Diagnosis of Amenorrhea
Case Study
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).
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.
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.”
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.
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.
- Review the interactive case study. Your post should address the following:
Summary of your case study
What is your differential diagnosis?
Why did you make this diagnosis decision?
What is your treatment plan? - What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention)?
- • What resources did you use to meet your best practice guidelines?
• What do you think about being a mandated reporter and how the laws may allow a teen to make her own choices with regards to her reproductive health? What ethical dilemmas and/or other issues do you need to consider?
• Address the ethical dilemmas and/or other issues for your case study: - Ethical issues
Psychological issues
Physical issues
Financial issues