Adolescent Abuse Counseling Case Study
RNSG 2274: Clinical II
Case Scenario:
You are an RN working at a Planned Parenthood Clinic in your town. Today, a 15-year-old girl,
M.C., comes in with her boyfriend for an office visit. You call the girl’s name and her boyfriend rises as
well. You explain that you will be rooming the patient for the Nurse Practitioner that will see her, and
that her boyfriend should wait in the waiting room. Her boyfriend insists that he will accompany her
into the room. M.C. does not look directly at you, but nods. You agree to allow her boyfriend to be with
her while you obtain her weight and vital signs. M.C.’s boyfriend is very talkative, commenting on M.C.’s
weight gain and general health. M.C. remains quiet, holding hands with him and leaning her head on his
arm. You ask the reason for the visit. M.C. looks at her boyfriend, then you, and answers, “We’d like to
get birth control pills.” You note this in her chart and return the boyfriend to the waiting room. He tells
you, “Be sure to come and get me as soon as the Nurse Practitioner is done. M.C. needs me to be with
her, I don’t want her to be alone.”
When you return to the exam room to prepare the supplies for the exam, M.C. tells you, “My
mom knows I’m here, but she’s working and couldn’t bring me here. My boyfriend took the afternoon
off to take me out to lunch and then to this appointment.”
Further findings:
*boyfriend’s age – 24 years; employed as furniture salesman
*M.C.’s parents are married; dad works evenings at a manufacturing plant, mom
works variable shifts at a restaurant.
*4 dime-sized bruises noted on inner aspect of upper right arm and fading
greenish-brown colored 2cm x 4cm bruise on left flank. M.C. states her
boyfriend “grabbed my arm to save me from falling down the stairs.”
M.C. states that she began having a sexual relationship with her boyfriend on her 15th birthday, which
was 2 months ago. She reports her desire to use birth control is “so I can be a full woman to Charlie.”
When questioned about her school activities and friends, M.C. indicates that she spends all her time
with Charlie and his friends. “I used to be a cheerleader for 9th grade Boy’s Basketball, but now it is so
much fun hanging out with Charlie and his married couple friends.”
Part I: Determining learning needs
Complete the following questions with short answers.
1. Discuss further questions and areas of assessment it is important to know for M.C.’s care. Consider
both physical and psychological care.
Last menstrual cycle, regularity, ask her if she feels safe in her relationship, ask her if she feels
safe in her home, ask her what she means by saying “so I can be a full woman to Charlie”, how many
partners has she had, and what is the purpose of seeking birth control.
2. What about this interaction causes you to suspect abuse? How will you approach this subject?
He answers for her, doesn’t want her to be without him in the room, and bruises on her arms.
Approach the subject by saying “this is a safe place and we have reason to be concerned that you are
not in a healthy relationship?”
3. After M.C. and her boyfriend leave, her mother calls the clinic and asks you how the appointment
went and what the Nurse Practitioner did and prescribed. What do you do?
“Sorry according to law we cannot release patient information without a signed release.”
4. In this brief encounter, M.C. shares with you that her family’s religion is Catholic. Knowing this and
considering her age and the request for birth control pills, how do you address her religion, emotional
development, social development/self esteem, intellectual function, and provide for psychological
safety?
Ask her if religion has any influence on her preferences for birth control methods. Ask her if she
feels emotionally ready for a sexual relationship. How do you feel your relationship is affecting your
social life? Tell me about yourself? Ask her how school is going. Ask if she has someone that she can
trust to talk to when she has a problem.
Part II: Care plan
1.
Assessment: Briefly cluster nursing information obtained from case scenario and list inferences
based on this data. Are there areas that would require further assessment? Use this process to identify
all actual/potential patient concerns/health needs.
Her behavior seems to be influenced by her boyfriend. She seems to depend on him for
decision making. Parents seem to work odd hours possibly leaving unsupervised. A majority of her time
is spent with her boyfriend and older people instead of peers.
2.
Diagnosis: List your top 3-5 nursing diagnosis based on inferences above. Remember to write
them as full two or three part statements with related factors and manifestations, as appropriate (actual
dx 3 parts, risk for dx 2 parts).
1. Risk for powerlessness due to lack of personal control over decisions related to birth control that
affects outlook goals and lifestyle.
2. Risk for infection transmission related to lack of knowledge of the contagious nature of the disease
and reports of high risk behaviors.
3. Risk for situational low self-esteem as manifested by new social life change resulting in loss of
cheerleader position in response to current relationship.
4. Risk for injury related to a perceptual or physiologic deficit, a lack of awareness of hazards, or
maturational age as evidenced by bruising on her arm and her physical age.
5.
Then, using the care plan template on the following page(s), create a care plan for the client. Choose
your top priority dx from your NANDA Nursing diagnoses listed above and identify at least 2 desired
outcomes (remember to include all 5 components of a goal), list 5-6 nursing interventions designed to
meet the outcomes, and the theoretical rationale for each intervention.
CARE PLANNING ACTIVITY TEMPLATE
#1 Nursing Diagnosis: Risk for injury related to a perceptual or physiologic deficit, a lack of awareness of
hazards, or maturational age as evidenced by bruising on her arm and her physical age.
Desired Outcomes/Evaluation
Criteria
1. Patient will state 2 abuse
and healthy relationship
resources by the end of
the appointment.
Nursing Interventions
Rationale
1. Nurse will provide written
materials containing hotline
numbers
1. We would like the patient to have
resources to reference if needed.
2. Nurse will help patient
identify support system.
3. Offering a supportive non
judge mental environment.
2. Client will verbalize correct
usage of birth control pills by the
end of the appointment.
4. Provide with written drug
information.
2. Patient needs to know support
systems before crisis arises.
3. Creating trusting open
communication to facilitate teaching.
4. Patient needs to be aware of
actions and side effects of drugs.
5. Prevent pregnancy
5. Educate on proper use of
birth control medication
6. Visual record of compliance.
6. Provide with a calendar for
tracking menstrual cycle and for
compliance.