female patient of 15 years, emergency consultation at the maternity clinic. Is carried by their parents who report accuses her daughter go because strong abdominal cramping pain in lower abdomen two-day, associated with genital bleeding. History of dysmenorrhea grade II to III, from menarche. Vital signs, BP 120/80, pulse 110 x min, FR 16 x min, T ° 37.5 ° C.
care In the box, out of sight of their parents, the patient reported that he had no periods since the summer, when that had sex with her boyfriend. Not been controlled by fear of their parents.
The review found a gravid uterus of about 2 ° month of pregnancy. The speculoscopy a gaping neck, by which POC out smelly, and regular blood in quantity.
QUESTION # 1 What
is (the) assessment (s) more likely (s) of the patient?
care In the box, out of sight of their parents, the patient reported that he had no periods since the summer, when that had sex with her boyfriend. Not been controlled by fear of their parents.
The review found a gravid uterus of about 2 ° month of pregnancy. The speculoscopy a gaping neck, by which POC out smelly, and regular blood in quantity.
QUESTION # 1 What
is (the) assessment (s) more likely (s) of the patient?
- Incomplete Abortion spontaneous Abortion
- Septic Abortion Abortion complete Abortion caused
- Threatened abortion
This patient is no longer pursuing a threatened abortion, and has pain and metrorrhagia , to which an associated alteration of the neck and the expulsion of products of conception, both indicators of an abortion in progress. Nor has hemodynamic, or a fever marked as to say she is on a septic abortion. Therefore likely diagnoses are full-Abortion incomplete, should be studied with ultrasound to confirm or exclude the presence of products of conception in the womb. Making a difference if it is spontaneous or provoked, it is important to note that the patient has no lacerations in the vaginal canal or neck, indicating some kind of manipulation, and the history of dysmenorrhea may indicate a physical problem in the child. Now, given the history of hiding the information to their parents, should not rule out the possibility of having committed to a method of inducing abortion, so it is important to continue investigating the matter. Therefore, so far most likely to be a spontaneous Abortion, failing to confirm if it is complete or incomplete.
Once the patient is only asked the doctor who treats you that do not communicate the diagnosis to their parents. But you need to make additional examinations and gynecologic ultrasound, for which should be hospitalized.
QUESTION No. 2
What should the doctor do?
Located in a very complicated situation, where for "protocol" should speak with parents, since it is a minor who presents a picture which is an OB-obstetrical Urgency, in which life child is potentially at risk. Examination should harmless to the body, but to better define the picture she presents, and will guide us in the treatment and prognosis. We are facing a girl who puts a lock us in our actions, but we must take into account. Despite being an obstacle, it is important to take the weight means to her, and not withdraw. It is imperative to achieve a partnership with the girl, giving all information strictly necessary to understand the seriousness of his painting and the importance of telling their parents, offering support in this process.
What do you see values \u200b\u200band principles that are in conflict? They are in conflict
nonmaleficence v / s Autonomy. Nonmaleficence is presented to be as necessary to do a test to confirm the diagnosis we can treat it, and that failure to do so (both the examination and subsequent treatment) for withholding information, it puts us in a situation of malfeasance for with the girl, and we should perform a procedure, and we are not doing. On the other hand, is a girl who has every chance of being a mature enough to make decisions, and if your choice is to keep the information in defense, has the autonomy to do so, and we can not threaten it.
As our duty is to protect life in all circumstances we tend to predominate the absence of malice, but not against the autonomy, but it by exerting their autonomy, to understand the importance of the review will mean the difference between life and death.
Question 3 What would you
. which are the physician's obligations to ...?
With What rights do parents have?
Parents have a right to know what happens to your daughter, what a physician's obligation to give information.
With patient
What rights?
The patient is entitled to receive adequate treatment, diagnosis and treat their disease. You have the right to receive it as an adult, without discrimination. It also has the right to express their autonomy and this is welcomed.
With Duties of society "to an abortion doctor?
A physician has a duty to prevent abortion, and promoting the care of a pregnancy, regardless of age, or socioeconomic status, so as not to cause an abortion. This is important because it must protect the life of the unborn, demonstrating and human dignity.
Once the patient is only asked the doctor who treats you that do not communicate the diagnosis to their parents. But you need to make additional examinations and gynecologic ultrasound, for which should be hospitalized.
QUESTION No. 2
What should the doctor do?
Located in a very complicated situation, where for "protocol" should speak with parents, since it is a minor who presents a picture which is an OB-obstetrical Urgency, in which life child is potentially at risk. Examination should harmless to the body, but to better define the picture she presents, and will guide us in the treatment and prognosis. We are facing a girl who puts a lock us in our actions, but we must take into account. Despite being an obstacle, it is important to take the weight means to her, and not withdraw. It is imperative to achieve a partnership with the girl, giving all information strictly necessary to understand the seriousness of his painting and the importance of telling their parents, offering support in this process.
What do you see values \u200b\u200band principles that are in conflict? They are in conflict
nonmaleficence v / s Autonomy. Nonmaleficence is presented to be as necessary to do a test to confirm the diagnosis we can treat it, and that failure to do so (both the examination and subsequent treatment) for withholding information, it puts us in a situation of malfeasance for with the girl, and we should perform a procedure, and we are not doing. On the other hand, is a girl who has every chance of being a mature enough to make decisions, and if your choice is to keep the information in defense, has the autonomy to do so, and we can not threaten it.
As our duty is to protect life in all circumstances we tend to predominate the absence of malice, but not against the autonomy, but it by exerting their autonomy, to understand the importance of the review will mean the difference between life and death.
Question 3 What would you
. which are the physician's obligations to ...?
With What rights do parents have?
Parents have a right to know what happens to your daughter, what a physician's obligation to give information.
With patient
What rights?
The patient is entitled to receive adequate treatment, diagnosis and treat their disease. You have the right to receive it as an adult, without discrimination. It also has the right to express their autonomy and this is welcomed.
With Duties of society "to an abortion doctor?
A physician has a duty to prevent abortion, and promoting the care of a pregnancy, regardless of age, or socioeconomic status, so as not to cause an abortion. This is important because it must protect the life of the unborn, demonstrating and human dignity.
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