HAART Medications -Paula Case Study

As far as her pregnancy, if Paula doesn’t take her HAART medications religiously, she risks having a baby who is HIV positive. I am concerned about how she is going to care for a baby with her multiple medical issues. On the practical side, I wonder how she will physically care for this child. She has a semi-paralyzed right hand and walks with a limp. Additionally, when her foot ulcers flare up, she can barely put pressure on her feet. Newborns take a lot of time and energy, and I am not sure she has the capacity to handle the needs of an infant—let alone a toddler. I have not made any formal recommendations to Paula regarding whether to continue the pregnancy, but I have told Paula that, if she does decide to have the child, she must take her HAART medications every day. I explained that this is vital to her health and the health of her unborn child.

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Psychiatrist

Dialogue 2

When her social worker, who I am in regular contact with, informed me that Paula announced she was pregnant, I was obviously concerned. Knowing Paula as well as I do, I felt I could be honest with her and give her my opinion about the situation. I told her that she should abort. Based on her medical history, including her physical and mental health disabilities, I did not believe she had the capacity to care for this unborn child. She has absolutely no support at all, outside of the treatment team, and would have no familial assistance to take care of this child. My recommendation for abortion was only solidified when we had to involuntarily hospitalize her. I fear that Paula cannot take care of herself, and she cannot be trusted to take her medications. If she does decide to continue with the pregnancy, my recommendation would be that she stay on the psychiatric unit for her entire pregnancy. That way, we will know that she is taking her medications and that the fetus is safe.

HAART Medications -Paula Case Study

OB Nurse

Dialogue 2

Paula is most definitely a high-risk pregnancy, but that does not mean she can’t have a healthy baby. If she keeps up with her HAART medications and comes to her prenatal visits, there’s no reason this baby can’t be born healthy and HIV negative. My larger concern is with the pain medications she takes for her foot ulcers. There is a slight chance the baby will be born addicted to them. We would have to plan for a stay in the NICU if that occurs. While Paula clearly started to decompensate and exhibited some very risky behaviors recently, I think we should try and understand the stress she has been under. While it is not my place to tell the patient what she should do about a pregnancy, I don’t see that we would have to recommend termination.

Social Worker

Dialogue 2

Paula has overcome many obstacles in her life, but a baby—at her age and with her medical profile—is very different. Paula has made many bad decisions in her life, and the decision to keep this baby may or may not be the best for both her and the child. That being said, if her decision is to continue the pregnancy, we need to find a way to face the mountain of obstacles. She has little to no social support, and there will be many difficulties she will face caring for the baby alone. Paula also has limited financial resources and will need to apply for WIC and Medicaid. There are the numerous supplies that we will need to obtain, such as a crib, clothing, diapers, and formula. She has historically been unreliable about following up with referrals, so she is going to need a lot of encouragement and support. Honestly, I may not believe this pregnancy is a good idea, although I would never tell her that—that’s not up to me or anyone else. We all, ultimately, need to accept her decision and move on. Our goal now is to help Paula make it safely through this pregnancy and work on a plan to help her care for this baby once it is born. I don’t agree that she should be kept on the psychiatric unit for the next seven or eight months. Allowing Paula to play an active role in preparing for the baby is an important task, and she will need to be out in the community and in her home taking care of things. We have to show that we believe in her and her willingness to manage this situation to the best of her ability. We need to affirm her strengths and support her weaknesses.

HAART Medications -Paula Case Study