Advanced nurse practice in reproductive health care

Case #4. Stephanie. History of Present Illness (HPI): Stephanie is a 15-year-old female G0 who presents to the office with her mother. She c/o heavy bleeding during her periods, anxiety, and mood swings, which had been occurring for the past 4 months. Her symptoms usually occur a few days before the onset of her menses and improve by day 3. She uses 2 pads every 1-2 hours and sometimes needs to double up on the pads. She also c/o severe bloating, pelvic pain, and back pain during her periods. She has missed numerous days of school due to her symptoms, and lacks interest in usual daily activities, staying in bed all day. Around 2 months ago, she was seen by an adolescent psychiatrist and was diagnosed with major depression and started on sertraline 50mg once daily. She has refused to take the medication because she rejects the diagnosis of depression. She states that she knows she is not depressed and is angry that nobody believes her. Prior medical history: Questionable depression. Prior surgical history: None Current medications: None. Allergies: Sulfa. OB- GYN History: Menarche age 12, cycle length was 5-7 days- frequency every 28 days- 3 pads per day, until the past 4 months. LMP: 1 week ago. Contraception history: None Social history: Lives with her parents. She is an only child. Denies EtOH, smoking, or recreational drug use. Sexually active once (vaginal) – 1 year ago with same partner- none since. Participates in sports: basketball Family history: Mother alive and well, Father with diabetes Review of Systems (ROS): Unremarkable with exception of as noted in HPI. Physical Exam (PE) VS: BP: 122/74, P: 64, RR: 16, T: 97.8 Weight: 146 lbs., Height: 63 inches, BMI 26.2 General Examination: Well developed, well nourished, in no acute distress. Psych: alert and oriented, cooperative with exam, appears frustrated. Abdomen: Soft, NTND, no masses Gynecological: EXTERNAL EXAM: normal, appropriate hair distribution, no erythema, no skin discoloration, no lesions. SPECULUM/INTERNAL EXAM: Cervix: normal appearance, no lesions, no bleeding/discharge, no cervical movement tenderness, nulliparous. UTERUS: normal size, shape, and consistency, normal mobility, nontender. ADNEXA: no masses or tenderness bilaterally.