PIWIT, Leslie RAMOS, Alexis
RUBIO, Marissa SIMON, Joanna
SOTERO, Jannah VENTURA, Dania
WAGAWAG, Aldrin
- Women without adequate support
can have an experience so frightening
and stressful they can develop a
posttraumatic stress syndrome (Tam &
Chung, 2007).
Problems with the Psyche Factors
1) Inability to bear down properly – A
pregnant mother whose psychosocial
ability has significantly changed due to
shocking and depressing experiences
which has the propensity to diminish
the quality of care she could give to
herself and her unborn baby
2) Fear/Anxiety – is a feeling induced by
perceived danger; a mental shackle
that a pregnant mother may feel due to
past experiences, or the fear of being
not enough (as a caregiver), the fear
of not having enough means to provide
her needs as well as the child’s;
fear of being alone.
INABILITY TO BEAR DOWN
Possible diagnoses: Risk for Injury:
Vulnerable for injury as a result of
environmental conditions interacting
with the individual’s adaptive and
defensive resources, which may
compromise health.
Ineffective Individual Coping: Inability to
form a valid appraisal of the stressors,
inadequate choices of practiced
responses, and/or inability to use
available resources.
Risk factors
Alteration of muscle tone/contractile
pattern.
Maternal fatigue.
Mechanical obstruction to fetal
descent.
Nursing Management
Optimize uterine activity. Monitor uterine
contractions for dysfunctional patterns;
use palpation and an electronic monitor.
Prevent unnecessary fatigue. Check the
client’s level of fatigue and ability to
cope with pain.
Prevent complications of labor for the
client and infant.
Assess urinary bladder; catheterize as
needed.
Assess maternal vital signs, including
temperature, pulse, respiratory rates,
and blood pressure.
PIWIT, Leslie RAMOS, Alexis
RUBIO, Marissa SIMON, Joanna
SOTERO, Jannah VENTURA, Dania
WAGAWAG, Aldrin

Check maternal urine for acetone (an 12. Difficulty falling or staying asleep
indication of dehydration and 13. Decreased self-esteem
exhaustion).

Assess condition of fetus by monitoring DIAGNOSTIC/LAB TEST

FHR, fetal activity, and color of amniotic
fluid.
Provide physical and emotional support.
Promote relaxation through bathing and
keeping the client and bed clean, back
rubs, frequent position changes
(sidelying), walking (if indicated), and by
keeping the environment quiet.
Coach the client in breathing and
relaxation techniques.
Provide client and family education.
Medical Managements:
Narcotic or sedative, such as morphine,
pentobarbital (Nembutal), or
secobarbital (Seconal), for sleep
ANXIETY/FEAR
SIGNS AND SYMPTOMS
1. Anger
2. Poor impulse control
3. Emotional detachment or numbness
4. Hyper alertness, hyperarousal, and
exaggerated startle reflex
5. Social withdrawal
6. Self-destructive behavior
7. Survivor’s guilt
8. Relationship problems
9. Avoidance of people, places, and
things associated with the traumatic
experience
10. Depersonalization (sense of loss of
identity as a person)
11. Relationship problems
- see psychiatrist for treatment
- Hamilton Rating Scale for Depression
(Ham-D)- The scale is widely available
and has two common versions with
either 17 or 21 items and is scored
between 0 and 4 points. The first 17
items measure the severity of depressive
symptoms and as examples the
interviewer rates the level of agitation
clinically noted during the interview or
how the mood is impacting on an
individual’s work or leisure pursuits. The
extra four items on the extended 21-
point scale measure factors that might
be related to depression, but are not
thought to be measures of severity, such
as paranoia or obsessional and
compulsive symptoms. Scoring is based
on the 17-item scale and scores of 0–7
are considered as being normal, 8–16
suggest mild depression, 17–23
moderate depression and scores over
24 are indicative of severe depression
[3]; the maximum score being 52 on the
17-point scale
- Ultrasonography
NURSING DIAGNOSES
1. Anxiety related to fear of death and
change in health status as evidenced
by verbal expression of worry
(Domain: Perception/cognition)
2. Hopelessness secondary to rape
(Domain: Self-perception)
3. Risk for compromised human dignity
(Domain: Self – perception)
PIWIT, Leslie RAMOS, Alexis
RUBIO, Marissa SIMON, Joanna
SOTERO, Jannah VENTURA, Dania
WAGAWAG, Aldrin

4. Social isolation related to shame, 9. Encourage client to accept

secondary to rape trauma (Domain: forgiveness from self and others.
Coping/ Stress Tolerance)
10. Emphasize with the client the
5. Rape- trauma syndrome (Domain:
importance of strict adherence to
Coping/ Stress Tolerance)
medications.

NURSING MANAGEMENT 11. Refer client to other sources of

(Fear/Anxiety)
1. Establish rapport with client to gain
trust. It is important that the nurse should
accept client’s current level of
functioning. She should also be
consistent, positive, and honest as
well as adapt a nonjudgmental attitude
when working with the client.
2. Provide time and opportunity for
client to express feelings. It is essential
that nurse should detect an ongoing
grieving process and help client to find
conclusion.
3. To manage outbursts of anger, assist
client to identify sources of emotions.
Assist client in regaining control.
4. Assist client in using displacement
whenever emotional by providing things
she can manipulate or destroy
such as clay.
5. After every outburst, discuss with the
client how fear or anxiety escalates.
6. Desensitize client to memories of
traumatic event.
7. Administer prescribed medications as
needed. Evaluate his responses to the
medications and if client is taking and
not hoarding them.
8. Remind patient that setbacks on the
process of treatment are not failures but
an expected part of the therapy.
support such as community
organizations and support groups.
12. Encourage client to express
emotions verbally rather than physically.
Medical Management
- Antidepressants – nortriptyline,
desipramine
- Psychotherapy- may be beneficial in
women who prefer to avoid
antidepressant medication.
- Pain Management
- Low-dose antipsychotic agents –
Haloperidol
Treatment
Position and Posture
• Can decrease pain/ increase comfort
• Facilitate gravity
• Change pelvic diameters
• Help in cardinal movements
• Facilitate descent
Trust
1. Recognizing the client’s
feelings.
2. Honesty
3. Respect for the client
4. Non-judgmental attitude
PIWIT, Leslie RAMOS, Alexis
RUBIO, Marissa SIMON, Joanna
SOTERO, Jannah VENTURA, Dania
WAGAWAG, Aldrin

Emphasize Positive Results

- Do not argue with the client.
- Recognize that the client is
experiencing pain but do not dwell on
that pain.

Medication prescribed by the

Physicians:
- Use of Buspirone (Buspar) which is
pregnancy safe is an appropriate
alternative medication option.
Cognitive behavioral therapy should be
considered as an alternate treatment
option
- use of haloperidol (Haldol) is preferred
during pregnancy as extensive data
suggests it is not associated with any
congenital malformations with first
trimester exposure.
- Tricyclic antidepressants (TCAs) and
selective serotonin reuptake inhibitor
(SSRI) fluoxetine (Prozac) have been
shown to be relatively safe for use during
pregnancy

REFERENCES:

M. Belleza. (2017). Postpartum Depression.

Retrieved February 15, 2021, fromL
https://nurseslabs.com/postpartum-
depression/
Pillitteri, A. (2010). Maternal and Child Health
Nursing Care of the Childbearing and
Childrearing Family (6th Edition).
Lippincott Williams & Wilkins. pp. 693-696
Caliva, K. (2017). Problems with the Psyche
Factors. Retrieved from https://prezi.com/mg-
6wf81o3i2/problems-with-the-psyche-
factors/?fbclid=IwAR0zAh4HbeDIC6dsY-
Bpw2f9ei92_kYCyiwy_S1896bPBU3ivKd2g
S8KEHU