Growth & Development of Amy Juergens

Growth & Development of Amy Juergens ___

By: Tabby Nightingale NURS 332

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This is the story of Amy Juergens:

Amy is a freshman at Ulysses S. Grant High School. The summer before she entered high school, she lost her virginity at band camp. When she found out that she was pregnant she told her two best friends, Lauren and Madison. Her secret pregnancy was spread throughout the entire school.

Initially, Amy decides to put the baby up for adoption, however, later on she decides to keep the baby. Even though Amy gets pregnant, she stays in school and juggles dating. She goes through the ups and downs in relationships, her pregnancy and her parents upcoming divorce.

Who is Amy?

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Born in 1993 Brown hair and hazel eyes 5’2”, 115 lbs.

Grade: Freshman in high school Relationships: Got pregnant by Ricky, dating Ben Parents: Anne and George Siblings: Ashley and Robby

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Social Network: Amy’s Mom, Anne, is caring and understanding of Amy’s pregnancy. She is supportive.

She is going through a divorce with Amy’s Dad, George. Anne is supportive of Amy’s initial decision to put the baby up for adoption. However, George and Amy’s siblings think Amy should keep the baby. Amy’s life is further complicated when she finds out that her Mom is pregnant.

Amy enjoys playing the flute and is in the band. She is not interested in sports. She isn’t religious but she is having a hard time understanding how to deal with her pregnancy and what the “right” choice is. She is close to her friends and family.

Amy’s best friends, Lauren and Madison, want to be supportive and throw Amy a surprise baby shower. Amy keeps going back to the father of the baby, Ricky, and her new boyfriend Ben. She wants to be a family with Ricky but things just don’t work out. It’s a constant struggle for her to keep up with her relationships.

Parenting Style: Authoritative

Amy’s parents have an authoritative style of parenting.

They guide Amy and allow her to make her own decisions. For example, Amy is pregnant and she has to make a decision on whether to keep the baby or give it up for adoption, her parents are not forcing her to do anything.

They are allowing her to make her own decision, but at the same time they are giving her their opinions. Amy’s Mom is encouraging Amy to put the baby up for adoption, while her Father is convinced that she should keep the baby. Her parents also give Amy her privacy and respect her choices. This enables Amy to trust her parents. Her parents are going through a divorce and it’s confusing for Amy. However, her parents are still co-parenting and trying to do what is best for Amy, Robby and Ashley.

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Growth & Development: Adolescents (12-20 years-old)

Physical Development: ​Adolescents in this age group have reached 20-25% of their height during puberty. Amy started her period at the age of 13 and is now 15 years-old.

Adolescent girls stop growing 2-2.5 years after having their first period. They grow 5-20 cm and gain 15-55 pounds (ATI Maternal Newborn Nursing, 2013).

Sexual Maturation: ​In adolescent girls, sexual maturation occurs in the following order: breast development, pubic hair growth, axillary hair growth and menstruation (ATI Maternal Newborn Nursing, 2013).

Physical Development and Sexual Maturation of Amy: Amy has met her physical development and sexual maturation milestones. She is a young woman who has reached her maximum height. However, because Amy is pregnant, her body will change. She will gain weight and her breast will increase in size due to the production of milk. Her body will grow through changes that is not expected for this age group. Amy should gain between 25-35 pounds during her pregnancy (Choose Myplate).

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Cognitive Development: Piaget Adolescents are highly imaginative and idealistic during this period. They have an increased ability to maintain attention for a longer duration of time and are able to judge their quality of their thoughts. Adolescents should be able to think and understand how their actions may influence others. They should have an increased ability to make formal decisions and use logic in making them. During this period, adolescents are able to think about the future (ATI Nursing Care of Children, 2013).

Amy: ​Amy is struggling between making a life choice which is whether to give the baby up for adoption or keep the baby. Either way this choice will change her life. She is going back and forth with her decision. She is highly imaginative but she is not idealistic about her situation. She decides to get married to the baby’s biological father and doesn’t comprehend how this can affect others around her. She doesn’t understand how her actions influence her family and friends. She has scattered thoughts and is not able to focus in on what she really wants.

Psychosocial Development: Erikson During the adolescent time period, the individual is going through ​identity versus role confusion​. Adolescents are able to develop a sense of personal identity. They also develop an understanding of who they are as unique individuals. Individuals in this age group also develop group identity, where their peers have an influence on their own individual behavior (ATI Nursing Care of Children, 2013).

Amy: ​Amy is confused about her identity and is taking on the role of being a mother and future wife. She is a teenager who thinks she knows what she wants but everyday her thoughts about the future changes. Her friends are important to her and influence her. Her relationships with the men in her life also influence her identity. She is constantly going back and forth between two boys and these relationships dictate how she feels day to day. She is confused about her role as a future mother and is starting to learn about her identity (ATI Nursing Care of Children, 2013).

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Moral Development: Kohlberg

The Kohlberg moral development for adolescents include being able to solve moral issues using moral principles that have been internalized. Adolescents during this stage also question their existing values to the ones that other individuals or the entire society offer them (ATI Nursing Care of Children, 2013).

Amy: ​Currently, Amy is struggling with her moral dilemma of whether to put the baby up for adoption or keep the baby. She goes back and forth with her decision. Ultimately, she decides to keep the baby because she feels that it’s the right thing to do.

Gross and Fine Motor Skills: Age appropriate gross and fine motor skills for an adolescent (12-20 years-old) include: learning and being able to type, write stories, draw a person, and good hand-eye coordination (ATI Nursing Care of Children, 2013). Amy has met the milestones for this age group. She is attending high school and is able to perform like her peers. She is also in the school band.

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Nutrition Status: Adolescent (12-20 years old) The nutritional status of a 15 year-old girl includes increased nutrients and vitamins due to the rapid growth and high metabolism. During this time caloric restriction like dieting should not be done due to the necessity of calories needed for growth.

Increased levels of vitamins and minerals are needed like calcium, iron, zinc and protein.

However, it is common for an adolescent to have low levels of folic acid, vitamin B6, vitamin A, zinc, iron and calcium. A balanced diet should be encouraged by parents and parents should not use food as a reward. Physical activity should be encouraged. Yearly assessments of BMI, height and weight should be obtained (Choose MyPlate, n.d.).

According to Choose MyPlate (n.d.), a 15 year-old who weighs 115 pounds and is 5’2” with 30-60 minutes of daily activity, requires 2,000 calories. According to the CDC (2017), the BMI of a 15 year old with these characteristics is 21.0 which is considered a healthy weight.

Nutritional Status of Amy: Amy has a BMI of 21.0 which puts her at the 69th percentile for girls who are 15 years-old and this is considered a healthy weight (Child Development, 2017). Amy has increased nutritional requirements. Taking in consideration, Amy’s age, height, weight activity level and pregnant she requires an increase in calories, protein intake, calcium, and iron. An increase in 340 calories/day is recommended by the second trimester and this increases if Amy decides to breastfeed. Amy’s protein should also be increased and folic acid should be increased to 600 mcg (Perry, Hockenberry, Lowdermilk, & Wilson, 2014) . She has to start taking prenatal vitamins. She needs to increase calcium in her

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diet and limit caffeine which will be hard for a teenager.

OREM’s Self- Care Requisites: Identify Feelings: ​Met: Amy has been able to relate to her feelings. She can be emotional at times but she uses appropriate ways to calm down. She doesn’t resort to drugs or alcohol to mask her feelings.

She has supportive family and friends who she is able to talk to.

Family & Friends: ​Met: She has two great friends who are supportive. Her Mother and father are also great parents to her. They understand that she is going through a hard time.

She has a brother and sister who she is also close with.

Sex and Sexuality: ​Partially Met: Amy had sex at band camp with a boy who she wasn’t in a relationship with.

She did not use a condom, even though she knew the consequences of unprotected sex. She is “partially met” in Orem’s self-care requisite regarding sex and sexuality because she made a mistake and had lack of judgment but she is taking the steps to try to make the right decision for herself.

Drug or Alcohol Use: ​Met: She does not use any drugs or alcohol. She knows the consequences of engaging in activities that involve drugs and alcohol.

Body Image: ​Partially Met: Amy has a healthy body image. Her BMI is 21.0 which indicates that she has a healthy weight. However, her pregnancy will change her body features and might have an influence on her body image.

She might become overwhelmed with all the changes that her body is going through.

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Family & Patient Teaching Nutrition

Physical Development

Amy will need to make adjustments to her diet.

She will need to increase her intake of calories, protein, calcium, iron and folic acid. Amy will also need to take prenatal vitamins. Adolescent mothers have the highest risk of giving birth to a baby with low birth weight. Anticipatory guidance should be given to Amy on the varieties of different fruits and vegetables she should eat and type of prenatal vitamin she should take.

Interventions: ❏ Encourage early prenatal care (Perry et al., 2014). ❏ Assess current diet/history and intake and provide information on resources like MyPlate.org. ❏ Provide information on appropriate weight gain during pregnancy.

Adolescents may have a difficult transition into adulthood. Changes in their body and physical development may be hard for them to understand.

Amy’s body will change. She will start to gain weight and may start to feel insecure about her body.

Anticipatory guidance would include why her body is changing and how it is “normal.”

Interventions​: ❏ Amy should be encouraged to say positive comments about her body image during her pregnancy (Perry et al., 2014). ❏ Information should be given to Amy about the changes that her body will go through during pregnancy. ❏ Amy should be given the opportunity to discuss her feelings and concerns about her upcoming pregnancy.

Social Development Pregnant adolescents have the risk of social isolation (Perry et al., 2014). There is risk for social isolation from peers and family members.

Amy might feel like she doesn’t “fit in” with her friends anymore. She might feel a lack of social support as well. Anticipatory guidance would include resources for social support.

Interventions:

❏ Amy should be encouraged to talk with her family and friends about her concerns (Perry et al., 2014) ❏ She should join parenting classes and childbirth classes to connect with other expecting mothers. ❏ Amy should identify her support systems and what kind of support she needs (Perry et al., 2014)

Safety teaching should be geared toward her risk for injury related to inadequate prenatal care and her screenings (Perry et al., 2014). Amy’s goal is to give birth to a healthy baby and safety teaching and anticipatory guidance should be focused on this.

Anticipatory guidance would include signs and symptoms of an unhealthy pregnancy.

Interventions:

❏ Amy should be taught about the importance of screening for sexually transmitted infection (STI) during her pregnancy (Perry et al., 2014). ❏ Risks associated with alcohol, drug and tobacco use should also be discussed with Amy. ❏ Amy should be aware of the different appointments she will need to have with her doctor and screenings that are involved.

Safety Teaching

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QSEN The Quality and Safety Education for Nurses (QSEN) is a project that developed to prepare future nurses with the education, skill and attitudes to provide quality patient centered care that is safe. There are six categories, which include: patient centered care, teamwork and collaboration, evidence based practices (EBP), quality improvement (QI), safety and informatics. Amy’s care needs to be geared towards her physical, psychological and emotional development. Amy’s pregnancy will be a new transition focusing on evidence-based practices to ensure she receives quality care is important (QSEN, 2014).

- The End -

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References: ATI Nursing Education (2013). ​Nursing Maternal Newborn Nursing ​(6​th​ ed.). Leawood, KS: Assessment Technologies Institute, LLC. ATI Nursing Education (2013). ​Nursing Care of Children​ (6​th​ ed.). Leawood, KS: Assessment Technologies Institute, LLC. Child Development. (2017, January 03). Retrieved June 25, 2017, from https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence2.ht ml Choose MyPlate. (n.d.). Retrieved June 23, 2017, from https://www.choosemyplate.gov/nutritional-needs-during-pregnancy Division of Nutrition, Physical Activity, and Obesity. (n.d.). Retrieved June 23, 2017, from https://nccd.cdc.gov/dnpabmi/Result.aspx?&dob=4%2F7%2F2003&dom=5%2F 6%2F2017&age=169&ht=62&wt=115&gender=2&method=0&inchtext=0& wttext=0 Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., & Wilson, D. (2014). ​Maternal Child Nursing Care ​(5th ed.). St. Louis, MO: Mosby: Elsevier.

QSEN Institute. (2014). QSEN Competencies. Retrieved from http://qsen.org/competencies

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Images: [Untitled image] Retrieved June 25, 2017 from https://www.tumblr.com/search/amy%20juergens, [Untitled image] Retrieved June 25, 2017 from https://www.timetoast.com/timelines/secret-life-of-the-american-teenager-seasonone [Untitled image] Retrieved June 25, 2017 from https://s-media-cache-ak0.pinimg.com/736x/b0/10/44/b01044a420da2496a398 edfa680d7f2a.jpg [Untitled image] Retrieved June 25, 2017 from http://www.fanpop.com/clubs/amy-juergens/images/9967745/title/amy-photo [Untitled image] Retrieved June 25, 2017 from http://www.wetpaint.com/holiday-gift-guide-for-secret-lifes-amy-juergens-63325 1/ [Untitled image] Retrieved June 25, 2017 from https://www.choosemyplate.gov/nutritional-needs-during-pregnancy [Untitled image] Retrieved June 25, 2017 from http://s3.amazonaws.com/uploads.kidzworld.com/article/34385/sex1.jpg?126323 8209

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[Untitled image] Retrieved June 25, 2017 from https://pbs.twimg.com/profile_images/565738224878755840/tQkoAP5I.jpeg