Please reply to this case study/discussion post

Posted: July 1st, 2022

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Please reply to this case study/discussion post and explain how you might think differently about the types of tests or treatment options that your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position. Patient Information: Initials: AM Age:38 Sex: Female Race: Caucasian S. CC: “Here for my annual, but I might be pregnant” HPI: Patient AM is a 38-year-old Caucasian woman who presents to the office for annual visit. Upon assessment the patient immediately becomes very emotional stating her abusive ex- boyfriend pinned her down and made her have sex with him. She had obvious bruising on her upper extremities. The bruises are from two weeks ago, but he has forced himself on her on numerous occasions. The patient has irregular periods and has not had one since 01/21/2022. The patient states that she has one child with the man, and he comes from a very well-known family, so she is powerless in trying to fight him or turn him in. The patient has been very tired, but she assumes it is due to the stress. Current Medications: OTC Tylenol as needed. Allergies: No medication, environmental, or food allergies. PMHx: Patient has a history of one vaginal child birth without complications and one uncomplicated abortion at four weeks. Soc & Substance Hx: Patient is negative for alcohol, nicotine, or drug use. The patient does use her seatbelt. She is up to date on her immunizations and did receive the flu vaccine in 10/2021. Fam Hx: Patient was adopted and does not know any of her natural born relatives. Surgical Hx: No surgical procedures in the past. Mental Hx: Patient does have anxiety and depression. She has never thought of harming herself or anyone around her. Violence Hx: Abusive Ex-Boyfriend. Obvious bruising on bilateral upper extremities. Reproductive Hx: Abnormal mensus. Last period 01/21/2022. One natural birth. One abortion at 4 weeks gestation. ROS: GENERAL: No weight loss, fever, chills, weakness, but does have fatigue. HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat. SKIN: No rash or itching. CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema. RESPIRATORY: No shortness of breath, cough, or sputum. GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness. HEMATOLOGIC: No anemia, bleeding, or bruising. LYMPHATICS: No enlarged nodes. No history of splenectomy. PSYCHIATRIC: No history of depression or anxiety. ENDOCRINOLOGIC: No reports of sweating or cold or heat intolerance. No polyuria or polydipsia. GENITOURINARY/REPRODUCTIVE: no burning on urination. Positive Pregnancy today. LMP: 1/21/2022. No Breast-lumps, pain, or discharge. ALLERGIES: No history of asthma, hives, eczema, or rhinitis. O. Physical exam: Breast: No breast lumps, pain, or discharge. Pelvic examination: Positive for pregnant exam. Diagnostic results: Pregnancy test: Positive urine test. Ultrasound: Positive for pregnancy showing yolk sac with baby at 23 weeks gestation. A. Primary and Differential Diagnoses Pregnant: Patient had positive pregnancy test and an ultrasound showing 23 weeks in gestation. “Among rape victims, 77.3% reported a current/former intimate partner perpetrator, and 26.2% of intimate partner rape victims reported rape-related pregnancy compared with those raped by an acquaintance (5.2%) or stranger (6.9%).” (Basile et al., 2018). Intimate partner violence: “Exposure to violence contributes to the genesis of, and exacerbates, mental health conditions, and existing mental health problems increase vulnerability to partner violence, a loop that imprisons victims and perpetuates the abuse.” (Mazza et al., 2021). Anxiety and depression: “Experiencing a rape incident gives rise to rape trauma syndrome which has physical, psychological and social impacts on health.” (Szymanski et al., 2021). This patient has had abuse from her ex- boyfriend for more than 10 years. She has mental and physical issues because of the trauma she has endured. P. This patient was a very touchy subject especially with the new overturn of roe vs. wade. The abuse hotline was called, and an anonymous tip was submitted. She came to us today with the idea of already being pregnant and looking to seek an abortion. She believed she was around 4-5 weeks pregnant, however ultrasound showed she was 23 weeks pregnant. This clinic does not do abortions being a catholic based facility. Her options for adoption and support were given to her and she was told we would be here if she needed anything. She plans to go to Colorado to seek a late term abortion. “THIS INITIATIVE WOULD PROHIBIT AN ABORTION AFTER 22 WEEKS GESTATIONAL AGE OF THE FETUS.” (Leg.colorado.gov. n.d.). Feelings aside, the babies’ measurements and movement were within normal limits so the baby would have no issues to require abortion at this time. The patient will go home and call us back with what she plans to do. References Basile, K. C., Smith, S. G., Liu, Y., Kresnow, M. J., Fasula, A. M., Gilbert, L., & Chen, J. (2018). Rape-related pregnancy and association with reproductive coercion in the US. American journal of preventive medicine, 55(6), 770-776.https://doi.org/10.1016/j.amepre.2018.07.028 Mazza M, Marano G, Del Castillo AG, Chieffo D, Monti L, Janiri D, Moccia L, Sani G. (June, 2021). Intimate partner violence: A loop of abuse, depression and victimization. World J Psychiatry.11(6):215-221. https://doi.org/10.5498/wjp.v11.i6.215 PMID: 34168968; PMCID: PMC8209536. Szymanski, D. M., Strauss Swanson, C., & Carretta, R. F. (2021). Interpersonal sexual objectification, fear of rape, and US college women’s depression. Sex Roles, 84(11), 720-730. Leg.colorado.gov. (n.d.). Retrieved June 27, 2022, from https://leg.colorado.gov/sites/default/files/initiative%2520referendum_200final.pdf

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