, the greater the risk of her infant
dying during the first year of life.

NURSING MANAGEMENT

Prenatal Assessment
Health History
Family profile
Physical examination

NURSING DIAGNOSES
1. Imbalanced nutrition : less than body
2.
3.
4.
5.
6.

requirements related to insufficient intake

Risk for injury : maternal & fetal related to
inadequate prenatal care & screening.
Social Isolation related to body image changes
Interrupted family processes related to
adolescent pregnancy
Disturbed body image related to situational
crisis of pregnancy
Risk for impaired parenting related to
immaturity & lack of experience

Recommendations
Focus on women and girls reproductive

health and education outcomes.

Provide Emergent obstetric care.
The provision of reproductive health care

services to teens requires sensitivity to the

special needs of this age-group including
knowing about laws about confidentiality
and services for birth control, pregnancy,
abortion, and adoption.
Source: Stanhope and Lancaster (2006)

Thorough assessments are vital, because factors such

as a history of sexual victimization, family dysfunction,

substance use, and failure to use birth control can
influence whether a young girl becomes pregnant.
The pregnant teen will need support during and after

pregnancy from her family and friends and from the

father of the baby.

Source: Stanhope and Lancaster (2006)

Reforms

In Chile, under the new regulations, public health services are authorized to

prescribe, and to provide free of charge, traditional and emergency

contraceptives to adolescents over 14, without the need for parental consent.

In Botswana, increased child support rules and daycare and encouragement

for teens to stay in school have led to decreased teen pregnancy rates.

In Ghana, Media Campaigns to encourage condom use among sexually active

youth are proving to be effective in reducing the number of adolescent

pregnancies.
Source: Health-Chile and Plus News Global

The Young and Wise campaign sponsored by Planned

Parenthood in Ghana is another good campaign to decrease

the number of adolescent pregnancies.
The Stop Aids Love Life program in Ghana is also an

effective tool in promoting self esteem leading to lower

incidences of adolescent pregnancy.
The African Youth Alliance is moving towards progress in

reducing adolescent pregnancy.

Successful Pregnancy Prevention

Programs
Include collaborative approaches by

the teens, their families, teachers,

health professionals, businesses, the
faith community, lawmakers, and
other community organizations.

Source: Brandis, Sattley, and Mamo (2005)

The Parent-Adolescent Relationship

Education (PARE) Program
The program provides a
curriculum for prevention of STDs
and pregnancy in middle school
youth and focuses on
strengthening family
communication about sexual
issues and behaviors to help
prevent teen pregnancy.
Source: Lederman, R.P., & Mian, T.S (2003).

The National Campaign to Prevent

Teen Pregnancy advocates PARE and

includes information about
reproduction, sex risks, and safe-sex
behaviors including contraception
and abstinence.

PARE emphasizes the importance of

parental involvement on the

reduction of early pregnancies.

AGENCIES FOR LOWERING HIGH PREGNANCY

RATES IN THE UNITED STATES

National

Campaign to Prevent Teen and

Unplanned Pregnancy was formed. They are
dedicated to solving the issue of teen
pregnancy in the United States.

Every

year since 2002, this campaign

celebrates the National Day to Prevent Teen
Pregnancy on the first Wednesday of May.
President
Barack Obama
has
publicly
supported this day.

Education is Key
Education should be

started before the age

of 14, when young
people become sexually
active.
Information should be
provided for teenagers
about avoiding
unintended
pregnancies, including
detailed information
about contraception
and its side effects.

Education is Key
Better management and training for

nurses, so they can deal sympathetically

with teenagers requiring contraception
provide the necessary information and
education campaigns that take away the
stigma of teenage sexuality, so that
adolescents are not afraid to ask for
contraception.
All teenagers should not just be allowed
to remain in school and to return to
school after birth, but they should be
strongly encouraged to do so.

Conclusion

Source: World Health Organization (WHO)

(2006)

Every minute,
somewhere in the world
a young mother dies from
complications in
pregnancy and childbirth.
4 million babies die each
year within their first 28
days of life,
3.3 million are stillborn.
Millions of lives could be
saved using the
knowledge we have
today, but the challenge
is to transform this
knowledge into action.

Journal Articles

Cheryl Anderson & Michelle Mccarley :

Psychological Birth trauma in

adolescents experiencing an early birth.
Maternal & Child Nursing. May/Jun 13
Cross- sectional descriptive study compared 2
groups of adolescents(delivering prior to 38
weeks & between 38 42 weeks) for PBT.
Results: single Primigravida over 16 yrs of
age. Adolescents delivering before 38 weeks
though LSCS reported symptoms of
depression & were at highest risk for PBT.
Additionally they lacked pain control &
unsupportive caregivers in Labor.

Does Watching
Sex on
Television DrPH,Steven
Predict Teen Pregnancy?
-Anita
Chandra,
C. Martino,

PhD

Data from a national longitudinal survey of teens (1217

years of age, monitored to 1520 years of age) were used to

assess whether exposure to televised sexual content
predicted subsequent pregnancy for girls or responsibility
for pregnancy for boys. We measured experience of a teen
pregnancy during a 3-year period.
RESULTS: Teens who were exposed to high levels of
television sexual content were twice as likely to experience
a pregnancy in the subsequent 3 years, compared with
those with lower levels of exposure

Depression and Teenage Pregnancy

By Jane Collingwood
Analysis showed that teenage mothers had higher

levels of depression than other teenagers or adult

mothers, but the experience of teenage
childbearing did not appear to be the cause.
Rather, teenage mothers depression levels were
already higher than their peers before they
became pregnant, and they remained higher after
childbearing and into early and middle adulthood.
Results suggest that the combination of poverty
and existing distress was a good predictor of teen
pregnancy.

Thank You

THE ELDERLY PRIMIGRAVIDA

Definition
Any women who is pregnant

for the 1st time at or above the

age of 30-35years is called as
an elderly primigravida,
More in developing countries.

Types
One with high fecundity
A woman married late but conceives soon

after the marriage

One with low fecundity

Women married early but conceives long after

marriage. This type isprognostic ally more

unfavorable. Moreover, because of low
fecundity chance of future progressive are
remote.

Reasons for delaying pregnancy

Desire for advanced education
Career priorities
Use of better contraceptives
Result of fertility therapies
Dilemma: pregnancy has positive &

negative effects
Select right time for pregnancy
Partners share the preparation for
parenthood.

Outcomes of Pregnancy in elderly

women
Adverse peri-natal outcomes more common.
More likely to have LBW Infants, premature
births & multiple births.
risk for maternal mortality due to
hemorrhage, infection, embolism,
hypertensive disorders of pregnancy,
cardiomyopathy & strokes.
maternal age leads to infertility &
spontaneous abortions, GDM , PIH,
chromosomal abnormalities, genetic
disorders, placenta previa, Preterm labor &
surgical births

COMPLICATIONS-For mother
During pregnancy

Increased chance of abortion,

Pregnancy induced hypertension
Pre eclampsia- because of increased association

of hypertension,
Abruption placenta of pre-eclampsia & folic acid
deficiency
Intra uterine growth retardation.
Medical complicationsrelated with advancingage
like Hypertension,Diabetes,Organic heart lesion.
Tendency of Pre-term or Post-term birth &
Caesarean birth

Uterine fibroids :

The long period of infertility may induce the

development of uterine fibroids which may
complicate the pregnancy.

During labor
increased chance ofpremature labour
Prolonged labour due to uterine inertia caused by
Anxiety
Mal position (occipito posterior),
Impaired joint mobility
Inelasticity of soft tissues of birth canal.
Maternal & fetal distress appears early
Chances of operative intervention areincreased
chance of retained placenta is increased due to

uterine atony & increasedassociation of fibroid

Labor tends to be longer in the elderly

primigravida than in the multipara.

Posterior position of the occiput are also
common .Abnormal uterine action may
complicate labor..
There is increased need for obstetric
intervention because of the rigid perineum
and prolonged labor.

puerperium
increased morbidity due to operative

interferencefailing lactation
Prognosis
The maternal morbidity is high & the maternal
mortality, is increased due toprematurity,
increased congenital malformation (trisomy21)
& operative

Fetal

The neonatal morbidity and mortality are increased

because of
prematurity,
prolonged labor and
the need to intervene,
the increase evidence of congenital fetal
abnormalities (eg: mangolism, hydrocephaly,
anencephaly etc. ) with increase maternal age

Increased chance of congenital

malformation (trisomy 21) due to age

If necessary triple test should be done at
14-16 weeks.

Challenge to midwife
Maternal morbidity and mortality

are higher in elderly primigravidae

than in young primigravidae is
faced the nurse midwife must refer
all elderly primigravidae to the big
hospital for delivery.

Nursing Management
Pre natal Assessment
Begin prenatal care early
Fortunately women in this age group are well
informed
Few may attribute lack of menstruation to
menopause.
Health History
Ask about present symptoms of pregnancy.
How they feel about pregnancy
Enquire about any self medication.
Family Profile : source of income

Physical Examination
Thorough physical examination at 1st prenatal

visit to establish general health & identify

problems
Inspection of lower extremities for
varicosities.
Urine specimen : glucose, protein
Assessment of breast
Assessment of FHR & Fetal movements.
Chromosomal assessment: triple screen ( AFP.
HCG & Unconjugated estriol level)

Complications related to Labor,

childbirth & Postpartum period
Failure to progress in labor : cervix does not

dilate as spontaneously due to elasticity in

cells
Difficulty in accepting the event : second
thoughts about childbearing during labor &
childbirth
Postpartum Hemorrhage : uterus may not
contract readily due to inelasticity

NURSING CARE
Social, genetic & environmental factors need to
be considered & appropriate interventions
planned!!!!!
First Trimester
Anxiety related to deficient knowledge as
evidenced by womens question & concerns
Imbalanced Nutrition : less than body
requirements related to nausea & vomiting as
evidenced by womens reports & weight loss.
Fatigue related to hormonal changes in the
first trimester as evidenced by womans
complaints

Second Trimester
Constipation related to progesterone effect on
the Gastro-intestinal tract as evidenced by
womans report of altered patterns of
elimination
Third Trimester
Fear related to deficient knowledge regarding
onset of labor & processes of labor related to
inexperience as evidenced by womans
questions & concerns.

INTRAPARTUM CARE
Risk for injury: maternal & fetal

due to complications associated

with elderly pregnancy.
Pain related to labor process.
Knowledge deficit related to
labor processes

Postpartum care
Pain related to episiotomy or

caesarean birth .
Knowledge deficit related to neonate
care related to lack of experience.
Risk for interrupted family processes
related to inclusion of new family
member.

ELDERLY PREGNANT WOMEN

2 groups of women have emerged:
Multiparous women : have an additional child
during the menopausal period
Primiparous women : deliberate delay of
childbearing
May seek information about pregnancy from

books, friends & internet.

Multiparous Women
Some may have never used contraceptives
Some may have used contraceptives
successfully during childbearing years.
As menopause approaches, they cease
menstruating or stop use of contraceptives &
consequently become pregnant.
Mixed emotions among mothers.
Parents must prepare a safe & nurturing
environment during pregnancy 7 after birth.
Must integrate child into an established family
system.

Developmental Tasks & Pregnancy

Developmental challenge over 40: expand

their awareness or develop Generativity.

Sandwich Generation : caring for aging
parents & growing children.
Ambivalent feeling towards pregnancy.
Need help to cross 2 simultaneous phases of
life : becoming involved with the world &
concentrating on the baby inside her.

Journal Article

M.A. Sajjad et all, FIVE YEAR STUDY OF ELDERLY

PRIMIGRAVIDA AT AMIN HOSPITAL Iranian Journal of Public
Health 1977;6(3) : 121-134
In a period of 5 years there were 30000 deliveries at Amin hospital,
among them, 355 deliveries of primigravidas over 35 years of age
who were included in this retrospective study. Comparison with the
same number of primigravidas under 30 years of age indicate a
much higher rate of fetal and neonate mortality as well as other
minor and major complications in the older group.
Incidence of breech presentation and twins was high,
Duration of pregnancy, first and second stage of labor also was
longer
Operative deliveries including forceps and vacuum deliveries were
more frequent and the rate of cesarean-section was high (19.4%
comparing with 5.5% in control group).
Toxemia of pregnancy, hyper tension, ante partum and
postpartum, hemorrhage, fetal and neonatal mortality showed an
increased' frequency in the studied group
Distribution of congenital malformations were found to be equal
except that a case of Down syndrome was recorded in the studied

The outcome of pregnancy in elderly

primigravidas.

Haifa A Al-Turki, Saudi medical journal(impact factor: 0.52).

11/2003; 24(11):1230-3
To investigate the effect of advancing age of 35 years and more on the outcome of
pregnancy in nulliparous women and to compare the type of complications observed
in this group of women to those in the age of 20-34 years.
This was a retrospective analysis of 2517 primigravidas delivered at King Fahd
Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia between 1996-2000.
The data were collected from the records of the labor room and the medical records
were screened for maternal age, antenatal complications, gestational age, birthweight of the neonate, sex of the neonate and the Apgar score.
Between age of 20-34 years (Group A) there were 1950 patients with the mean age
of 24.79 years (range 20-34) and in women over the age of 35 years (Group B)
there were 205 patients with the mean age of 38.72 years (range 35-48 years).
Group B had significantly less number of normal deliveries 59.9 compared to group
A 81% with p value of <0.001. Diabetes mellitus was common in group B as
compared to group A and was statistically significant at p value <0.001.
The gestational age in group B was 36.06 weeks and in group A it was 38.84 weeks
(p value was markedly significant at <0.001).
Women in group B had more deliveries by cesarean section (CS) 23.8% as in group
A 12.6%, a significant p value <0.001. The birth-weight in group B was less
compared to group A, p value of <0.002.
Childbearing in elderly primigravidas does have higher rates of complications due to
diseases such as diabetes mellitus and preeclamptic toxemia. They are liable to
have more deliveries by CS than by other methods, in spite of lower gestational age

Thank You

UNWED
MOTHERS

Definition
Lady who becomes pregnant without

legal justification of physical intimacy

between man & woman.
In traditional societies like India,
becoming pregnant before marriage is
considered a sin.
The psychosocial impact of becoming
an unwed mother is very stressful &
depressive.

Cause of unwed mother

Factors associated with

Unwed
Pregnancy
Poverty
Prostitution
Teenage mistake
Improper Sex Education
Contraceptive failure

Poverty:

The foundation of unwed mother

lies somewhere in poverty.

It is well known that very
unfortunate parents due to their
poverty sell their daughter.
The reality of this statement is
well established by the newspaper
and news telecast on T V .
Many of these girls end result is
unwed mother.

Prostitution :
Prostitute is an individual who

for sake of some reward engage

in illegal sexual act with various
individual either of same or
opposite sex.
The tragedy of this prostitutes is
also being unwed mother.

Teen age mistake:

Many teen age girls due to

inefficient decision making make

a mistake that make them an
unfortunate mother unwed
mother.

Improper sex
education:
Due to lack of improper sex

education among teen agers and

adolescent , the unwanted
pregnancy is an emerging issue.

Contraceptive failure:
Contraceptive failure can also be a reason of

unwed mother.
If sexual relationship before marriage is made
but used contraceptives does not work them it
result in an unwanted pregnancy making the
lady an unwed mother.

CONSEQUEN
CES OF
BEING AN
UNWED
MOTHER

For the mother

Not socially acceptable
Considered a curse.
Brings a lot of personal

disorganization
Lack of support from family &
society
Difficult life ahead

For the family:

The darkness of being unwed mother

not only remain to mother but her

family also has to face it
The society boycott the family of
unwed mother
family loose their relationship with the
society
which leads to isolation and hence
result in psychological trauma on family.

Economic problems :
As unwed mother lacks support

from family and society ,

therefore she faces great
economic problems.

Health problems:
Both mother and child are at great

risk of serious health problems.

This may be due to lack of support
(emotional , Nutritional) both to
mother and baby,
unsafe delivery practices which
are usually conducted at unhygienic
places to hide unwanted pregnancy
from society or due to improper
guidance for rearing of child.

Support system
available to unwed
mother

Support system to unwed mother is

more available in western societies than
traditional one..
For east few decades the government
provides free food, free medical support
system , jobs to earn income , proper
education facilities to unwed mothers
child.

Legal rights of unwed mothers

Establish paternity :
Unwed mother has a right to

raise the case in the court to

establish paternity for her child
against men who she is
expected that he is father of her
child.

Support to child :
Once paternity is established,

the mother can demand the

support from father to raise her
child. The support can be in form
of money or in some other form.

Custody of child :
Even if paternity is

established still has the right

to undertake the custody of
her child if she want it.

Prevention

Prevention of Unwed Pregnancy

Peer education
Sex education
Supply of contraceptives
Abolition of Prostitution

Peer education :
Peer education should be

implanted to provide education to

those who are not able to go
school. Education regarding
sexual and regarding sexual and
reproductive health can be
provided to them by forming a
group of peers.

Sex education :
Well designed and well

implemented sexual and

reproductive health education
can be provided to young
people , so that they can engage
in a safe and responsible sexual
behavior

Supply of
contraceptives :
Government has made easy

access to contraceptives
therefore should take benefit of it
Must take necessary step to
prevent the occurrence of unwed
mother .

Abolition of
prostitution
Prostitution mostly result in

unwed mother.
So in order to prevent this the
prostitution should be banned
or prostitute should be informed
about the use of contraceptives.

Factors influencing care

of unwed
mothers
Age of the mother
Family support
Financial stability
Approach towards pregnancy
Social and cultural background

Role of a Nurse

Role of a Nurse
As an :

Educator
Advocate
Helper
Researcher

As educator :
Nurse should play a vital role in

providing sex education to

youngster to prevent occurrence
of unwed mother.
Nurse can provide knowledge
to youngster about the evil
effect of being unwed mother.

As an advocator :
As an advocator, she can

advocates the rights of unwed

mother and can protect her from
further exploitation .
She must inform the mother about
her legal rights which are provided
by government to them so that
mother can take benefit of them.

As a helper :
As a helper , she can help

the mother to raise her child

in the society.
Nurse must provide free
services to the mothers
which are provided by
government agencies to help
them.

As a researcher :
As a researcher , she should

make research in the best

preventive measure to avoid the
occurrence of unwed mother.

Case Presentation
Ms Jeevitha, 26 yr old unmarried woman presented to

casualty 0n 23/07/13 with complaints of severe

headache & GTCS, one episode of vomiting &
unconsciousness on 23/07/13
H/o severe anemia before 2 months, transfused 2 pints of
blood,
B.P.- 220/180 mmhg
Alleged to have LMP 7 days back.
Diagnosed as ? Hypertensive of young & seizure disorder.
Shifted to I ward, confided LMP was 26/01/13.
Scan showed fetal movement & fetal heart ve
Final diagnosis : Unmarried Primi @ 253 weeks
of gestation with Eclampsia.

Termination of pregnancy advised.

Induced : expelled fresh still born baby boy @

3;40 pm on 24/07/13.
TPR stable, B.P- 130/90 mmhg
Patient feels guilty of being pregnant.
Cries occasionally, feeling shy to face parents
now
Few family members told about actual
diagnosis : supportive of the mother.
Patient now wants to do her parents will for
her whatever it may be!!!!!!!!!!

Thank You

SUBSTANCE ABUSE IN PREGNANCY

Introduction

Most pregnant women reluctant to

reveal substance abuse.

Use of drug risk of medical
complications in mother & baby.
Placenta acts as an active transport
mechanism.
Many drugs : Teratogenic effects.
Critical determinants of effect of drug on
fetus : drug, dosage, route of
administration, timing of exposure.

DEFINITION
Substance abuse, also known

asdrug abuse, refers to a

maladaptive pattern of use of a
substance (drug) that is not
considered dependent.Substance
abuse/drug abuse is not limited to
mood-altering or psycho-active
drugs.

Use of these drugs may lead to

criminal penalty in addition to

possible physical, social, and
psychological harm, both strongly
depending on local jurisdiction.

Common substances abused during

pregnancy
Alcohol
Caffeine
Nicotine
Cocaine
Marijuana
Narcotics
Sedatives

amphetamines,
barbiturates,
benzodiazepines(particularlytemazepam,

nimetazepam, andflunitrazepam),
opioids.

Substances

Effect on Pregnancy

1. Alcohol

Spontaneous abortion, LBW, IUGR, FAS, ARBD, MR

2. Caffeine

Vasoconstriction & mild diuresis in mother, fetal

stimulation

3. Nicotine

Vasoconstriction, utero-placental flow, LBW, Abortion

4. Cocaine

Vasoconstriction, GHTN, Abruptio Placentae, snow baby

syndrome, CNS Defects, IUGR

5. Marijuana

Anemia, weight gain, Amotivational syndrome,

newborn tremors, prematurity & IUGR.

6. Narcotics

Maternal & Fetal withdrawal, Abruptio placentae,

preterm labor, PROM, asphyxia, newborn sepsis,
intellectual impairement, malnutrition

7. Sedatives

CNS Depression, newborn withdrawal , maternal seizures

in labor, newborn abstinence syndrome, delayed lung
maturity

Characteristic Features
(FASD)
Small head circumference
Short palpebral fissures & small eye openings.
Thin upper lip
Receding jaw
Low nasal bridge
Skin folds at corner of eyes
Small, flat midface area

Alcohol related effects

No amount of alcohol consumption is safe

during pregnancy.
FAS Fetal Alcohol Spectrum Disorder (FASD)
FASD includes;
Craniofacial dysmorphia
IUGR
Microcephaly
Limb & Cardiac anomalies

Cognitive & Behavioral problems

Attention Deficit / hyperactivity Disorder
Inability to foresee consequences
Inability to learn from previous experiences
Lack of organization
Learning difficulties
Poor abstract thinking
Poor impulse control
Speech & language problems.

NURSING MANAGEMENT
Emphasizes screening & prevention to reduce

the high incidence of obstetric & medical

complications among users as well as their
passively addicted infants
Assessment
History
Screening questionnaires
Urine toxicology screening

NURSING
INTERVENTIONS
Education about effects of substance

exposure of fetus
Interventions to improve mother child
attachment & improve parenting.
Psychosocial support
Referral to outreach programs
Follow up of children born to dependent
mothers.
Dietary counseling
More frequent prenatal visits
Support systems & vocational assistance.

SEXUAL ABUSE/ SEXUAL

VIOLENCE

Types of Abuse
Mental :
Threatening to kill the victim
Forcing victim to perform humiliating acts
Making demeaning remarks about victim
Physical:
Hitting, grabbing, pushing, choking , kicking or

causing physical harm to victim

Sexual :
Forcing woman to have vaginal, oral or anal
intercourse against her will.
Biting victims breast or genitals
Forcing victim to perform sexual acts with other
people

INTRODUCTION
Social problem affecting all societies.
1 out of 4 US women have been

physically & sexually assaulted by an

intimate partner.(NVAWS)
1 women being battered every 12
sec in US (Penny 2004)
2 types of violence : intimate partner
violence & sexual abuse.

Definition-sexual abuse
Any sexual act , attempt to obtain a
sexual act, unwanted sexual comments
or advances or acts to traffic , or
otherwise directed , against a persons
sexuality using force /complsion, by any
person regardless o their relationship to
the victim, in any setting including but
not limited to home and work.

Forms and
contexts of
sexual abuse

Types of sexual
abuse

Rape within marriage or dating

relationships
Rape by strangers
Systematic rape during armed conflict
Unwanted sexual advances or sexual
harassment , including demanding sex
in return for favours

Sexual abuse of mentally or physically

disabled people.
Sexual abuse of children
Forced marriage or cohabitation ,
including the marriage of the children.
Denial of the rights to use the
contraception or to adopt other
measures to protect against sexually
transmitted diseases.

Non-consensual, forced physical

sexual behavior(rapeand
sexual assault).
Unwanted touching, either of a child or
an adult.
Sexual kissing, fondling, exposure of
genitalia, andvoyeurism,exhibitionism
and up tosexual assault.

Exposing a child to pornography.

Saying sexually suggestive

statements towards a child (

child molestation).
Also applies to non-consensual
verbal sexual demands towards an
adult.

The use of aposition of trustto

compel otherwise unwanted sexual

activity without physical force (or
can lead to attempted rape or
sexual assault).
Incest(sexual deviancy ).
Certain forms of
sexual harassment.

Spousal sexual abuseis a form of

domestic violence. When the abuse

involves forced sex, it may constituterape
upon the other spouse, depending on the
jurisdiction, and may also constitute an
assault.
Sexual misconductcan occur where one
person uses a position of authority to
compel another person to engage in an
otherwise unwanted sexual activity.

Sexual harassment in educationmight

involve a student submitting to the sexual

advances of a person in authority in fear of
being punished, for example by being
given a failing grade.
For example,sexual harassmentin the
workplace might involve an employee
being coerced into a sexual situation out of
fear of being dismissed.

Sexual violence
Sexual violence includes rape ,

defined as physically forced or

otherwise coerced penetration even
if slight of the vulva or anus using a
penis, other body part or an object..
The attempt to do so is known as
attempted rape.
Rape of a person by 2 or more
perpetrators is known as gang rape.

THE CYCLE OF
VIOLENCE
Tension
Building

Abusive
Incident

Honeymoo
n Phase

Tension Building : 1st phase. Tension

escalates between the couple. Excessive

drinking, jealousy & other factors may lead to
hostility & friction.
Abusive Incident : explosion of violence
.Victim is assaulted. Batterer loses control
both physically & emotionally.
Honeymoon Phase: period of calm, loving,
contrite behavior on the part of the batterer.
He may be genuinely sorry for the pain he
caused to his partner. Attempts to make up
his behavior & believe he can never hurt the
woman he loves.

Violence during
Pregnancy
Pregnancy often start or escalation of violence.
Pregnant women are vulnerable at this time.
Factors leading to battery:
Inability of couple to cope up with stressors of
pregnancy.
Doubt about partners fidelity.
Perception of baby as a competitor
Financial burden related to expenses of
pregnancy.
Stress of role transition
Insecurities & jealousy of pregnancy.

Types of Sexual Violence

Childhood sexual abuse
Incest
Rape
Statutory
Acquaintance
Date
Female Genital Mutilation
Human Trafficking

Child sexual abuse

It is a form ofchild abusein which a child is

abused for the sexual gratification of an

adult or older adolescent.
In addition to directsexual contact, child
sexual abuse also occurs when an adult
indecently exposes their genitalia to a child,
asks or pressures a child to engage in
sexual activities, displayspornographyto a
child, or uses a child to produce child
pornography

Childhood Sexual Abuse

Any type of exploitation that involves a child

younger than 18 yrs of age.

Includes disrobing, nudity, masturbation,
fondling, digital penetration & intercourse.
Lifelong impact on survivors.
Early abuse : lowers self esteem & ability to
protect themselves.
Influences the way victims live their lives &
form relationships

Effects of child
sexual abuse

Effects of child sexual

abuse

GuiltandSelf-blame,
Flashbacks,
Nightmares,
Insomnia,
fear of things associated with the

abuse (including objects, smells,

places, doctor's visits, etc.),

CON.
self-esteemissues,
sexual dysfunction,
chronic pain,
addiction,
self-injury,
suicidal ideation

CON.

Somatic complaints
Depression,
Post-traumatic stress disorder,
Anxiety,
Mental illnesses(including
borderline personality disorder)
Propensity tore-victimizationin
adulthood,and physical injury to the child,
among other problems.

Victims of child sex abuse are over six times

more likely to attempt suicideand eight times

more likely to repeatedly attempt suicide.
The abusers are also more likely to commit
suicide.
Much of the harm caused to victims becomes
apparent years after the abuse happens.

Sexual abuse by a family member is a

form ofincest, and results in more serious

and long-termpsychological trauma,
especially in the case of parental incest.
Approximately 15% to 25% of women and
5% to 15% of men were sexually abused
when they were children.

Most sexual abuse offenders are

acquainted with their victims;

approximately 30% are relatives of the
child, most often fathers, uncles or cousins;
around 60% are other acquaintances such
as friends of the family, babysitters, or
neighbors; strangers are the offenders in
approximately 10% of child sexual abuse
cases.

Most child sexual abuse is committed by

men; women commit approximately 14% of

offenses reported against boys and 6% of
offenses reported against girls.
Most offenders who abuse pre-pubescent
children arepedophiles;however, a small
percentage do not meet the diagnostic
criteria for pedophilia.

Sexual abuse of people with

developmental
disabilities

People with developmental disabilities are

often victims of sexual abuse. According
to research, people with disabilities are
at a greater risk forvictimizationof
sexual assault or sexual abuse because
of lack of understanding (Sobsey &
Varnhagen, 1989).

Identifying Abused
Children

No child is psychologically prepared to deal

with ongoing or intensive sexual

stimulation.
Even very young children, two or three
years old, may sense that the sexual
activity is "wrong," but they are unable to
stop it.
Children are frequently threatened that if
they tell anyone, they will be killed or sent
away, or their puppy will be killed; or their
whole family will breakup.

Children subjected to sexual over-

stimulation, with or without threats, will

develop problems.
Those older than five years of age become
caught between loyalty to or dependence
on the perpetrator, and shame at doing
something "wrong.
Over time, the child develops low selfesteem, feelings of being worthless or
"dirty," and an abnormal view of sexuality

Identifying signs

Withdrawal and mistrust of adults

Suicidality
Difficulty relating to others except in sexual or

seductive ways
Unusual interest in or avoidance of all things
sexual or physical
Sleep problems, nightmares, fears of going to bed
Forcing sexual acts on other children
Extreme fear of being touched
Unwillingness to submit to physical examination

Frequent accidents or self-injurious

behaviors
Refusal to go to school, or to the
doctor, or home
Secretiveness or unusual
aggressiveness
Sexual components to drawings
and games

Neurotic reactions (obsessions,

compulsiveness, phobias)
Habit disorders (biting, rocking)
Wears long sleeves in hot weather
(to hide bruises?)
Unusual sexual knowledge or
behavior
Prostitution

Specific physical indicators

of recent sexual abuse

Difficulty in walking or sitting

Torn, stained or bloody clothing
Pain or itching in genital area
Bruises or bleeding in genital area or mouth
Pregnancy or sexually transmitted diseases,

especially in preteens
Repeated urinary infections or genital
blockages

Incest
Sexual exploitation between blood relatives

or surrogate relatives before victim reaches

18 yrs of age.
Victims often tricked, coerced or
manipulated.
Perpetrators often threaten their victims so
they are afraid to disclose the abuse.

Rape

It is an act of violence
Legal rather than a medical term
Denotes penile penetration of the female or male

without consent
Statutory Rape : sexual activity between an
adult & a person under 18 despite the willingness
of the underage person.
Acquaintance Rape : involves someone being
forced to have sex by a person he or she knows.
Date Rape : sexual assault which occurs within
dating relationship
Drugs used : club drugs; Rohypnol, Ketamine etc

Phases of Rape Recovery

Acute Phase : shock, fear , disbelief , anger ,

shame , guilt, feelings of un-cleanliness,

insomnia & nightmare
Outward Adjustment Phase : appears
outwardly composed & returns to work or
school ; refuses to discuss the assault & denies
need for counseling
Re-organization Phase : survivor attempts
to make life adjustments by moving or
changing jobs.

Female Genital Mutilation

Also called female circumcision.
Cultural practice followed in Africa, Middle-

East & Asia.

Definition - Procedure involving the partial or
total removal or other injury to the female
genital organs, whether for cultural or other
non- therapeutic purposes.(WHO)
More than 140 million girls estimated to have
undergone FGM
2 million at risk annually.

Reasons for performing

Ideology & cultural value of each community.
Rite of passage into womanhood
Means of preserving virginity
Performed when girl is between 4 and 10 yrs

old ; age when she cannot give informed

consent for a procedure with life-long health
consequences.
Untrained village practitioners using no form
of anesthesia perform the operation.
Cutting instruments : broken glass, knives, tin
lids, scissors, unspecialized razors & crude
instruments.

Types of FGM Procedures

Types

Procedure

Type 1

Excision of Prepuce

Type 2

Excision of Clitoris & part or all of the Labia Minora

Type 3

Excision of all or part of the external genitalia & stitching of

vaginal opening

Type 4

Pricking or Piercing or incision of the clitoris or Labia

Cauterizing by burning the clitoris & surrounding tissue
Scraping or cutting vaginal orifice
Introduction of corrosive substance into vagina
Placing herbs into vagina to narrow it.

Health Risks Associated with FGM

Intense pain & dysmenorrhea
Pelvic infections
Hemorrhage
HIV infection
Damage to urethra, vagina & anus
Recurrent vaginitis
UTIs
Incontinence
Vulvar abscess
Dyspareunia
morbidity & mortality during childbirth

Human Trafficking
Modern form of slavery
Women & children are held captive & forced to

have sexual intercourse with numerous people.

Victims : lack education, employment
Traffickers promise victims employment as
nannies, maids, models etc.
Traffickers transport victim from their countries to
unfamiliar destinations.
Once captive, traffickers coerce them using rape,
torture, starvation, imprisonment into prostitution,
pornography, sex trade or forced labor
- Violence Protection Act,
2000

Impact of Sexual Violence

Devastating short & long term effects.
Women experience psychological, physical &

cognitive symptoms.
Posttraumatic Stress Disorder : develops
when an event outside the range of normal
human experience occurs that produces
marked distress in the person.
Intrusion: Re-experiencing the trauma, includes

nightmares, flashbacks, recurrent thoughts.

Avoidance: Avoiding trauma related stimuli,
social withdrawal, emotional numbing.
Hyper-arousal: Increased emotional arousal,
exaggerated startle response, irritability.

Nursing Management
Deficient Knowledge related to understanding

the cycle of violence & availability of

resources.
Fear related to possibility of severe injury to
self or child during cycle of violence.
Low self esteem related to feelings of
worthlessness.
Hopelessness related to prolonged exposure
to violence.
Compromised individual & family coping
related to persistence of victim-abuser
relationship.

Interventions
Goal : enable victim gain control of her life.
Key : good, non- judgmental communication.
Primary : aimed at breaking the abuse cycle

through community educational initiatives by

health worker.
Secondary : deals with victims & abusers in
early stages with goal of preventing
progression of abuse.
Tertiary : activities geared toward helping
severly abused women & children recover &
become productive members of society.
Rehabilitating abusers to stop the cycle of
violence.

JOURNAL ARTICLES

Rape and Abortion by Fr. Frank A. Pavone

International Director Priests for Life
The woman who has been raped has undergone a
terrible trauma and injustice.
Will an abortion help her? First of all, the abortion will
not un-rape the woman
Second, abortion brings a trauma of its own.
In rape, the trauma is "Someone hurt me." In
abortion, the trauma is "I hurt and killed someone
else -- my child."
Abortion is never the answer. Let's not add violence
to violence. When it comes to the woman who carries
a baby conceived by rape, let's choose to love them
both!

Women Who Became Pregnant Through Sexual Assault Say, Ask Us

Of the respondents, 164 were victims of rape and 28 were victims of incest
(sexual assault involving a family member). Overall, 69 percent continued
the pregnancy and either raised the child or made an adoption plan, 29
percent had abortions and 1.5 percent had miscarriages.
Nearly 80 percent of the women who aborted the pregnancy reported that
abortion had been the wrong solution.
Most women who had abortions said that abortion only increased the
trauma they were experiencing.
In many cases, the victim faced strong pressure or demands to abort. 43
percent of rape victims who aborted said they felt pressured or were
strongly directed by family members or health workers to abort.
In almost every case where an incest victim had an abortion, it was the
girls parents or the perpetrator who made the decision and arrangements
for the abortion, not the girl herself.
More than 80 percent of the women who carried their pregnancies to term
said that they were happy that they had continued the pregnancy.
None of the women who gave birth to a child conceived in sexual assault
expressed regret or wished they had aborted instead.

SUBSTANCE ABUSE IN PREGNANCY

Introduction

Most pregnant women reluctant to

reveal substance abuse.

Use of drug risk of medical
complications in mother & baby.
Placenta acts as an active transport
mechanism.
Many drugs : Teratogenic effects.
Critical determinants of effect of drug on
fetus : drug, dosage, route of
administration, timing of exposure.

DEFINITION
Substance abuse, also known

asdrug abuse, refers to a

maladaptive pattern of use of a
substance (drug) that is not
considered dependent.Substance
abuse/drug abuse is not limited to
mood-altering or psycho-active
drugs.

Use of these drugs may lead to

criminal penalty in addition to

possible physical, social, and
psychological harm, both strongly
depending on local jurisdiction.

Common substances abused during

pregnancy
Alcohol
Caffeine
Nicotine
Cocaine
Marijuana
Narcotics
Sedatives

amphetamines,
barbiturates,
benzodiazepines(particularlytemazepam,

nimetazepam, andflunitrazepam),
opioids.

Substances

Effect on Pregnancy

1. Alcohol

Spontaneous abortion, LBW, IUGR, FAS, ARBD, MR

2. Caffeine

Vasoconstriction & mild diuresis in mother, fetal

stimulation

3. Nicotine

Vasoconstriction, utero-placental flow, LBW, Abortion

4. Cocaine

Vasoconstriction, GHTN, Abruptio Placentae, snow baby

syndrome, CNS Defects, IUGR

5. Marijuana

Anemia, weight gain, Amotivational syndrome,

newborn tremors, prematurity & IUGR.

6. Narcotics

Maternal & Fetal withdrawal, Abruptio placentae,

preterm labor, PROM, asphyxia, newborn sepsis,
intellectual impairement, malnutrition

7. Sedatives

CNS Depression, newborn withdrawal , maternal seizures

in labor, newborn abstinence syndrome, delayed lung
maturity

Characteristic Features
(FASD)
Small head circumference
Short palpebral fissures & small eye openings.
Thin upper lip
Receding jaw
Low nasal bridge
Skin folds at corner of eyes
Small, flat midface area

Alcohol related effects

No amount of alcohol consumption is safe

during pregnancy.
FAS Fetal Alcohol Spectrum Disorder (FASD)
FASD includes;
Craniofacial dysmorphia
IUGR
Microcephaly
Limb & Cardiac anomalies

Cognitive & Behavioral problems

Attention Deficit / hyperactivity Disorder
Inability to foresee consequences
Inability to learn from previous experiences
Lack of organization
Learning difficulties
Poor abstract thinking
Poor impulse control
Speech & language problems.

Causes

Family history factors that influence

a child's early development have

been shown to be related to an
increased risk of drug abuse, such
as
chaotic home environment,
ineffective parenting,
lack of nurturing and parental
attachment.

Factors related to a child's socialization outside

the family may also increase risk of drug abuse,

including
inappropriately aggressive or shy behavior in
the classroom,
poor social coping skills,
poor school performance,
association with a deviant peer group or
isolating self from peers altogether,
perception of approval of drug-use behavior.

Symptoms and
Signs

Depending on the actual compound,

drug abuse including alcohol may

lead to health problems,
socialproblems,morbidity,injuries,
unprotected sex,violence,deaths,
motor vehicle accidents,homicides,
suicides,physical dependenceor
psychological addiction.

Signs to watch
Giving up past activities such as

sports, homework, or hanging out

with new friends
Declining grades
Aggressiveness and irritability
Significant change in mood or
behavior
Forgetfulness

Disappearing money or valuables

Feeling rundown, hopeless, depressed, or

evensuicidal
Sounding selfish and not caring about
others
Use of room deodorizers and incense
Paraphernalia such as baggies, small
boxes, pipes, and rolling paper

Physical problems with unclear cause

(for example, red eyes and slurred

speech)
Getting drunk or high on drugs on a
regular basis
Lying, particularly about how much
alcohol or other drugs he or she is using
Avoiding friends or family in order to
get drunk or high

Planning drinking in advance, hiding

alcohol, and drinking or using other

drugs alone
Having to drink more to get the same
high
Believing that in order to have fun you
need to drink or use other drugs
Frequent hangovers
Pressuring others to drink or use other

Taking risks, including sexual risks

Having "blackouts," forgetting what he or

she did the night before

Constantly talking about drinking or
using other drugs
Getting in trouble with the law
Drinking and driving
Suspension or other problems at school
or in the workplace for an alcohol- or
drug-related incident

When to Seek Medical Care

Mildtremorsor an alcohol withdrawal seizure

not accompanied by hallucinations or confusion

Jaundice(yellow skin and eyes)
Increasing abdominal girth
Legswelling
Coughthat won't go away
Continuing feelings of sadness or depression
Pain at an injection site
Fever
Chest pain

If any of the following occur, admit the patient to

a near by hospital immediately:
Thoughts of harming yourself or others
Chest pain, rapid heartbeat, difficulty
breathing, orlightheadedness
Severeabdominal pain
Confusion or ongoing hallucinations
Severetremorsorrecurrentseizures

Difficulty speaking, numbness,

weakness, severeheadache, visual

changes, or trouble keeping
balance
Severe pain at an injection site
(may be accompanied by redness,
swelling, discharge, and fever)
Dark, cola-coloredurine

Medical Treatment

Most substances abusers believe they

can stop using drugs on their own, but

a majority who try do not succeed.
Research shows that long-term drug
use alters brain function and
strengthens compulsions to use drugs.
This craving continues even after your
drug use stops.

Because of these ongoing cravings,

the most important component of

treatment, also called recovery, is
preventing relapse.
Treating substance abuse depends
on both the person and the
substance being used.

In behavioral treatment, a counselor

provides you with strategies to cope

with your drug cravings and ways to
avoid relapse. Your doctor may
prescribe medications, such as
nicotine patches andmethadone, to
control withdrawal symptoms and
drug cravings.

Often, a drug user has an underlying

behavioral disorder or other mental

illness, one that increases risk for
substance abuse. Such disorders
must be treated medically and
through counseling along with
treatment of the drug abuse.

Prevention of Substance
Abuse

Substance abuse may start in

childhood or adolescence.
Abuse prevention efforts in
schools and community
settings now focus on schoolage groups.

Programs seek to increase communication

between parents and their children, to

teachresistanceskills, and to provide
information in order to correct children's
misperceptions about cigarettes, alcohol,
and drugs and the consequences of their
use. Most importantly, officials seek to
develop, through education and the media,
an environment of social disapproval from
children's peers and families.

Prognosis of Substance Abuse

Individuals who suffer from substance
abuse tend to be more successful in
recovery when they are highly
motivated to be in treatment, are
actively engaged in their own
recovery, and receive intensive
treatment services. Prognosis for
substance abuse recovery is further
improved by being able to easily
access community-based social
supports.

Negative impact of
drug and alcohol use

Crime:
More than half of the economic

cost of alcohol and drugs is due to

crime. A substance abuser is 18
times more likely to be involved in
illegal activity than someone in the
general population. Many violent
crimes have been linked to the
mind-altering effects of drugs.

Disease:
Most abused substances have

harmful health effects. For some

substances, such as tobacco,
effects are caused by long-term
use. For other drugs, a single use
can cause death, disability, or
significant disease.

Behavior:
In addition to their direct effects

on health, drugs produce other

indirect effects. Many drugs lessen
inhibitions and increase the
likelihood that a person will
participate in risky behavior.

Studies show that the use of

alcohol and drugs among

teenagers increases chances for
teenpregnancyand contracting
HIV/AIDS or other
sexually transmitted diseases. Any
injected drug is associated with
contracting HIV/AIDS and
hepatitis BandC.

Substance abusers often commit thefts

to support their drug habits. Drugs and

alcohol have been linked to
domestic violenceandsexual assault.
At colleges, 75% of date rapes are
alcohol-related. Among jailed sex
offenders, 43% say they were under
the influence of drugs or alcohol at the
time of their crime.

Trauma: Up to 75% of injured

people treated at emergency

departments test positive for illicit or
prescriptiondrugs. Alcohol is strongly
associated with both intentional and
unintentionalinjury.
Drug use also puts people at risk of
violence. Nearly half of assault
victims are cocaine users.

NURSING MANAGEMENT
Emphasizes screening & prevention to reduce

the high incidence of obstetric & medical

complications among users as well as their
passively addicted infants
Assessment
History
Screening questionnaires
Urine toxicology screening

NURSING
INTERVENTIONS
Education about effects of substance

exposure of fetus
Interventions to improve mother child
attachment & improve parenting.
Psychosocial support
Referral to outreach programs
Follow up of children born to dependent
mothers.
Dietary counseling
More frequent prenatal visits
Support systems & vocational assistance.