Susan Pohl, Family Nurse Practitioner, felt extremely frustrated as she left Room 12. She had just spent the last 30 minutes with Lydia Lopez-Rivera, a developmentally disabled, 30-weeks-pregnant, 19-year-old Latina.
“What’s wrong, Susan?” asked Bernie Candales-Mitterman, the group’s social worker.
“I’ve just spent the last half-hour with Lydia Lopez—you know, the pregnant girl. I’m just so upset! She’s missed several appointments, even though I had the nurses call her. She was late today, as usual. She’s missed several important tests that need to be done during the second trimester. She’s here today with another urinary tract infection because she didn’t finish all the antibiotics from the last infection—they made her sick and she didn’t call us to let us know she had stopped them, even though I gave her specific verbal and written instructions. Now she’s got large quantities of ketones in her urine. On top of that, her blood type is Rh negative. I’ve worked hard to try to prevent anything from happening. I just don’t know what to do!”
“I understand your frustration. What was her excuse for missing the appointments?” asked Bernie.
“That’s just it!” exclaimed Susan. “She has no excuse. She just sits there and smiles. The more I try to talk to her, the quieter she becomes.”
“Any luck setting up help for her? I know she’ll need it with her mom out of the picture and her boyfriend working,” said Bernie.
“Another frustration. The red tape. The forms they want filled out. I just know she won’t have any help when that baby comes.” Susan sat down and held her face in her hands. “This is just what I tried to avoid by keeping her here with us in our family practice rather than transferring her to the high-risk clinic at Children’s Hospital. I didn’t want her to
‘get lost,’ but that seems to be exactly what has happened. What should I do?”
Questions
1. What is your diagnosis of this patient?
2. How would you treat the various problems?
3. What are the psychosocial issues?
4. What are the ethical issues?
5. How does the nurse practitioner feel?
6. How would you feel caring for this patient?
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