Women S Health Mini-Residency for Primary Care Nursing 12/5/12

Women S Health Mini-Residency for Primary Care Nursing 12/5/12

Women’s Health Mini-Residency for Primary Care Nursing 12/5/12

MST Scenario

Facilitator’s Guide

At completion of this scenario, the learner will be able to:

  1. Explain the ramifications of military sexual trauma
  2. Use appropriate language and modify the pelvic exam to increase patient comfort

Monica, a 28-year-old female, G1P0A1, presents with a complaint of dysmenorrhea. She’s asking for “something stronger than Midol”. She states that her menstrual cycles are regular, occur about every 30 days, and last about 6 days. Her Paps have been normal, however she admits that her last Pap was 4 years ago. She has never used birth control. Her responses are abrupt andshe brushes off questions that she sees as unrelated to her cramps.

  1. What significant information has Monica provided?

•Normal cycles

•Has had one pregnancy that did not go to term

•Needs a Pap smear

•No birth control

•Uneasy with questioning

  1. What additional information would be helpful?

•Has she tried any other medication or treatments for cramps

•Why did her pregnancy not go to term - abortion vs. miscarriage

•What age was she when pregnant

•Is she sexually active; Is she monogamous; Is her partner

•What precautions does she take to prevent STI’s

•Social history- smoking, drinking, drugs

Monica becomes teary when asked about her pregnancy and seemsreluctant to talk about it. She won’t make eye contact and her affect becomes flat. Your gentle probing elicits the information that she was raped by a fellow soldier about 18 months ago while in the military and had an abortion for the resulting pregnancy. She’s been dating a co-worker on and off for several months, and states“so far I haven’t let him touch me”. She denies smoking and drugs, and drinks a couple of beers every night to help her sleep.

  1. What tests might the provider want to perform? What supplies would you make available?

Tests:

•Pap smear withHPV reflex testing

•STI cultures including Chlamydia, Gonorrhea, and wet mount or AFFIRM if indicated

Supplies:

•ThinPrep solution (or slides with fixative depending on Pap screening at your site)

•Spatula/endocervical brush/broom collection devices for Pap smear

•Speculum

•Water-soluble lubricant

•Large cotton-tipped swabs

•pH paper

•KOH tape/solution with collection tube and cotton tip applicator for wet mount if used by site

A chaperone is required regardless of provider gender or patient’s sexual orientation; nursing personnel may assist in this role.

You tell Monica that it is time for her exam. You give her a gown and cover, asking her to undress from the waist down placing the cover over her legs. Monicabecomes very anxious and keeps glancing at the door.

4.What things could you do to make her more comfortable?

•Describe the procedure and ask Monica what she anticipates will be the most difficult part

•Brainstorm with her about coping strategies

•Employ distractions

•Let her know that the provider will stop if she asks

•Check periodically throughout the exam to ask how she is doing

•Ensure that she feels in control by reminding the provider to ask permission before touching her

5. What other VA resources are available for women who have experienced MST?

•MST Coordinator

•MST support groups

•Mental Health

•Vet Center

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