Princess Levie Ceniza BSN 2A Group 1 Case study 121

SCENARIO

L. W., a 20-year-old college student, comes to the university health clinic for a
pregnancy test. She has been sexually active with her boyfriend of 6 months, and
her menstrual period is now 2 weeks late. The pregnancy test is positive. The
patient begins to cry, saying,“I don't know what to do.”

1. How will you begin to counsel L.W.?

- Create a safe environment by listening and giving honest answers.Encourage

questions and verbalization of fears.
- Teach pt about her options, childbirth and parenthood.

2. What options does a woman experiencing an unplanned pregnancy have?

If you have an unplanned pregnancy, options include:

 continuing the pregnancy and becoming a parent

 terminating the pregnancy (having an abortion)
 continuing the pregnancy and choosing adoption or alternative care
arrangements for the child.

3. If your role is to assist her in making a choice, what information will you want
L.W. to provide?

- -Her medical history,financial situation and support from father of baby,or family.
- what are women’ s experiences of decision-making about pregnancy and birth care
- how is informed choice being addressed in this research to date?

4. What are the nurse's moral and ethical obligations in this situation?

- The nurse practices with compassion and respect for the inherent dignity, worth, and
unique attributes of every person. The nurse must have a high level of respect for all
individuals, and allow dignity in regards to dealings in care and communication.
- The nurse owes the same duties to self as to others, including the responsibility
to promote health and safety, preserve wholeness of character and integrity, maintain
competence, and continue personal and professional growth. A nurse must also
demonstrate care for self as well as others.

5. L.W. asks you to tell her about abortion. What will you tell her?

Is abortion the right option for her?

Abortion is very common, and people have abortions for many different reasons. 
Only you know what’s best for you, but good information and support can really help
you make the decision that is best for your own health and well-being.

Why do people decide to have an abortion?

Everyone has their own unique and valid reasons for having an abortion. Some of the
many different reasons people decide to end a pregnancy include:

 They want to be the best parent possible to the kids they already have.
 They’re not ready to be a parent yet.
 It’s not a good time in their life to have a baby.
 They want to finish school, focus on work, or achieve other goals before
having a baby.
 They’re not in a relationship with someone they want to have a baby with.
 They’re in an abusive relationship or were sexually assaulted.
 The pregnancy is dangerous or bad for their health.
 The fetus won’t survive the pregnancy or will suffer after birth.
 They just don’t want to be a parent.

What can I think about to help her decide?

Here are some things to consider if you are thinking about an abortion:

 Am I ready to be a parent?
 Would I consider adoption?
 What would it mean for my future if I had a child now?
 What would it mean for my family if I had a child now?
 How would being a parent affect my career goals?
 Do I have strong personal or religious beliefs about abortion?
 Is anyone pressuring me to have or not have an abortion?
 Would having a baby change my life in a way I do or don’t want?
 Would having an abortion change my life in a way I do or don’t want?
 What kind of support would I need and get if I decided to get an abortion?
 What kind of support would I need and get if I decided to have a baby?

When did she have to make a decision?

It’s important to take the time you need to make the best decision for you. It’s also a
good idea to talk to a nurse or doctor as soon as you can so you can get the best
medical care possible. The staff at your local Planned Parenthood health center is
always here to provide expert medical care and support, no matter what decision you
make.

6. L.W. wants you to explain the difference between vacuum aspiration and medical
abortion. How would you explain this to her?
VACUUM ASPIRATION

There are two methods of vacuum aspiration (also called suction aspiration):
 Manual vacuum. This procedure can be used around 5 to 12 weeks after the
last menstrual period (early first trimester). It involves the use of a specially
designed syringe to apply suction. This method is not available everywhere. But
it may be more available than machine aspiration in some geographic areas.
 Machine vacuum. This procedure is a common method used in the first 5 to
12 weeks (first trimester) of pregnancy. Machine vacuum aspiration involves the
use of a thin tube (cannula) that is attached by tubing to a bottle and a pump,
which provides a gentle vacuum. The cannula is passed into the uterus, the pump
is turned on, and the tissue is gently removed from the uterus.
Vacuum aspiration procedure
Hours before or the day before a vacuum aspiration procedure, a cervical (osmotic)
dilator may be placed in the cervix to slowly open (dilate) it. Just before, antibiotics
are given to prevent infection. A medicine called misoprostol may be given to soften
the cervix before the procedure.
Vacuum aspiration usually takes between 10 and 15 minutes. It can be done safely in
a clinic or medical office under local anesthetic. For this procedure, the health
professional will:
 Position you on the exam table in the same position used for a pelvic exam,
with your feet on stirrups while lying on your back.
 Insert a speculum into the vagina.
 Clean the vagina and cervix with an antiseptic solution.
 Inject a numbing medicine (local anesthetic) in the cervix. Medicine for pain
or sedation, in addition to the local anesthetic, may be given by mouth or through
a vein (intravenously). Vasopressin, or a similar medicine that slows uterine
bleeding, may be mixed with the local anesthetic to reduce blood loss.
 Grasp the cervix with an instrument to hold the uterus in place.
 Open (dilate) the cervical canal with a small instrument. Dilation reduces the
risk of any injury to the cervix during the procedure.
 Pass a thin tube (cannula) into the cervical canal, and apply suction to gently
remove all tissue from the uterus. As the uterine tissue is removed, the uterus will
contract. Most women feel cramping during the procedure. The cramps will
decrease after the tube is removed. Some women also may have nausea or
sweating or feel faint.
The tissue removed from the uterus during a vacuum aspiration procedure is
examined to make sure that all of the tissue has been removed and the abortion is
complete.
Sometimes a dilation and curettage (D&C) procedure is needed after a vacuum
aspiration if all of the tissue has not been removed. D&C uses a sharp surgical
instrument to clear tissue from the uterus.
What To Expect After Surgery

Vacuum aspiration is a minor surgical procedure. A normal recovery includes:

 Irregular bleeding or spotting for the first 2 weeks. During the first week,
avoid tampons and use only pads.
 Cramps similar to menstrual cramps. These may be present for several hours
and possibly for a few days, as the uterus shrinks back to its nonpregnant size.
After the procedure:
 Take your full course of prescribed antibiotics to prevent infection.
 Rest quietly for the day. You can do normal activities the following day, based
on how you feel.
 Acetaminophen (such as Tylenol) or ibuprofen (such as Advil) can help
relieve cramping pain. Be safe with medicines. Read and follow all instructions
on the label.
 Do not have sexual intercourse for at least 1 week. Use birth control following
the abortion. And use condoms to prevent infection. You can start certain birth
control methods right after the procedure.

MEDICAL ABORTION

Medical abortion is a procedure that uses medication to end a pregnancy. A medical

abortion doesn't require surgery or anesthesia and can be started either in a medical
office or at home with follow-up visits to your doctor. It's safer and most effective
during the first trimester of pregnancy.
Having a medical abortion is a major decision with emotional and psychological
consequences. If you're considering this procedure, make sure you understand what it
entails, side effects, possible risks, complications and alternatives.

Why it's done

The reasons for having a medical abortion are highly personal. You can choose
medical abortion to complete an early miscarriage or end an unwanted pregnancy.
You can also choose to have a medical abortion if you have a medical condition that
makes continuing a pregnancy life-threatening.
Risks
Potential risks of medical abortion include:

 Incomplete abortion, which may need to be followed by surgical abortion

 An ongoing unwanted pregnancy if the procedure doesn't work
 Heavy and prolonged bleeding
 Infection
 Fever
 Digestive system discomfort
Medical abortion isn't an option if you:
  Are too far along in your pregnancy. You shouldn't attempt a medical
abortion if you've been pregnant for more than nine weeks (after the start of
your last period). Some types of medical abortion aren't done after seven weeks
of pregnancy.
 Have an intrauterine device (IUD).
 Have a suspected pregnancy outside of the uterus (ectopic pregnancy).
 Have certain medical conditions. These include bleeding disorders; certain
heart or blood vessel diseases; severe liver, kidney or lung disease; or an
uncontrolled seizure disorder.
 Take a blood thinner or certain steroid medications.
 Can't make follow-up visits to your doctor or don't have access to
emergency care.
 Have an allergy to the medications used.

7. She tells you that she has heard that if a woman has an abortion, she might not be
able to get pregnant again. How would you counsel her?

Think of the acronym G.L.I.I.D.E. — a way to ease, or glide, into a conversation in

order to first build rapport and trust before offering discussing solutions

G = GRACE
Remember to extend GRACE—make it about her not about you.
For example, you may say “You are obviously upset. I can’t imagine the feelings and
thoughts that must be running through your head right now. Can you tell me more?

L = LISTEN
Focus on what your friend is saying. Ask a few questions along the way:
• How far along are you?
• How long have you known?
• Who else have you told?
Tune out all distractions. Summarize what she says in order to ensure you understand
what she is saying. The goal is for her to feel accepted and understood.

I = INQUIRE
You can prompt her by asking open-ended questions
• Thank you for trusting me with this information.
• How are you doing with everything that’s going on?
• Do you feel comfortable sharing more about what’s going on?
• How do you feel about the pregnancy?
• How does the father of the child feel about the pregnancy
• What options are you considering at this point?
• Can you tell me what you know about those options?

D = DIG DEEP AND DIGEST

Take time with the pregnant woman to dig into the material given to her at the
pregnancy center. Help her think of the positives and negatives of each option. Then,
encourage her to take some time to digest the information, praying with her (if given
permission) and for her throughout the process. If she is a spiritual person, encourage
her to read through scripture and pray about it. Gently challenge her to think through
the long-term aspects, including her emotional, physical, and spiritual health.

E = EMPOWER
Help her to know and understand that she does have options. Encourage her by
saying that you are there to support her through her pregnancy decision process. Help
her make a plan of action of what she will do next.

8. What types of emotional reactions do women experience after an abortion?

- Women experience a variety of emotions after an abortion. Feelings of relief,

sadness, elation, or depression are common and may be strong due to the hormonal
changes that occur after an abortion. Most women find these feelings do not last very
long.

9. L.W. wants to know about adoption. What will you tell her?

- Adoption is the establishment of a legally recognized, lifelong relationship between

adoptive parents and the adoptee(s) in question. Adoption is a permanent choice for
birth parents. Adoption can occur in varying ways. A person can adopt
their stepchild or relative.

- Closed adoption (also called confidential adoption) is when the birth parent(s) and
adoptive family have limited or no information about each other, and they don’t stay
in contact after the adoption process is finished. People may choose closed adoption
in order to have more privacy.

Open adoption is when the birth parent(s) and adopting family meet each other before
the adoption, and continue to build a relationship as the child grows up. Most
adoptions in the U.S. are open. Sometimes there’s a lot of communication between the
families and sometimes there’s little, but in open adoptions the child always knows of
the adoption.

In open adoptions, you choose who adopts your child and you learn important things
about them like their values, lifestyle, educational backgrounds, and religion. You
develop a relationship with the adoptive family, and there’s often a legally
enforceable agreement for ongoing visits with the child.

Birth parents and the adoptive family decide together what kind of relationship they
want to have, and how often visits, phone calls, and updates happen. People may
choose open adoption if they want to be able to pick their child’s adoptive family and
be in their child’s life.

10. L.W. asks you if there are any actions she should be doing now to take care of
herself. How will you respond?
- It’s important to take care of your baby, even before he or she is born. You can do

this by living a healthy lifestyle and keeping doctor’s appointments while you’re

pregnant. So the mother should take care of its self by simply avoiding unhealthy

foods and improve physical activities like minimal exercises and walking.

11. What factors affect carrying a pregnancy to term? L.W. asks you about the
importance of prenatal care. Explain.

Prenatal care is important to:

 Provide education about healthy behaviors during pregnancy.

 Monitor maternal and fetal well being throughout the pregnancy.
 Detect early signs of potential complications of the pregnancy.
 Provide anticipatory guidance to the woman and family.

12.Finally, L.W. wants to know how long she has to decide.

Abortions can be carried out as soon as you find out that you are pregnant. In most
cases, this will be after your first missed period at 4 weeks. You can make your first
appointment at the abortion clinic before you miss a period if you already know that
you‘re pregnant. However, many women wait a little longer before taking a
pregnancy test or visiting the clinic. About 80% will speak to a doctor within the first
10 weeks of the pregnancy.