Unfolding Case Study 2: Ethical Dilemmas in Advanced Nursing Practice 14 year old female

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).Decision Point One What information do you need? More information about her stomachaches, such as where they are, what makes it better or worse, and any other symptoms.

More information, such as living arrangements, how things were at her previous school, whether she likes this school. When her last doctor’s appointment was, whether she’s had anything like this before, and whether her diet is different? CORRECT although the other answers are getting at important information, this is your first time with Felicia, and starting off just addressing the problem is preferable. It is important to establish a rapport with her first. Additionally, she sees that you are listening to her. 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.

Further Description

She states she’s feeling better and doesn’t want to miss her next class. You tell her that: Tell her to just ride it out. Give her a note so she can snack in class. Have her come back at another time. INCORRECT Recommend she try to get to bed earlier. CORRECT you are letting her know that you are interested and listening. She appears to be starting to open up a little. Additionally, there are more assessments that need to be done. 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.” Where would you go with your next questions? Does she like church and has she made friends there yet? Why do you call him a “pig”? I NCORRECTIs there anyone at church she feels she can talk to? INCORRECT what is her diet like? CORRECT although the other questions are good ones, Felicia may be giving you an opening to something she needs to tell someone. 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.

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