Evidence-based Research

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Paula Cortez

SOCW 6311

Paula Cortez is a 43-year-old multiracial female who is HIV positive, has Hepatitis C,

and was diagnosed with bipolar disorder 10 years ago.

In addition to HIV and hepatitis, Paula has multiple foot ulcers that can be debilitating at

times. She currently lives alone in subsidized housing and reports no immediate or

extended family in the area. She is a member of a local church, but her attendance has

only been sporadic due to her physical pain and symptoms; therefore, she has not built

relationships with other members. Paula is receiving disability benefits due to her

multiple diagnoses and is supported by an interdisciplinary team of a physician,

psychiatrist, obstetrical nurse, and social worker.

Paula has recently become pregnant, following a sexual encounter with a brief

acquaintance. She has been unsure whether she wants to continue the pregnancy or

terminate. Paula told her social worker she is fearful of the father of the baby, and she is

convinced he will try to hurt her. In fact, the father of the baby has started to harass,

stalk, and threaten her many hours of the day. Paula has begun to exhibit increased

paranoia and has reported she started smoking again to calm her nerves. She also

stated she stopped taking her psychiatric medications and has been skipping some of

her HIV medications.

Paula disclosed to the social worker that she was neither eating nor taking her

medication—and she had not gotten out of bed for days. The social worker observed

that Paula appeared to be rapidly decompensating, potentially placing herself and her

pregnancy at risk. Based on the social worker’s suicide risk assessment, Paula has

been involuntarily hospitalized and placed on the psychiatric unit, for a minimum of 72

hours.

Interdisciplinary Team

The interdisciplinary team have come together to discuss Paula’s case, voice their

concerns, and begin to devise a plan that addresses Paula’s medical and psychiatric

needs and the needs of the unborn child, should she continue with the pregnancy.

The psychiatrist reported that Paula is often noncompliant with her medications,

stopping them after she remembers she doesn’t like the way they make her feel. She

has been hospitalized to stabilize her medications several times over the last 10 years.

Recently, she had seemed to appreciate the benefits of taking her medications and her

compliance has much improved. She had been seeing her social worker regularly, and

her overall mental health and physical health were improving. However, this has

changed recently, after several stressful life events.

The physician concurred about concerns related to medication management and the

risk of a baby who is HIV positive.

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The nurse stated that if Paula keeps up with her HIV medications and comes to her

prenatal visits, there’s no reason this baby can’t be born healthy and HIV negative. The

nurse’s larger concern is with the pain medications she takes for her foot ulcers. There

is a slight chance the baby could be born addicted to them, and the team would have to

plan for a stay in the NICU if that occurs.

The social worker stated that Paula has little to no social support, and there will be

many difficulties she will face caring for the baby alone, should she choose to continue

with the pregnancy. Paula also has limited financial resources and will need to apply

for WIC and Medicaid. There are numerous supplies 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.

The goal now, the social worker stated, is to help Paula make it safely through the

pregnancy and work on a plan to help her care for the baby once it is born.