Felicia Walker is a 14-year-old female who presents to your school-based
teen clinic. She is complaining of daily stomachaches for the past several weeks. She states that she has been complaining about them but everyone tells her it's just stress from moving and it will get better after she makes some friends. Felicia is new to your school this year and her record notes that she frequently misses her first class of the day. She lives with her aunt and uncle, who are her legal guardians. (Your clinic has private rooms that each person goes into; so there is no waiting room but they are assured privacy).
You ask her more information such as her living arrangements, how things were at her previous school, whether she likes this school (possible social issues contributing to her pain anxiety?
Decision Point Two
Felicia states that if she eats something it is better, but if she gets hungry it's worse. As you discuss her symptoms more, she relates that she is often late in the morning because she's been so tired recently. She states she's feeling better and doesn't want to miss her next class.
She decides to leave for her next class. Your next step is;
ask her to come back another time to discuss her symptoms and issues further with her since shes opening-up
Decision Point Three
Felicia comes back during her lunch break. You find out that she is also worried because she has not had her period since moving in with her aunt and uncle 3 months ago. She likes living with them but they are very religious and are at church three or four times a week.
As you talk with her more, you find she was removed from her mother's care due to drug use, and her mother's boyfriend was found to have drugs in the home. She says she's glad to be away from him because he's a "pig.
Ask Felicia why she called her mother's boyfriend a pig...Her reason is below...
Decision Point Four
She says he's a pig because he smells like one. Upon further discussion, she tells you that he would come into her room at night and touch her. She is reluctant to go further with this conversation and starts crying.
To gain more information, you reflect on and clarify what she has told you, and you ask if this is one reason she is concerned about stomachaches and missed periods....
Decision Point Five
Upon additional questioning, Felicia says she is concerned that's why she hasn't gotten her period and just thinking about it makes her nauseous. She says she can't sleep at night because she thinks her aunt and uncle won't want her if they know. You do a urine pregnancy test and the result comes back positive. She states she doesn't want this baby in her. You find out that the mother's boyfriend is 40 years old, and Felicia feels safer now that she's in a different city than him.
You are aware of your particular state's regulations and are aware that the age of consent is 12 unless there is coercion or if the other party is more than 5 years older. As in all states, you are a mandated reporter if abuse, rape, or coercion are involved. According to reproductive laws in your state, anyone 12 years of age or older can seek reproductive health care (i.e., contraception, screening, and treatment for STIs, and counseling) and psychiatric care without the consent of a parent or guardian. Teens younger than 18 years of age cannot sign for any other medical or surgical treatment for themselves however, they can sign for treatment of their child.
You made Felicia aware that you are a mandated reporter. Additionally, she needs unbiased assistance in helping her make her next choices.
Looking at this case Scenario,
being a mandated reporter and how the laws may allow a teen to make her own choices with regard to her reproductive health? What ethical dilemmas and/or other issues do you need to consider?
-What is your differential diagnosis?
-Why did you make this diagnosis decision?
-What is your treatment plan?
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