Re: Digest Number 585

[Guest guest]

> Jeanine,

I work in a huge ob-gyn clinic in an inner city hospital. Pregnant patients

frequently (ie just about every day) walk in or call c/o abdominal pain. No

way this patient would have been sent home and told to take tylenol. She'd have

gone straight to L and D.

Yikes!

DEB

>

>

> Date: Sun, 18 Feb 2001 00:48:40 -0500

>

> Subject: Treatment of teens

>

> Ok, this week I had some sad news about one of my home care prenatal patients,

a 17 year old who was 22 weeks pregnant. I found out that she had delivered.

The baby lived almost a day, then died. I was asked by the insurance case

manager to go out for a postpartum visit, which I did. The sad thing about this

kid was that she awoke with abdominal pains at 3AM one morning, but because of

her responsibility to her job, she went to work. Her job sent her home, but she

still didn't know what was going on, so she called the clinic (a high risk

clinic which has a special teenage pregnancy program) and told her case manager

about the pains. She was told it was just ligament stretching, and to take a

Tylenol!!! I felt really bad, because she has even more guilt than usual,

because she feels at fault for not going to the hospital sooner. She even told

me that she remembered the preterm labor information I give all prenatal

patients regardless of their preterm labor risk, but she di!

> dn't think it possibly could be labor at 22 weeks. Since I only had one visit

before she delivered, I never had a chance to reinforce that teaching, which I

usually would do.

> Anyway, I find myself very annoyed with the nurse (yes, it was a nurse) who

brushed off her complaints without evaluating further. I know this was a

teenager, but a very mature one, and even if she was not, she still has the

right to appropriate and careful care, correct?

> So, for those of you who work where you might get a call from an obviously (or

known) teenager with a complaint of abdominal pains at 22 weeks (this could be

L & D, schools, home care, or workplace of any kind), what advice would be given

where you work? To me, suggesting just a Tylenol with this sort of complaint

without investigating further is wrong. This young mom arrived in the emergency

room already with the baby and the intact membranes bulging. Everything was

tried to stop it, but by then, she had been laboring for about 12 hours, so

there was no stopping it.

> --------Jeanine

>

[Guest guest]

Thank you, Deb. I thought so.

The unfortunate thing is that this is at least the second teen patient of

mine with this case manager who's legitimate complaints have been brushed

off. Most often, it seems like there is little consequence for poor

instructions because many of these girls are low income kids. To me, that is

no excuse. This is why several of the local insurance providers are

requesting home care prenatal visits for patients who are receiving prenatal

care and would otherwise not be home care candidates--simply for appropriate

followup and some one on one attention and teaching. One of my last teens, a

14 year old, was never offered the teaching and parenting classes usually

offered in the adolescent pregnancy program she attended at clinic. The

reason? She was told it wasn't necessary because she had " good family

support " ! This was true, but this kid had such a thirst to learn, it was a

crime to have deprived her of that. She read every book and tape and TV show

I offered or recommended. Even people with good family support should have

been offered the same classes and teaching as anyone would be--if she

declined, then fine, but offer it!

--------Jeanine

Re: [OBnurses] Digest Number 585

> > Jeanine,

>

> I work in a huge ob-gyn clinic in an inner city hospital. Pregnant

patients frequently (ie just about every day) walk in or call c/o

abdominal pain. No way this patient would have been sent home and told to

take tylenol. She'd have gone straight to L and D.

> Yikes!

> DEB