Case study: Tina

Tina is a twenty-six-year-old female who attended the doctor’s surgery with her four-year-old daughter, Flora, for her pre-school booster immunisation. On arriving at the clinic, Ben, the nurse, commented to Tina that she did not appear well and asked if she was OK. Tina stated that she woke up that morning with left-sided lower abdominal pain and had vomited once. She thought she may have a ‘tummy bug’.

Although the appointment had been made for Flora to have her pre-school injection, Ben focused his attention on Tina as he felt that something was seriously wrong. A medical history and physical examination of Tina’s abdomen was undertaken. They revealed that Tina had an appendectomy at aged 17 years and that she was on the combined oral contraceptive pill. Tina said she had not missed any pills and was in a long-term sexual relationship. A urine sample was taken to test for possible infection and to exclude pregnancy. The test showed no signs of infection and the pregnancy test was negative. Tina’s vital signs were Temperature 37.1, Resps 20, BP 146/88, Pulse 108 (regular). Tina experienced severe pain when the left lower aspect of her abdomen was palpated.

Ben made an urgent referral to the hospital as he felt Tina could have an ovarian cyst or ectopic pregnancy. At the hospital Tina’s Beta HCG was positive and a transvaginal ultrasound confirmed an ectopic pregnancy.

1. How did Ben make the decision to refer Tina to the hospital?

2. Reflect on a nursing situation where you made a decision.

3. What factors influenced your decision? Was it based on objective tools, evidence or on your personal judgement and beliefs?