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• Melissa Jooiner.

The 15-Year-Old Patient Evaluation & Management Plan

•         It is not unusual for an adolescent patient to feel nervous during her first gynecological visit and especially during the physical exam. add something prior then, previous research by this author has proven that many adolescents will not willingly share information due to fear of repercussions from their parents Joiner, M. (2019). Pediatrics Theory Discussion [Unpublished assignment submitted for NUR 507]. The healthcare provider must be cognizant of creating an appropriate environment prior to eliciting sensitive conversations with an adolescent before, the opportunity is extinguished. Confidentiality assurance is the primary inhibitor of adolescents sharing intimate details of their behavior choices and lifestyle (Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 2021).

         This patient who is a minor at 15 years of age is seeking birth control to prevent unplanned pregnancy. Patient has her mother’s approval. She expresses her nervousness and embarrassment about her mother sharing details of her becoming sexually active. The healthcare provider should display an understanding demeanor and provide reassurance that she is in a safe environment. Discussing the process and reasons for the gynecological exam will also alleviate her nervousness. Providing the patient with an opportunity to express fears and concerns she may has proven to be helpful in providing a more relaxed presence during the gynecological exam. There a several different methods of birth control utilized in the United States with oral birth control being the most popular (Arcangelo, 2017). A thorough review of the patient’s sexual habits, status of relationship whether monogamous or not should be taken into consideration prior to deciding on the best option for birth control. Patient education should include careful review of the high risk of sexually transmitted diseases some of which are incurable. Previous research by this author has proven opportunity to educate, screen, with goal to intervene potential unsafe decisions that propose detriment to the adolescent’s health Joiner, M. (2019). Pediatrics Theory Discussion [Unpublished assignment submitted for NUR 507].

           The patient should be made aware that although she is vaccinated with Gardasil for Human Papilloma virus (HPC) it does not protect her from many other strains specifically 31, 33, 45 and 53 which have been attributed to other cancers. The vaccine provides protection from strains 16 and 18 which have been attributed to three fourths of confirmed cervical cancer cases (Human Papillomavirus (HPV) Vaccines, 2021). The patient should receive education about the efficacy of birth control and strict adherence to dosing instruction to maintain the highest percentage of efficacy to prevent unwanted pregnancy. This is how the successful outcome of birth control utilized is determined. Allowing the patient time to consider birth control method options is appropriate. The patient should be made aware that only abstinence is 100% effective in not contracting sexually transmitted diseases and unwanted pregnancy (Burns, 2017).

          The patient should be assured that what is discussed during her visit remains confidential. Previous research by this author has proven that confidentiality refers to an agreement between patient and provider, that information discussed during an encounter, will not be shared with another party, unless their permission is granted. Florida Statue 381.0051, regarding minor confidentiality, states that a minor, anyone under the age of 18 does not require parent consent for contraception healthcare (The 2020 Florida Statutes; Family Planning, 2021). The patient should be made aware that if she is paying for services through her parent’s insurance company then there is a risk her parents will be made aware of any services billed through their insurance company. When establishing a confidentiality agreement with an adolescent, it is recommended to have it in writing and encourage open dialogue between the patient and her mother (Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 2021).  This visit also provides an optimal time to provide this patient education and preform baseline screening for intimate partner abuse (Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 2021).

References 

Arcangelo, P. V. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach (4th Ed.). Philadelphia: Lippincott Williams & Wilkins American.

Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. (2021, January 22). American Academy of Pediatrics: https://brightfutures.aap.org/clinical-practice/Pages/default.aspx (Links to an external site.)

Burns, C. E. (2017). Pediatric primary care (6th ed.). St. Louis: Elsevier.

Human Papillomavirus (HPV) Vaccines. (2021, February 10). National Cancer Institute of the Institutes of Health : https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet (Links to an external site.)

The 2020 Florida Statutes; Family Planning. (2021, January 26). Official Site of Florida Legislature: http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=contraception+health&URL=0300-0399/0381/Sections/0381.0051.html