Causes, incidence, and risk factors• Adolescent pregnancy and babies born to adolescents have dropped since reaching an all-time high in 1990. This is mostly due to the increased use of condoms.
• 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 age 18 - 19 years old.
Risk factors• Younger age• Poor school performance• Economic disadvantage• Older male partner• Single or teen parents
SymptomsPregnancy symptoms include:• Abdominal distention• Breast enlargement and breast tenderness• Fatigue• Light-headedness or actual fainting• Missed period• Nausea/vomiting• Frequent urination
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). Examination may show increased abdominal girth, and the health care provider 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 the cervix, and softening and enlargement of the uterus.• A pregnancy test of urine and/or serum HCG are usually positive.• A pregnancy ultrasound may be done to confirm or check accurate dates for pregnancy.
• All options made available to the pregnant teen should be considered carefully, including abortion, adoption, and 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.
• Having her first child during adolescence makes a woman more likely to have more children overall. Teen mothers are about 2 years behind their age group in completing their education.• Women who have a baby during their teen years are more likely to live in poverty
• Teen mothers with a history of substance abuse are more likely to start abusing by about 6 months after delivery.• Teen mothers are 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.
Pregnant teens are at much higher risk of having serious medical complications such as:• Placenta praevia• Pregnancy-induced hypertension• Premature delivery• Significant anemia• Toxemia
• Infants born to teens are 2 - 6 times more likely to have low birth weight than those born to mothers age 20 or older.• Prematurity plays the greatest role in low birth weight, but intrauterine growth retardation (inadequate growth of the fetus during pregnancy) is also a factor.
• 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.
• Unwed mother is the lady who has become pregnant without legal justification of physical intimacy between man and woman .• In the traditional societies like India the physical relationship before marriage or becoming mother before marriage is considered as a sin.• Therefore the result of such women in the traditional societies is very bad.
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.
Consequences for mother:Being mother before marriage , a mother has to face great consequences like unwed mother is not socially acceptable in our traditional societies .
In traditional society it is believed as a curse, therefore it brings alot of personal disorganization in women who become unwed mother as she lack a support from the family , relatives , society which makes her living quite hard.
Consequences 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 and 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.
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 and 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.
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.
Definition• 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 coercion , by any person regardless o their relationship to the victim, in any setting including but not limited to home and work.
• 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.
• 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 (rape and sexual assault).• Unwanted touching, either of a child or an adult.• Sexual kissing, fondling, exposure of genitalia, and voyeurism, exhibitionis m and up to sexual 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 a position of trust to 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 abuse is a form of domestic violence. When the abuse involves forced sex, it may constitute rape upon the other spouse, depending on the jurisdiction, and may also constitute an assault.• Sexual misconduct can occur where one person uses a position of authority to compel another person to engage in an otherwise unwanted sexual activity.
• Sexual harassment in education might 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 harassment in the workplace might involve an employee being coerced into a sexual situation out of fear of being dismissed.
• It is a form of child abuse in which a child is abused for the sexual gratification of an adult or older adolescent. In addition to direct sexual 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, displays pornography to a child, or uses a child to produce child pornography
somatic complaints,• depression,• post-traumatic stress disorder,• anxiety,other mental illnesses (including borderline personality disorder) propensity to re-victimization in adulthood, and physical injury to the child, among other problems.
• Victims of child sex abuse are over six times more likely to attempt suicide and 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 of incest, and results in more serious and long-term psychological 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 are pedophiles; however, a small percentage do not meet the diagnostic criteria for pedophilia.
Sexual abuse of people with developmental• disabilitiesPeople with developmental disabilities are often victims of sexual abuse. According to research, people with disabilities are at a greater risk for victimization of sexual assault or sexual abuse because of lack of understanding (Sobsey & Varnhagen, 1989).
• 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 self-esteem, feelings of being worthless or "dirty," and an abnormal view of sexuality
• 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 physicalindicators 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
• The elderly primigravida is a patient going through her 1st pregnancy at or over the age of 35years.This definition may be adopted in the developing countries but it must be remembered that the reproductive activity of the women in developing countries starts at a much earlier age than that of the women in developed countries.
• Although the age limit is being raised from 35-40 years in Britain and other European countries , it may e wise to regard as an elderly primigravida, any women who is pregnant for the 1st time at the age of 30years or more in developing countries.
complications• Tendency to abort• Increased incidence of hypertension, pre eclampsia. This is understandable because the older the women, gets the more likely to develop hypertension.• The long period of infertility may induce the development of uterine fibroids which may complicate the pregnancy.•
• 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.
The neonatal morbidity and mortality are increased because of• prematurity,• prolonged labor and• the need to intervene, as well as the increase evidence of congenital fetal abnormalities (eg: mangolism, hydrocephaly, anencephaly etc. ) with increase maternal age
• 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.
• Substance abuse, also known as drug 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.
• Activity is also considered substance abuse when inappropriately used (as in steroids for performance enhancement in sports).• Therefore, mood-altering and psychoactive substances are not the only drugs of abuse.• Substance abuse often includes problems with impulse control and impulsivity.
• The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts. The terms have a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect.
• Some of the drugs most often associated with this term include• alcohol,• amphetamines,• barbiturates,• benzodiazepines (particularlytemaze pam, nimetazepam, and flunitrazepam ),• cocaine,• methaqualone, and• opioids.
• Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction.
• Family history factors that influence a childs 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 childs 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.
• Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprote cted sex, violence, deaths, motor vehicle accidents, homicides, suicides, physic al dependence or 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 even suicidal• 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 drugs
• 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
• Mild tremors or an alcohol withdrawalseizure not accompanied by hallucinations or confusion• Jaundice (yellow skin and eyes)• Increasing abdominal girth• Leg swelling• Cough that wont 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, or lightheadedness• Severe abdominal pain• Confusion or ongoing hallucinations• Severe tremors or recurrent seizure s
• Difficulty speaking, numbness, weakness, severe headache, visual changes, or trouble keeping balance• Severe pain at an injection site (may be accompanied by redness, swelling, discharge, and fever)• Dark, cola-colored urine
• 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 and methadone, 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.
• Substance abuse may start in childhood or adolescence. Abuse prevention efforts in schools and community settings now focus on school-age groups.
• Programs seek to increase communication between parents and their children, to teach resistance skills, and to provide information in order to correct childrens 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 childrens peers and families.
Prognosis of Substance AbuseIndividuals 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.
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 teen pregnancy and contracting HIV/AIDS or other sexually transmitted diseases. Any injected drug is associated with contracting HIV/AIDS and hepatitis B and C.
• Substance abusers often commit thefts to support their drug habits. Drugs and alcohol have been linked to domestic violence and sexual 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 prescription drugs. Alcohol is strongly associated with both intentional and unintentional injury. Drug use also puts people at risk of violence. Nearly half of assault victims are cocaine users.