Family Planning among Teenagers - Term Paper Example

? Family Planning among Teenagers The essay aims to address a two-fold objective to wit to analyze the case study presented; and (2) to answer seven relevant questions pertaining to the case study and sexuality issues among female teenagers. Family Planning among Teenagers 1. Can a practitioner provide family planning services to a minor without parental knowledge? If an adolescent demands confidentiality, how can a physician prevent the transfer of billing/insurance information to reach parents? The provision of family planning services to a minor depends on the legal concept of “personal representative.” According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) of the U.S. Department of Health and Human Services (2003), a personal representative is a person who has the legal authority to make health care decisions on behalf of the individual as in the case of minors (n.p.). Parents are often the personal representatives of minor children; thus, parents have the right to obtain health information about a minor child. However, the Privacy Rule specifies three circumstances in which certain minors can obtain specified health care without parental consent such as when the State or law does not require parental consent when obtaining particular health services (e.g., mental health treatment), when the court determines other authority rather than the parents to make treatment decisions for the minor, and when the parent to confidential relationship between the minor and the physician (U.S. Department of Health and Human Services, 2003, n.p.). In the case study presented, the 14-year-old teenager in an unemancipated minor with parents acting as the legal authority. Under the Privacy Rule, one has to get the consent and agreement of a parent to a confidential relationship between the minor and the physician prior to the provision of health care services; however, family planning services such as use of contraceptives allow minors to give their own consent and a practitioner could provide family planning services to a minor without parental knowledge. Provided that confidentiality is given to the adolescent, the real challenge lies on billing and third-party reimbursement. A physician can prevent the transfer of billing/insurance information to reach parents by letting the minors use the option of requesting restrictions on disclosure of confidential communications. 2. What is the normal age range for menarche? According to Pillitteri (2009), the normal or usual age range for menarche is 9 to 17 years with average age of onset at 12.4 years (p. 99). The 14-year-old female in the case study experienced menarche at age 13 and thus, falls within the normal range. 3. What are some common treatments for dysmenorrhea? In the case study presented, the teenager stated that she experiences pain when she has her menses. The teenager also stated that the pain is occasionally bad enough that she misses school. The teenager suffers from a condition called dysmenorrhea or painful menstruation where treatment measures are geared towards pain relief and development of coping strategies. Treatment measures are grouped into three, namely: administration of low-dose oral contraceptives or Depo-Provera to suppress endometrium, administration of prostaglandin inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain, and initiation of lifestyle changes. Patients treated with NSAIDs are usually prescribed to take Ibuprofen 400-800 mg or Naproxen 250-500 mg both three times a day (Ricci & Kyle, 2009, 94). In addition, patients treated with NSAIDs must be advised to take it with meals, cautioned against taking with aspirin or alcohol, and watched for signs of GI bleeding. Meanwhile, low-dose contraceptives are taken daily with advice to take active pills for an extended period of time to reduce the number of monthly cycles while the 150 mg of Depo-Provera is administered intramuscularly every 12th week with information that one could be amenorrheic after 9-12 months of treatment (Ricci & Kyle, 2009, 94). Lastly, treatment pertaining to lifestyle changes includes engagement in daily exercise, limiting salty foods, weight reduction, smoking cessation, and learning relaxation techniques (Ricci & Kyle, 2009, 94). 4. Name some things that should be discussed with a female adolescent during a physician visit? The American Congress of Obstetricians and Gynecologists recommends that the first physician or gynecologic visit should occur within 13 to 15 years of age (Altchek & Deligdisch, 2009, 126). A physician visit must focus on prevention and health education and on establishment of a mutual, respectful, and lifetime relationship between physician and adolescent. As a physician visit is educative and preventive, topics to be discussed with a female adolescent include: girl’s adolescent development, six forms of sexuality, menarche, sexual orientation, family planning and methods of contraception, sexually-transmitted diseases (STDs), nutrition, and injury prevention (Altchek & Deligdisch, 2009, 126). The health care provider in the case study has provided good preventive measures by counseling the teenager on monitoring her menses, warning against STDs and HIV, encouraging condom use, and discussing contraceptive options. The health care provider has also established a mutual relationship with teenager as shown in her admission of confidential information and agreement to the pelvic examination and STD screening. 5. What is the normal cycle length, amount of blood loss, and duration of flow in menses? Brunner et al. (2009) stated that normal cycles vary from 21 to 42 days, with menstrual flow duration of 4 to 5 days in which 50-60 ml (4 to12 tsp.) of blood are lost (p. 1413). 6. What is the most common side effect of progestin-only contraceptive methods? The most common side effect of progestin-only contraceptive methods is irregular bleeding or spotting (Carr et al. 2007, 16). Irregular and increased breakthrough bleeding is the most common side effect because the progestin only contraceptive method works by altering the woman’s menstrual cycle. As a result, the usual menstrual flow and frequency of periods changed. Other side effects of progestin-only contraceptive methods include breast tenderness, headaches, hot flashes, decreased libido, vaginal dryness, hair loss, mood swings, weight gain, and acne (Carr et al. 2007, 16). Progestin-contraceptive method offers immediate contraception among teenagers and helps in alleviating dysmenorrhea through thinning of the endometrium; however, side effects may be intolerable for a teenager during the first year which explains why the teenager decided on combined oral contraceptive pill. 7. If a speculum exam cannot be performed, or the patient refuses, how can screening for chlamydia and/or gonorrhea be accomplished? Chlamydia and gonorrhea are two of the most common sexually transmitted infections particularly among adolescents (Beigi, 2012, 10). Several states require screening for chlamydia and gonorrhea among adolescents but this seems to be a major challenge for health care providers. Teenagers are often hesitant to be screened and feared the examination as they viewed internal vaginal examination as unacceptable and threatening. Thus, most of the teenagers refused screening with a speculum and prevent themselves from seeking medical care. In the case study, the situation is different. The teenager initially refused the pelvic exam probably because of her mother. After offering privacy and educating the teenager of the need for a gynecological exam and how it will be done, the teenager agreed to have the pelvic exam and the STD screening. If the case comes to worst and the teenager still refused on a pelvic exam and screening for chlamydia and/or gonorrhea, other alternative methods include use of body fluids and collection techniques (Beigi, 2012, 11). Nucleic acid amplification tests (NAATs), self-vaginal swab testing, and urine specimen collections are options made available for adolescents to facilitate and increase chlamydia and gonorrhea screening. References Altchek, A. & Deligdisch, L. (2009). Adolescent Sexuality. Pediatric, Adolescent, & Young Adult Gynecology (1st ed.) (p. 124-130). New Jersey: Blackwell Publishing Ltd. Beigi, R.H. (2012). Specific Considerations for Pediatric and Adolescent Patients. Sexually Transmitted Diseases (p. 4-13). New Jersey: John Wiley & Sons, Ltd. Brunner, L.S. et al. (2009). Assessment and Management of Female Physiologic Processes. Brunner and Suddarth's Textbook of Medical-Surgical Nursing (12th ed.) (p. 1396-1436). Philadelphia: Lippincott Williams & Wilkins. Carr, P.L. et al. (2007). Gynecologic and Preventive Care. In a Page: OB/GYN & Women's Health (p. 8-19). Philadelphia: Lippincott Williams & Wilkins. Pillitteri, A. (2009). The Nursing Role in Reproductive and Sexual Health. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (6th ed.) (p. 83-115). Philadelphia: Lippincott Williams & Wilkins. Ricci, S. S. & Kyle, T. (2009). Common Reproductive Issues. Maternity and Pediatric Nursing (p. 90-140). Philadelphia: Lippincott Williams & Wilkins. U.S. Department of Health & Human Services. (2012). Personal Representatives. Retrieved on June 14, 2012 from http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/personalreps.html Read More