Question

Aretha is a school nurse at Belington Middle School. Late one Friday afternoon, Maria H, an eighth grader, comes to the clinic. Maria confides in Nurse Aretha that she thinks she may be pregnant. Two months ago, she had sex with her boyfriend, because she "wanted to see what it was like". Since that one and only time, Maria has not had her period. Nurse Aretha encourages Maria to tell her parents, but Maria refuses to tell them anything until she is positive she is pregnant. The policy at Belington Middle School does not allow Nurse Aretha to administer pregnancy tests, therefore, Nurse Aretha refers Maria to the Planned Pregnancy clinic. On the following Monday, Maria returns to the clinic and tells Nurse Aretha that the pregnancy test was negative.

Use the case study above to answer the following questions:

1) In addition to pregnancy testing, what other diagnostics should Nurse Aretha encourage the student Maria to under go?

2) An important counseling opportunity presents itself when a teen has a pregnancy test result that is negative. Use this time to clarify a desire or disinterest in pregnancy and to empower the client to influence her reproductive future. Which birth control method (condom only, birth control pills and condom, Depo-Provera and condom, etc) would you recommend for Maria to use if she agrees that she needs contraception? Explain your answer.

3) Identify 3 nursing activities that Nurse Aretha can carry out to contribute to the prevention of adolescent pregnancy at her middle school?

Answer 1

1. The patient in the question is suffering from amenorrhea, The required investigations for missed period if pregnancy test is negative are as follows:

- Thyroid-stimulating hormone (TSH),T3,T4 - to rule out any thyroid disorder

- follicle-stimulating hormone(FSH) and Luteinizing hormone(LH) for any ovarian disease

- prolactin level test to rule out pitutary tumor

- If patient is having increased hair growth then go for androgen testing

- Ultra sono gram (USG) to rule out any obstructive disease in reproductive tract

2. Best method she can use is Depo-Provera and condom. Its a injection which contains hormone progesteron, which acts by preventing ovulation from ovary. In addition to this it also makes the cervical mucosa thick, so sperm can not penetrate mucosa which makes fertilization difficult, thus preventing pregnancy.

In addition to depo-provera, couple must use condom to protect themselves from sexually transmitted diseases.

3. Following three activities can be done contribute to the prevention of adolescent pregnancy at her middle school:

a) Counseling the adolescents to delay the initiation of sexual activity

b) Encouraging the use of condoms and other contaceptives among sexually active teens

c) helping teenagers to create and maintain strong emotional relations to parents and other family members, so that they are emotionally satisfied.