Tamika J.: Nineteen-Year-Old Pregnant Teen

Jill Timm, RN, JD
Program Manager
Washington County Department of Public Health and Environment
Stillwater, Minnesota

Information Obtained during the First Visit/Encounter:

Tamika J., a 19-year-old single woman, came to the health department seeking food and assistance. She was living with a friend temporarily, but wanted to find her own apartment. She worked part time at a convenience store for minimum wage. Tamika was pregnant with her first baby and uncertain of her due date, but believed she was about seven months pregnant. She had not received medical care for her pregnancy because she had no medical insurance. Tamika did not know how to apply for medical/financial assistance, but had serious financial difficulties including running low on food.

Tamika said she experienced nausea and vomiting for about five months, and lost weight during that time. Her current weight was ten pounds more than her reported per-pregnancy weight; her pre-pregnancy weight was appropriate for her height. Tamika said she smoked ½ pack of cigarettes per day, and was not concerned about the effects of smoking on the baby. Several of her friends smoked during their pregnancies and their babies were fine.

The clinic nurse spent time with Tamika discussing pregnancy, fetal development, nutrition, and the importance of prenatal care. The nurse helped Tamika complete two referrals: health insurance/financial support and a free/low-cost community clinic where she could begin prenatal care regardless of her health insurance status. The nurse gave Tamika information about the negative effects of smoking on herself and her baby, recommended that she quit smoking, and suggested that she participate in stop smoking assistance/counseling. Tamika said she would think about it.

Application of the Omaha System:

DOMAIN: ENVIRONMENTAL

Problem: Income (high priority)

Problem Classification Scheme

Modifiers: Individual and Actual
SIGNS/SYMPTOMS OF ACTUAL:

• low/no income

• uninsured medical expenses

• difficulty buying necessities

Intervention Scheme

Category: Teaching, Guidance, and Counseling
TARGETS AND CLIENTS-SPECIFIC INFORMATION:

• finances (needed/wanted to use supportive community resources)

Category: Case Management
TARGETS AND CLIENT-SPECIFIC INFORMATION:

• finances (referral to public financial and medical assistance programs)

• medical/dental care (referral to free/low cost clinic for prenatal care)

Problem Rating Scale for Outcomes

Knowledge: 2-minimal knowledge (knew about clinic program, but little about other community resources)
Behavior: 2-rarely appropriate behavior (worked part time; waited to apply for clinic and medical assistance until third trimester)
Status: 1-extreme signs/symptoms (homeless-temporarily staying with friends, no health insurance, not enough money for food)

DOMAIN: PHYSIOLOGICAL

Problem: Pregnancy (high priority)

Problem Classification Scheme

Modifiers: Individual and Actual
Signs/Symptoms of Actual:

• difficulty with prenatal exercise/rest/diet/behaviors

• prenatal complications/preterm labor

Intervention Scheme

Category: Teaching, Guidance, and Counseling
TARGETS AND CLIENT-SPECIFIC INFORMATION:

• anatomy/physiology (normal physical changes of pregnancy, common discomforts)

• dietary management (healthy weight gain, ways to improve intake, importance of nutrients for growing fetus)

• growth/development (fetal development)

• medical/dental care (need for prenatal care and monitoring for possible complications)

Category: Case Management
TARGETS AND CLIENT-SPECIFIC INFORMATION:

• medical/dental care (referred to prenatal medical provider)

Category: Surveillance
TARGETS AND CLIENT-SPECIFIC INFORMATION:

• medical/dental care (follow through regarding medical care)

Problem Rating Scale for Outcomes

Knowledge: 2-minimal knowledge (receptive to nurse's information at clinic, aware that diet has been inadequate due to not enough food, not aware of importance of prenatal care)
Behavior: 2-rarely appropriate behavior (visited clinic for nutrition, did not seek prenatal medical care)
Status: 2-severe signs/symptoms (nausea and vomiting first half of pregnancy; low weight gain)

DOMAIN: HEALTH-RELATED BEHAVIORS

Problem: Substance use (high priority)

Problem Classification Scheme

Modifiers: Individual and Actual
SIGNS/SYMPTOMS OF ACTUAL:

• smokes/uses tobacco product

Intervention Scheme

Category: Teaching, Guidance, and Counseling
TARGETS AND CLIENT-SPECIFIC INFORMATION:

• substance use cessation (harmful effects of smoking on Tamika and fetus, suggested stop smoking/counseling referral)

Category: Surveillance
TARGETS AND CLIENT-SPECIFIC INFORMATION:

• substance use cessation (changes in use)

Problem Rating Scale for Outcomes

Knowledge: 1-no knowledge (not aware of effects of smoking on fetus)
Behavior: 1-not appropriate behavior (avoid using all substances when pregnant; smoked ½ pack cigarettes/day)
Status: 2-severe signs/symptoms (serious danger to self and fetus)