Case Study 6 Flashcards
Lisa is 17 and lives with her single mother, Jill. Jill was a school cleaner but retired due to severe arthritis. Lisa left school after S5 and is currently looking for work. She attends aerobics twice a week with her friends. She started smoking at 14. She has been with her boyfriend Martin since she was 15. Martin smokes, works in the local car garage and drinks more than recommended guidelines, mostly at weekends and has become breathless when running up the stairs at work over the last year or two.
Lisa has missed a period and discovered she is pregnant.
Lisa comes to see you in the early stages of pregnancy, wondering whether to keep the baby.
List two ethical, two psychological and two social issues that she may be considering
Ethical
- beliefs regarding termination
- any religious beliefs
- thoughts regarding bringing a child into the world that you do not feel able to care for
Psychological
- anxiety about being a parent
- anxiety about going through with a termination
- stress/anxiety about level of support she may have from family/friends
Social
- support network - does she feel her friends would be supportive
- her social life will dramatically change after having a baby
- ability to find a job/work will be affected in short or longer term
Following discussion with her GP and close family and friends, Lisa decides to keep the baby. She knows that she doesn’t have the healthiest lifestyle and until now has not felt the need for change. What factors might increase the chance of someone changing their behaviour?
- you think the advantages of change outweigh the disadvantages
- you anticipate a positive response from others to your behavioural change
- there is social pressure for you to change
- you perceive the new behaviour to be consistent with your self image
- you believe you are able to carry out the new behaviour in a range of circumstances
Using smoking or alcohol, how might these factors apply to Lisa’s situation? Give five factors
- advantages of not smoking/drinking i.e. healthy baby outweigh the disadvantages
- anticipate positive response from others to your behaviour change e.g. partner also wants the child to be healthy
- social pressure to change e.g. very socially unacceptable to smoke when pregnant
- perceive new behaviour to be consistent with your self image i.e. a good mother
- you believe you are able to carry out the new behaviour in a range of circumstances e.g. at home, celebrations
Other than smoking or alohol, what other factors affecting foetal wellbeing might Lisa’s GP discuss with her?
- illicit drugs
- prescription drugs
- OTC medication, internet remedies, herbal medication
- x-rays
- dietary factors - lack of folic acid, soft cheese, pate
- infectious diseases e.g. toxoplasma, rubella, cytomegalovirus, herpes
What kind of actions might the government take to promote health in the population as a whole?
- legislation/policies on smoking/alcohol e.g. minimum age to buy products, licensing laws, taxation
- improvements in housing
- provision of health education
- health and safety laws
- traffic/transport legislation/policies
A few weeks later, Lisa tells the GP that Martin has left her but turns up at her house late at night at the weekend after drinking with his friends. He is often drunk and upset, and occasionally angry.
Are there any issues that the GP might note here?
Which other health professional might the GP liaise with to get a better picture of the home situation?
Issues:
- Potential for gender based violence (domestic violence)
- might be child protection issues at a later date
Health professional:
- the health visitor - regular contact with families of pre-school children
Despite the issues, Lisa considers herself to be quite healthy and normal.
What is the World Health Organisation (WHO) definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
According to the WHO definition, give five reasons why Lisa might feel she is healthy
- she has no illness/long term condition (chronic disease)
- she exercises regularly
- she is on no regular medication
- she manages to work and socialise
- ‘healthy diet’
- she managed to become pregnant
Give two reasons why Lisa might feel that smoking is normal behaviour
- might be normal for her peer or social group but would be abnormal perhaps for the wider population
- might watch TV programmes where smoking is normal behaviour
After a relatively uneventful pregnancy, Baby Kayleigh is born a little premature weight 2400 grams.
What definition applies to babies below 2500 grams?
Low Birth Weight
At a “new mums” group, 7 weeks post-natal, Lisa realises that other babies are already smiling but Kayleigh is not. She is anxious and mentions this to her health visitor.
List five advantages of using developmental milestones
- provides GPs and HVs with aid to management in child development and clear cut off points for referral
- makes it easier to reassure anxious parents about range of normality and to provide parents with a logical explanation about developmental progress
- provides a structure for developmental assessment
- aids parental interaction in child development e.g. encourage speaking and reading to aid development
- use in research - allows comparison across peer groups
List five disadvantages of using developmental milestones
- may result in parental anxiety
- potential for different interpretations of guidelines
- medicalisation of normality
- may place doctor in difficult situation e.g. parental anxiety resulting in unnecessary referral
- may be difficult to balance confounding factors such as prematurity against guidelines
Which country in Europe has the highest number of single parent families?
The United Kingdom
Approximately how many single parent families are there in that country?
Approximately 2 million
When Lisa attends the eight week baby check with the GP, the GP finds a small heart murmur which had not been picked up in the hospital - perhaps because the paediatrician was rushed on the post-natal ward round and examined Kayleigh for discharge while Lisa was in the shower. Lisa is upset and angry at the hospital doctor for missing the murmur.
How might the paediatrician have behaved differently to help avoid the angry reaction?
- diagnosed the murmur
- wait for mum and introduce himself
- fully examine the child with the mum
- explain findings and reasoning
- explain that there will be a second check at the GP
- ask if the mum has any questions
