Approaches to Patient Scenarios

Posted on: 17th May 2023


You are a nurse practitioner and you have 3 different patient scenarios. How would you approach these topics/scenarios?

1. A 12-year-old female has had secondary amenorrhea for 3 months. She started her menses at 9 years old and has had a 28-day cycle for the past 2 years. What do you want to do and why? How would your approach vary if the patient were 10 years old and had her menses for only 6 months?

2. After several discussions with her clinician, Erica decides to start taking birth control pills as her contraceptive method. She is dispensed 4 packs with verbal and written instructions. Erica, however, is also given advice by her girlfriend on how to take the pills. Whenever Erica begins her period, she stops taking the pill and does not start a new pack until the Sunday after her bleeding stops. In 6 months, Erica is pregnant.

3.Judy refuses any form of hormonal contraception. She is afraid of needles and therefore does not want Depo. She does not want to gain weight or “be changed” by the pill. The thought of something in her arm is “freaky”, no Norplant is out. She is consistently given condoms and vaginal contraceptive film by the clinic. Several months later, Judy is pregnant. She hadn’t been using condoms. She just shrugs, “I didn’t think that I would really get pregnant, I had chlamydia; doesn’t that make you infertile?”

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Approaches to Patient Scenarios

Approach to scenarios 1

For this case, what I would want to do as a nurse practitioner is to determine the underlying cause. Etiological factors include pregnancy, stress, weight changes, underlying illness, primary ovarian insufficiency, hypothalamus disorders, pituitary disorders, ovarian tumors, or other hormonal problems such as excessive production of prolactin and benign pituitary tumors (Kerns et al., 2022). Determining the cause will guide the diagnosis process and how to approach the issue in terms of treatment strategies. However, it is common for girls to skip or experience irregular periods, especially during the first two years. In the case of a ten-year-old who had menses for only six months, the approach would be similar. This is because the factors causing secondary amenorrhea are similar, especially during the first two years of menstruation. Ruling out the cause will also provide a practical guide for diagnosing the underlying abnormality and evaluating the applicable treatment strategy.

Approach to scenarios 2

Birth control pills are meant to prevent one from getting pregnant effectively. The instructions for a 28-day pack are that one pill should be taken daily for four weeks in a row and start a new pack on the 29th day (Borsella, 2021). Therefore, contraceptive pills are meant to be taken continuously during or off- periods. Taking contraceptive pills as directed can be about 99% effective in pregnancy prevention. Missing one or more pills during a cycle places one at a higher risk of unwanted pregnancy. This explains Erica’s situation. She followed the wrong guidelines in taking the contraceptive pills as she stopped taking the pill during her period instead of continuing. Also, she ought to complete a pack before beginning on a new pack. Her wrong ways of taking the contraceptive pills have made them less effective, which has led to her pregnancy. Therefore, I will explain to her the mistake that resulted in pregnancy for this scenario. After that, I will advise her to seek an effective family planning method six weeks after giving birth and follow the practical instructions and guidelines to avoid unwanted pregnancies.

Approach to scenarios 3

Chlamydia is a severe infection that causes Pelvic Inflammatory Disease (PID), which increases the risk of blockage, scarring, and inflammation of the reproductive organs, especially the fallopian tubes (Leeper & Lutzkanin, 2018). This can make fertilization impossible. However, one can still get pregnant with a chlamydia infection in some cases. Therefore, Judy should not have assumed that she would not get pregnant since she had the infection. Consequently, her contraceptive option, vaginal contraceptive film, is a super-thin film usually inserted in the vagina. It dissolves and eventually releases nonoxynol-9, a chemical responsible for killing sperms.

However, according to the Centres for Disease Control and Prevention, the vaginal contraceptive film is not as effective as other birth control methods. It is 82% effective; hence a woman may get pregnant within the first year of use ((Mauck & Vincent, 2020). However, another contraceptive method should be used to increase its effectiveness, such as in Judy’s case, where she was advised to use condoms. Her pregnancy resulted from the low effectiveness of vaginal contraceptive film and her failure to use another birth control as a backup. For her case, I will advise her to seek professional medical treatment to treat the chlamydial infection since it may lead to complications during pregnancy. During pregnancy, infected women are more likely to go into preterm labor, deliver prematurely, have a low birth weight baby, or experience premature membrane rupture (Leeper & Lutzkanin, 2018). Also, the antibiotics used to treat the infection are safe for use during pregnancy.



Borsella, M. (2021). Women’s Knowledge of, Access to, and Experiences with Emergency Contraception in New Brunswick (Doctoral dissertation, Université d’Ottawa/the University of Ottawa).

Kerns, J., Itriyeva, K., & Fisher, M. (2022). Etiology and management of amenorrhea in adolescent and young adult women. Current Problems in Pediatric and Adolescent Health Care, 101184.

Leeper, C., & Lutzkanin, A. (2018). Infections during pregnancy. Primary Care: Clinics in Office Practice45(3), 567-586.

Mauck, C. K., & Vincent, K. L. (2020). The postcoital test in the development of new vaginal contraceptives. Biology of reproduction103(2), 437-444.

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