Question

A 16-year-old student comes to the school nurse’s office and tells the nurse that she thinks she might be pregnant. The student tells the nurse that she has not had a period in 3 months. The nurse checks the student’s file and finds that she has a history of asthma and a seizure disorder for which she has been prescribed daily drugs. Because the student takes these drugs at home, the nurse has not seen her on a regular basis. The nurse counsels the student about obtaining a pregnancy test. The student tells the nurse that before she can leave the office, she needs to know what might be wrong with her baby. The student states that she drinks heavily on weekends and that she probably was drunk when she became pregnant. She also states that she was concerned about taking her seizure medication during the months she thought she was pregnant, but she was too embarrassed not to take it because she did not want to have a seizure in front of her friends. The student tells the nurse that she has not taken any asthma medication and that she has been having a difficult time breathing.

question 1:

What can the nurse tell the student about the interval when she was taking her medications after possibly becoming pregnant?

Question 2:

When the student asks specifically how her baby may have been affected, how should the nurse reply?

question 3:

The student asks what alcohol can do to her baby. What would be the best response by the school nurse?

Answer 1

A. the student here is 16 year old and she is telling about the absence of menstrual periods for consecutivly 3 months , and suspect she is pregnant based on the past events occured when she was drunken,

so there is more chance that she is pregnant , can confirm by doing pregnancy card test ,

she is giving history of drug intakes for asthma and seizure . since organogensis of fetus starting in early days of pregnancy , there is chance that the drugs she taken can affect the growth of the foetus and can leads to various organ anomalies , premature babies, still borne baby , underweight baby ..sometime can cause miscariage . even one episodes of drug intake during initial periods of gestation can affect the limb developments of fetus .

B, the asthma medications like short course of inhaled steroids,salbutamol ..and antihistamines are considerd safer during pregnancy when compared to the harmful effects of untreated asthma in pregnancy.

anti seizure medications are generaly considerd unsafe during pregnancy .they can cause side effects to the foetus like cleft palate , neural tube defects like spina bifida , suture synostosis,

skeletal abnormalites like polydactyly , club foot

urinary tract defects like hypospadiasis , multicystic dysplastic kidney

heart defects like tetralogy of fallot , atrial and ventricular septal defects , bicuspid aortic valve , pulmonary atresia

developmental delay , inguinal hernia

example of antiseizure medicines and effects

Phenytoin - causes foetal hydantoin syndrome and symptoms like microcephaly , mental retardation , hypoplastic nails and distal phalanges, cleft palate . heart defects like ASD(trial septal defects), PDA(patent ductus arteriosis),coarcation aorta

carbamazepine -leads to developmental problems like abnormal IQ , growth retardation

valproic acid - increased risk of neural tube defect like spina bifida

C. effects of alchohol in early pregnancy ,especialy during first 3 months of pregnancy it affects foetus . it increases chance of miscarriage , premature birth ,low weight babies,

alchohol use during pregnancy causes foetal alcohol syndrome , which affects brain growths ., these child develops small head , small eyes ,small nose, thin upper lips , smooth philtrum , short palpebral fissure ,underdeveloped jaw.