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Counseling For The Pregnant Adolescent Patient Discussion

Counseling For The Pregnant Adolescent Patient Discussion

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Hi, I appreciate this comprehensive discussion you provided regarding the 14-year-old female who presented with daily stomach ache complaints to your school-based clinic. The case summary is clear and concise, providing all the necessary information regarding the case without any omissions. I appreciate how you provided the information regarding her residence and the relationship she has with her mother and her stepfather. It is clear the patient did not leave her mother’s place willingly, but due to the hate she had with the mother’s boyfriend. The case summary is direct and to the point. From this case, I appreciate your differential diagnosis choice. It was a wise decision to carry out a pregnancy test to confirm her confession. The point of sexual abuse suspicion is also essential here, especially according to how she hates him and calls him names. Counseling For The Pregnant Adolescent Patient Discussion

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I concur with you regarding the choice of differential diagnosis. Based on the assessment, I would also make the same choice and appreciate that we can resonate the same way. Having reported that she missed her menses in 3 months, the pregnancy test automatically becomes the first differential diagnosis. I also agree with you that the treatment plan for such a case has several factors that must be considered before the treatment (Casas, 2019)Counseling For The Pregnant Adolescent Patient Discussion. Apart from pregnancy-related stress, the teenager also has just changed her school and residence as well. It is also essential to consider the fact that she was sexually abused, another stress. I like your decision, as the provider, to report the case to the authorities after the diagnosis. The issue of sexual abuse and defilement are severe issues in the country. That was, therefore, a sage decision for you as her healthcare provider because it shows how patriotic you are, following the laws of the land and standing against sexual abuse in society.

Indeed, this patient can seek care for both reproductive health and psychiatric care without the consent of her aunt and uncle. Encouraging the patient to notify her aunt and uncle of her pregnancy due to her living with them is essential. I like your sensitivity to the patient’s right to make her own choices. Including her aunt and uncle in discussing her issue is lovely as they are the closest people to her now. However, I would also suggest her mother be asked to appear at the clinic and get to know what her fiancé did to her daughter. This will challenge her to be a responsible mother and not to let strangers into her child’s life again. As you stated, FW really needs counseling, and the right individual for the same is the school counselor. The issue of sexual abuse might have affected her primarily. Therefore, continuous counseling sessions should be provided. In addition to counseling, I agree that carrying out HIV screening and testing for other sexually transmitted infections is also important (American Academy of Pediatrics, 2022)Counseling For The Pregnant Adolescent Patient Discussion.

I concur that it is alarming that there is a possibility of pregnancy following a sexual assault, especially for teenagers, as reported by Casas (2019). It is imperative to recognize the intricacy involved in making judgments on pregnancy termination under such distressing conditions. In addition, their findings about the incidence of STIs following an assault highlight the necessity of specialized medical care and assistance. The significance of providing survivors with comprehensive care is underscored by the elevated risk of HIV transmission, particularly in cases of mucosal trauma. Overall, this evidence shows the complex issues that survivors of sexual assault experience, highlighting the need for healthcare and support institutions to adopt a caring and knowledgeable approach. The ethical dilemma is tricky, considering that the law has to take its route and patient rights respected simultaneously. Rape is a severe issue, and the patient needs a suitable therapy plan, as you stated, considering that she is also a drug addict. Counseling For The Pregnant Adolescent Patient Discussion

References

American Academy of Pediatrics (2022); Options Counseling for the Pregnant Adolescent Patient; Options Counseling for the Pregnant Adolescent Patient | Pediatrics | American Academy of Pediatrics (aap.org)Links to an external site.

Casas X. (2019). They Are Girls, Not Mothers: The Violence of Forcing Motherhood on Young Girls in Latin America. Health and human rights, 21(2), 157–167.

Respond to your colleagues’ posts (from a different group) and provide additional insight that might be useful and appropriate for the issue addressed. Use your learning resources and/or evidence from the literature to support your position. Need 2 scholarly resources APA FORMAT. Counseling For The Pregnant Adolescent Patient Discussion

Summary of chosen case study:

FW, is a 14 y/o female who presents to the school-based teen clinic with complaint of daily stomach aches for the last several weeks. She recently moved to the area and in with her aunt and uncle. She was removed from her mother’s home after drug use and her mother’s boyfriend was found to have drugs in the home. The patient described her mother’s boyfriend as “a pig.” Upon further conversation, the patient reports that the mother’s boyfriend would go into her room at night and “touch her.” She reports that she has not had her menstrual period since moving in with her aunt and uncle 3 months ago. Urine pregnancy test was completed in clinic and was positive. The patient states that she does not want this baby inside her. The mother’s boyfriend is 40 years old.

Differential Diagnoses: 

Z33.1- Pregnant state, incidental- patient had a positive urine pregnancy test in clinic. Pt reports that she has not had menstrual period in approximately 3 months.

T76.22XA- Child sexual abuse, suspected- Pt reports that her mother’s boyfriend (age 40) would go into her room at night and touch her.

Why did you make this diagnosis decision:

I made this decision based on the assessment that was performed on this patient. This patient presented with reports of stomachache. Pt then reports that she has not had menstrual period in 3 months. Pt had positive UPT in clinic. Pt reports that she was taken out of mother’s home due to drug use. Pt reports that her mother’s boyfriend (age 40), was coming into her room at night and touching her before she was taken out of home. Counseling For The Pregnant Adolescent Patient Discussion

Treatment Plan:

There are many factors to consider when developing a treatment plan for this patient. This patient is 14 years old, has already been removed from her mother’s home and is now living with her aunt and uncle. Pt already has the stress of moving out of her home and moving to another school. This patient was sexually abused by her mother’s boyfriend while in the home and is now pregnant.

As a provider, I will be reporting what the patient told me today regarding her mother’s boyfriend sexually abusing her to authorities. This patient can seek care for both reproductive health and psychiatric care without the consent of her aunt and uncle. I would encourage the patient to notify her aunt and uncle of her pregnancy due to her living in their home. I would suggest that the patient have the aunt and uncle come to the clinic with her and with her permission, pregnancy and the options that she has can be discussed. Counseling for this patient would be initiated at this appointment with the school counselor. Pt would also be referred for continuing counseling services. Pt would be referred to OBGYN to discuss further options with pregnancy.

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HCG would be drawn this visit. Pt would also receive order for Pelvic ultrasound to verify pregnancy and to determine fetal age. Pt will also need to be screened for STIs. Pt will need HIV screen and Hepatitis screen.  Counseling For The Pregnant Adolescent Patient Discussion

What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention):

According to (Farahi and Mceachern 2021) The likelihood of pregnancy after sexual assault is approximately 5%, with higher rates among adolescents. When rape does result in pregnancy, patients are more likely to choose to terminate the pregnancy than to continue it. The risk of acquiring an STI after sexual assault is influenced by local prevalence rates and the type of assault. The most common STIs reported in sexual assault survivors are Chlamydia trachomatis, gonorrhea, and trichomoniasis. Chlamydia and gonorrhea may lead to pelvic inflammatory disease and infertility if untreated. The risk of HIV transmission from vaginal intercourse is 0.1% to 0.2% and for receptive anal intercourse is 0.5% to 3% and may be increased with mucosal trauma.

Address the ethical dilemmas and/or other issues for your case study:

Ethical Issues: 

In this case, this must be reported to authorities due to this patient being 14 years of age and reporting a sexual assault by the mother’s boyfriend. The difficult aspect of this case is that if the patient does not authorize the provider to speak with the patient’s aunt and uncle to notify them, the provider must respect her privacy with this. While we may feel that we have the best interest of the patient in mind, we must consider her rights as a patient as well.

Psychological Issues:

With this patient, psychological issues must be considered. This patient has been exposed to a great deal in her time living in her mother’s home. She has been surrounded by drug use and was also sexually abused by the mother’s boyfriend. People who experienced sexual abuse as children are at greater risk of substance abuse or eating and food issues. This is why it is imperative as a provider to refer this patient for therapy services.  Counseling For The Pregnant Adolescent Patient Discussion

Physical Issues:

Physical issues can also plague the victims of sexual abuse. Physical issues such as obesity, headaches, GI disorders, fibromyalgia and chronic pelvic pain.

Financial Issues: 

According to (National Sexual Violence Resource Center 2021), The economic impact of rape and sexual assault is estimated to be over $122,000 per victim throughout their lifetimeLinks to an external site..  With this patient being pregnant, that amount would obviously be higher whether the patient had an abortion, adoption or decided to keep the child.

References:

American Academy of Pediatrics (2022); Options Counseling for the Pregnant Adolescent Patient; Options Counseling for the Pregnant Adolescent Patient | Pediatrics | American Academy of Pediatrics (aap.org)Links to an external site.

Farahi, N, MD, McEachern, M, MD (2021); Sexual Assault of Women; Sexual Assault of Women | AAFPLinks to an external site.

National Sexual Violence Resource Center (2021); Economics as a Factor in Sexual Violence; Economics as a Factor in Sexual Violence | National Sexual Violence Resource Center (NSVRC)Links to an external site. Counseling For The Pregnant Adolescent Patient Discussion

Class Resources

  • Schuiling, K. D., & Likis, F. E. (2022). Gynecologic healthcare (4th ed.). Jones and Bartlett Learning.
    • Chapter 3,” Women’s Growth and Development Across the Life Spans) pp. 39–49)
    • Chapter 13, “Contraception” (pp. 236–266)
  • Morreim, H., Antiel, R. M., Zacharias, D. G., & Hall, D. E. (2014). Should age be a basis for rationing health care?Links to an external site.The Virtual Mentor: VM, 16(5), 339–347. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1001/virtualmentor.2014.16.05.ecas2-1405
  • World Health Organization. (2020). Ageing and life courseLinks to an external site.. https://www.who.int/ageing/en/

ADULT GERONTOLOGY RESOURCES

  • Harrison, B. J., Hilton, T. N., Rivière, R. N., Ferraro, Z. M., Deonandan, R., & Walker, M. C. (2017). Advanced maternal age: Ethical and medical considerations for assisted reproductive technologyLinks to an external site.. International Journal of Women’s Health, 9,561–570.

CLINICAL GUIDELINE RESOURCES

As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; CDC – for zika in pregnancy, etc.).

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  • American College of Obstetricians and Gynecologists (ACOG).Links to an external site.(2020).  https://www.acog.org/
  • American Cancer Society, Inc. (ACS). (2020). Information and Resources about Cancer: Breast, Colon, Lung, Prostate, Skin.Links to an external site.https://www.cancer.org/
  • American Nurses Association (ANA). (n.d.). Lead the profession to share the future of nursing and health careLinks to an external site.. https://www.nursingworld.org/
  • Centers for Disease Control and Prevention. (CDC). (n.d.). CDC in actionLinks to an external site..https://www.cdc.gov/
  • HealthyPeople 2030. (2020). Healthy People 2030 FrameworkLinks to an external site..  https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
  • The American Association of Nurse Practitioners (AANP). (2020). What’s Happening at your associationLinks to an external site.. https://www.aanp.org/  Counseling For The Pregnant Adolescent Patient Discussion

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