Problems with Psyche Factors

a. 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

b. 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.

For many mothers, pregnancy is a time of much anxiety. The first trimester may involve an anguished decision over whether
to continue or terminate the pregnancy. Later, women who have experienced infertility, multiple miscarriages or fetal loss
may be preoccupied by fears that they will lose this baby." In the third trimester, anxiety is focused on fetal abnormality and
coping with motherhood. In addition, fear of parturition (tocophobia) may be a reason for elective Caesarean section.
Prepartum anxiety is an independent predictor of postpartum depression These anxieties will usually be managed by
ventilation and support, but anxiolytic medication can be used cauratiously. Benzodiazepines carry the risk of fetal
intoxication (oppy infant syndrome)." Beta-adrenergic blocking

Factors/causes:
1. Anger
2. Poor impulse control
3. Emotional detachment or numbness
4. Hyperalertness, 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
12. Difficulty falling or staving asleep
13. Decreased self-esteem

Diagnostic/lab result:
-Regardless of circumstances, a woman with suicidal or psychotic svmptoms
should immediately see a psychiatrist for treatment.
- Hamilton Rating Scale for Depression (Ham-D)
- 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)
4. Social isolation related to shame, secondary to rape trauma (Domain: Coping/ Stress Tolerance)
5. Rape- trauma syndrome (Domain: Coping/ Stress Tolerance)

Nursing management
1. Establish rapport with client to gain his 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 his 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 he is angry by providing things he can manipulate or destroy such as clay.
5. After every outburst, discuss with the client how his anger escalates.
6. Desensitize client to his 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.
9. Encourage client to accept forgiveness from his self and others.
10. Emphasize with the client the importance of strict adherence to his medications.
11. Refer client to other sources of support such as community organizations and support groups.
12. Encourage client to express his anger verbally rather than physically

Treatment:
Position and Posture
• Can decrease pain/ increase comfort
- Facilitate gravity
• Change pelvic diameters
• Help in cardinal movements
- Facilitate descent
Forming a one-to-one relationship with the client
It will help the client to enhance communication, problem solving, and social skills.
Coping skills and trust in relationships may be learned or enhanced.
The nurse who establishes this relationship needs to be clear about its purpose and provide positive interaction with the client.
Establishment of o specific meeting time, expectations for interaction, and the duration of therapy are important boundaries
to establish.
Constructive Feedback
Given to the client so that the client's self-esteem will not be compromised.
When the confrontation technique is used, the nurse needs to discuss the discrepancies between the client's verbalized
intensions and non-verbal behavior carefully, without appearing to be attacking the client.