Content
3-5 Case Scenario
6-10 Health Risk
11 -12 Nuring Care Planning
13 -15 Physical Health
16 -20 Mental Health
21 -27 Husband ’s support
28 -31 Prenatal Lecture
32 Website
33 Reference
34 Group member assignment sheet
Case Scenario
Mrs. Kwok (32 -year -old)
Accounting clerk in shipping company
>>Her first gravidity and pregnant for 3 months
>>Long working hour → feel exhausted
>>Blamed by her Mather -in -law and father -in -law
>>Lose her appetite → has stomachache
>>Unable to attend prenatal class
>>Psychological distress → burst with tears without any reason frequently
>>She wants to have abortion
Case Scenario
Mrs. Kwok (32 -year -old)
Accounting clerk in shipping company
Objective data:
1.loses her appetite
2.Stomachache
3.burst with tears
4.unable to attend prenatal class
Subjective data:
1.She feel exhausted
2.She was blamed by her parents -in -law
3.She starts to worry about her baby ’s future
4.wants to have abortion
Case Scenario
Husband (Mr. Kwok)
>>Normal clerk
Family (Mother -in -law, father -in -law, mother and father)
>>Her parents -in -law for not taking good care of her baby -to -be -born and hersel
>>Mother is full -time housewife (had history of depression )
>>Father is running his own cafe
Health Risks
1. Life Roles
(Accounting clerk → fresh mum)
2. Psychological distress
(suspected depression)
The Main
Determinants of Health Dahlgren and Whitehead,1991
Life roles
1)Living and working conditions
Long working time → strongly affect her rest and diet . Getting greater times on working cause many negative influences .
● unable to attend prenatal class
● Lack of sleep → contribute to the symptoms of depression : feel tired and exhausted
● Her irregularly diet → unhealthy to herself and the fetus
Life roles
2)Family influence
● Lack of families(husband . mother -in -law . father -in -law) support → lead her feel helpless
● Family blaming her not taking good care of her baby -to -be -born and herself → lead her feel depressed & wants to have abortion
2.Psychological distress (suspected depression)
Reason:
● The changing of life role make her feel stressful
( Accounting clerk → fresh mum )
Signs and symptoms:
● Burst with tears without any reason frequently
(over stress and worry because she is not yet ready and lack of family support)
● Lose her appetite caused stomachache.
Nursing Care
Planning
The problems that Mrs Kwok need to change immediately:
1. Physical Health :
(unbalanced diet )
1. Mental Health :
(suspected depression in pregnancy)
3. Husband ’s support :
(Husband ’s responsibility and communication problem between a daughter -in -law and a mother -in -law)
Improvement of Physical Health
1) Physical Health: Balanced healthy diet
Fine -tuning eating habits
→Balanced diet: fruits and vegetables, breads and grains, protein sources and dairy products
→Receiving adequate nutrition for both mother and baby (Critical to baby ’s growth and development)
1a) Suggestion:Diet during pregnancy (Eat nutrition supplement )
Vitamin C Foolic acid Protein, B vitamins and Iron
Intake( daily ) at least 70 mg Recommendation: 0.4 mg The U.S. RDA recommendation: about 27 mg
Food
Fruits: oranges, grapefruits, honeydew
Vegetables: broccoli, tomatoes,brussel sprouts
Dark green leafy vegetables: Broccoli, cabbage, Spinach
Legumes: black beans, lima beans, black -eyed peas
Food: beef, chicken, lamb, liver, turkey, seafood, eggs, beans
Benefit prevent high blood pressure with swelling of the hands, feet and face (pre -eclampsia), anaemia and having a small baby.
prevent neural tube defects
Protein: developing baby needs plenty of protein, especially in the second and third trimesters.
Iron: essential for creating haemoglobin / carrying oxygen and Helps avoid symptoms such as fatigue, weakness, irritability, and depression
Improvement of Mental Health
According to the Postpartum Depression: A Public Health Problem by the Hong Kong Department of Health(2014) local situation: The rate of postpartum depression who attended the 9 Maternal and Child Health Centres of the Department of Health for routine antenatal care at their third trimester during the period 1/8/2009 to 31/8/2010 (805 Chinese women interview on 2 months after childbirth)
➽ 15.7% Have postpartum depression (126 people)
➽ 84.3% Have not postpartum depression (679 people)
→ about 1 in 6 women
Siu BW, et al. (2012)
Antepartum emotional problems
Women with antepartum emotional vs women without antepartum emotional problems.
← 39% increased risk of developing postpartum depressive symptoms (EPDS >12)
Milgrom J, et al. (2008)
According to the Postpartum Depression: A Public Health Problem by the Hong Kong Department of Health(2014)
According to the Postpartum Depression: A Public Health Problem by the Hong Kong Department of Health(2014)
Lack of social support (during antenatal period)
Women who always perceived social isolation vs women who never perceived social isolation
← about 3.6 times (more risk) as likely to develop postpartum depressive symptoms (EPDS >13)
Nielsen Forman D, et al. (2000)
2) Mental health changing: Improving emotional state
(Relieve depression)
Expected Outcome Nursing Interventions Rationale Evaluation Criteria
Short Term Goal:
→Carry out aerobic exercise for 45 -60 mins at least 4 days per week
→Recommends to exercise at home/ Pregnant woman's sport training class, for example yoga and fitball, to build up the habit of doing the exercise
→pregnant women do the sports exercise regularly are less anxiety and depression, the pregnant women not to do the sports exercise are easy to anxiety and depression, so suggest the patient to do more exercise is good for her mental and physical health. (LIU et al.,2016)
→Whether she actually attends the classes
→Whether she is more relaxed than before
→Whether there is an improvement of physical health condition and mental health
Improvement of Husband Support
3)Husband ’s Support
1)Physical health : Give a Hand in Housework and attend prenatal classes → decrease her workload
2)Mental Health : Accompany and encourage his wife be awareness to her wife / keep remaining her that you are with her
→ increase her security , reduce the chance of having depression
3) Improve communication problem between daughter -in -law and mother -in - law
Goal : Solve the misunderstanding
>>Husband should act as a bridge between wife and mother
Short term : Hold an event to increase meeting chance
(eg.family gathering, shopping)
Long term : Both of them learn therapeutic communication technique to learn a good communication attitude → maintain a good relationship between them.
1.Provide information
Mother -in -law can give some advices/reminder to Mrs. Kwok about pregnant
>>eg. What king of soup is really good for pregnant women.
How to have comfortable pregnancy.
2. Show Empathy
“ Put yourself into other ’s shoes ”
Mother -in -law
>>Try to understand why Mrs. Kwok need to work so hard
Daughter -in -law
>>Try to understand mother -in -law is really care about the baby.
3.Express observation
Equal to showing care
Mother -in -law :
>>need to pay more attention on Mrs. Kwok because being pregnant is a very hard period.
Long Term Programme
Step 1. Finish the questionnaire which about depression before the lectures start.
Step 2. Calculate the total marks in the questionnaire, if higher than 21 points, they need to listening a lectures.
Step 3. After finish a lectures → fill in the questionnaire again to see the different.
Also we will provide some useful information which about handle depression, such as some organiszation and arrange regular meeting.
Center for Epidemiological Studies -Depression
The Center for Epidemiological Studies -Depression (CES -D), originally published by Radloff in 1977, is a 20 -item measure that asks caregivers to rate how often over the past week they experienced symptoms associated with depression (restless sleep, poor appetite, and feeling lonely)
Response options range from 0 to 3 for each item
(0 = Rarely or None of the Time (less than 1 day),
1 = Some or Little of the Time (1 -2 days),
2 = Moderately or Much of the time (3 -4 days),
3 = Most or Almost All the Time (5 -7 days).
Scores range from 0 to 60 , with high scores indicating greater depressive symptoms.
Less than 15 points: no depression(emotions at the healthy level)
15 -21 points: mild depression(the situation is still moderate, but sugguest you consult a professional)
More than 21 points: moderate to severe depression.(depression is serious, and advisable to seek professional
treatment immediately)
Prenatal Lecture
Content:
Emotional Management(Psychologist)
Admission preparation, childbirth process ,breastfeeding, postpartum infant vaccine(Midwife)
Goal :
increase awareness of baby birth preparation , process and recognize the occurrence of the infant, reduce worry of the baby ’s future,decrease her depression
Object:
Ecpectent mother and her husband
Evaluation:
The Epidemiological Research Center Depression Scale (CES -D)
After finished the lecture, fill in the questionnaire
→ investigate the psychological state of depression.
In the scale, the public needs to respond to 20 questions again .(same questionnaire)
Suggection:
Clinical psychologist Leung Wai Yee stressed that if the public continues to have depression, insomnia,
lack of vitality, or even think of death for more than two weeks, they should seek immediate assistance.
Website
https://www.eggnutritioncenter.org/content/uploads/2016/01/pregnancy_food_guide1.pdf
https://www.chp.gov.hk/files/pdf/ncd_watch_sep2014.pdf
http://www.alabmed.com/content -147 -14865 -1.html
https://st2.depositphotos.com/3062907/12193/v/450/depositphotos_121935424 -stock -illustration -woman -facial -expressions.jpg
https://researchonline.jcu.edu.au/16419/2/16419_Berman_et_al_2010_Front_pages.pdf
therapeutic communication technique
https://wyrddesigns.files.wordpress.com/2016/10/psx_20161001_023124.jpg
Mayo Clinic Pregnancy and nutrition: Healthy -eating basics. (2017) Retrieved from http://www.mayoclinic.org/healthy -
living/pregnancy -week -by -week/in -depth/pregnancy -nutrition/art -20046955
Dieting During Your Pregnancy ( 2015) Retrieved from http://americanpregnancy.org/pregnancy -health/diet -during -pregnancy/
1.Radloff, L. S. (1977). The CES -D scale: A self report depression scale for research in the general population. Applied
Psychological Measurements, 1, 385 -401.
2.Lewinsohn, P.M., Seeley, J.R., Roberts, R.E., & Allen, N.B. (1997). Center for Epidemiological Studies -Depression
Scale (CES -D) as a screening instrument for depression among community -residing older adults. Psychology and Aging,
12, 277 -287.
3. Milgrom J, Gemmill AW, Bilszta JL, et al. Antenatal risk factors for postnatal depression: a large prospective study. J
Affect Disord 2008; 108(1 -2):147 -57.
4. Siu BW, Leung SS, Ip P, et al. Antenatal risk factors for postnatal depression: a prospective study of Chinese women
at maternal and child health centres. BMC Psychiatry 2012; 12:22.
5. Nielsen Forman D, Videbech P, Hedegaard M, et al. Postpartum depression: identification of women at risk. BJOG
2000; 107(10):1210 -7.