Question

A 16-year-old student comes to the school nurse’s office and tells the nurse that she thinks she might be pregnant. The student tells the nurse that she has not had a period in 3 months. The nurse checks the student’s file and finds that she has a history of asthma and a seizure disorder for which she has been prescribed daily drugs. Because the student takes these drugs at home, the nurse has not seen her on a regular basis. The nurse counsels the student about obtaining a pregnancy test. The student tells the nurse that before she can leave the office, she needs to know what might be wrong with her baby. The student states that she drinks heavily on weekends and that she probably was drunk when she became pregnant. She also states that she was concerned about taking her seizure medication during the months she thought she was pregnant, but she was too embarrassed not to take it because she did not want to have a seizure in front of her friends. The student tells the nurse that she has not taken any asthma medication and that she has been having a difficult time breathing.

1. What can the nurse tell the student about the interval when she was taking her medications after possibly becoming pregnant?

2. When a student asks specifically how her baby may have been affected, how should the nurse reply?

3. The student asks what alcohol can do to her baby. What would be the best response?

Answer 1

1.The interval when she was not taking the seizure medication can be no harm to the fetus until now but it can place the student at risk for seizure and then affecting the growing fetus.

2.The nurse should not provide information which can make the student fearful because she herself is in her late childhood or in teens where they are very sensitive to information which can harm their interest or wishes. It is always better not to provide rough or false reassurance before appropriate investigations, so reassure the teen that an expert can help and so far there is no problems which are symptomatic.

3.The best response which can be given to the student are

• It can cause congenital abnormalities
• The baby's behavioral changes can be seen as they grow
• The fetus is at risk for abortion
• Certain children may have intellectual disabilities
• Growth problems
• Microcephaly