NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples
NURS-6551N-9: Primary Care of Women
Week 03: Contraceptive Treatments
Main Post
Case Study # 3
A 33-year-old Caucasian female is being seen in clinic for contraception. She is using birth control pills, but forgets to take them because her work schedule changes every week. She has been married for 14 years and has two children. She is looking for an effective method that will be easy to remember. She has a history of chronic headaches and hypertension during pregnancy. She has never been treated for a sexually transmitted infection and is in a mutually monogamous relationship. Family history is significant for an aunt with breast cancer. She smokes half a pack of cigarettes per day. She is 5 ft. 8 in. and 215 lbs. Her vital signs are: BP 120/78, p 72, reg.
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Multiple contraceptive modalities are available to prevent the unintended pregnancy. Contraceptive treatment and management plays vital role in the care of women patient population. However, it is imperative that healthcare provider involve female patient and work closely with them to gather adequate information regarding her health history, lifestyle, and specific needs and/or preferences. Moreover, trusting relationship and comfort environment developed by provider makes it easy to educate patient on different available options and aid in making decision according to their needs and preferences (Schuiling & Likis, 2017).
For this case scenario, first of all I would discuss with the patient that whether she wants permanent or reversible option. As her being only 33 years old with two children I don’t think she want permanent option like tubal ligation or vasectomy because they are hard to reverse if she changes her mind to have another baby later but I will still give her information and educate her with its risks and benefits. As she shared that she wants something that she doesn’t have to be worried or remember to take daily and her family history positive for breast cancer I would recommend her for long term reversible contraceptive LTRC that includes ParaGard (Intrauterine Device IUD for 10 years) which is traditional and made up of copper with no hormones in it and another one is good for 5 years that have small amounts of hormones (levonorgestrel) in it. NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples
Tubal Ligation
Tubal ligation is the surgical procedure in which the fallopian tubes are tied, blocked or cut to prevent the eggs from travelling from the ovaries to the fallopian tube where the fertilization occurs between egg and sperm. This is the permanent method of contraception and it is very difficult to reverse because scar tissues are formed over the time that block the tubes permanently. Tubal ligation can be done without surgical procedure by implanting a metal spring called Essure in the fallopian tube that aid in developing scar tissues to block the tubes. This can be done as an outpatient procedure (Marshall, & Romito, 2015). However, this permanent birth control method does not prevent pregnancy by 100% and is not effective against sexually transmitted diseases. Patient can still get pregnant for multiple reasons. According to the studies over the time of 2 years 1 out 100 women with tubal ligation gets pregnant but the pregnancy can be high or fatal for mother or the child (Marshall, & Romito, 2015). It is essential to educate the patient on the minor and major complications that can be arouse due to the tubal ligation. These includes infection and wound separation and major complications that might occur are heavy blood loss, post-anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery due to sudden complications (Marshall, & Romito, 2015).
Intrauterine Device (IUD)
Intrauterine devices are long-term reversible contraception to prevent the pregnancy, it is being used since early 1960’s but die to defects in the formation of devices and increased side effects they are not the first line of choice for birth control. Presently there are two different kind of IUDs are available copper IUDs (ParaGard) effective for 10 years and hormonal IUDs (Mirena, Kyleena, Liletta, and Skyla) effective for 3-5 years which contains levonorgestrel at various dosages (Schuiling & Likis, 2017). An IUD is a tiny plastic T shaped flexibles device that’s inserted in your uterus to prevent pregnancy by blocking the travel of eggs in the fallopian tubes. The ParaGard IUD uses copper to prevent pregnancy as the Sperm doesn’t survive in the presence of copper, therefore the ParaGard IUD makes it almost impossible for sperm to reach eggs for fertilization. Whereas the hormonal IUD like Mirena, Kyleena, Liletta, and Skyla prevent pregnancy in two ways: 1) they make the consistency of the mucus thick in the cervix which blocks and traps the sperm and 2) the progestin hormone halts the process of ovulation and stop the eggs to leave ovaries, if there is no egg no sperm would be fertilized and pregnancy does not occur (Planned Parenthood Federation of America, 2017). The most common complication of IUD involves unscheduled excessive bleeding, which often decreases over time with hormonal IUDs but not with ParaGard. Additional side effect or complaints include lower abdominal pain, back pain, complexion changes, breast tenderness, headaches, changes in mood, and nausea which reduces over the time (Schuiling & Likis, 2017).
In my opinion placing IUD would the best option for the patient in the case study as it gives peace of mind and patient does not have to remember to take everyday pills. However, it does not provide 100% prevention of pregnancy and also does not prevent women from STDs. Therefore, it is the duty of the provider to explain each available option clearly to the patient so patient can decide which one is best for herself. As the selection of contraception is highly individualized according to patient’s choice and perception but if in case patient disagree with the recommended options, other options and their possible advantages or disadvantages along with the keeping in mind patient’s insurance coverage (Schuiling & Likis, 2017). NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples
References
Marshall, S., & Romito, K. (2015). Tubal ligation/implants/tubes Tied: Effects, chances of
pregnancy after. Retrieved from http://www.webmd.com/sex/birth-control/tubal-ligation-and-tubal-implants
Planned Parenthood Federation of America. (2017). IUD birth control: Info about Mirena &
ParaGard IUDs. Retrieved from https://www.plannedparenthood.org/learn/birth-control/iud
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA:
Jones & Bartlett Learning.
NURS 6551: Primary Care of Women
INITIAL POST
Case Study #3
A 33-year-old Caucasian female is being seen in clinic for contraception. She is using birth control pills, but forgets to take them because her work schedule changes every week. She has been married for 14 years and has two children. She is looking for an effective method that will be easy to remember. She has a history of chronic headaches and hypertension during pregnancy. She has never been treated for a sexually transmitted infection and is in a mutually monogamous relationship. Family history is significant for an aunt with breast cancer. She smokes half a pack of cigarettes per day. She is 5 ft. 8 in. and 215 lbs. Her vital signs are: BP 120/78, p 72, reg. NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples
Contraception Treatment
Providers play an important role in providing information and education while supporting patients’ decision making of choosing the appropriate contraceptive. It is a complex decision to make to choose the most suitable contraceptive method during contraceptive counseling. The goal of contraceptives is not only preventing unintended pregnancies, but also to prevent sexually transmitted diseases, recognize potential risk factors, or to regulate symptoms induced from hormonal imbalance. Birth control counseling takes an important place in women’s health. Providers must take the time to educate their patient on the several methods of birth control but also the proper use of it. Birth control counseling should involve two important questions: when the patient wants to have a baby or another baby and secondly, how important it is for her to prevent pregnancy until then. This will give enough information to the provider to provide the patient with the best individualized birth control option. NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples
Male condoms are a contraceptive method which can assist in preventing the transmission of STDs from one to another and also pregnancy. However, in this case study, the patient has been married for 14 years and has only one sex partner which makes this method an option but not the most suitable since the patient mentioned she wanted an easy to remember method. Another potential dissatisfaction may be that the patient wants more security of not becoming pregnant (Johnson, Pion & Jennings, 2013). The contraceptive pills are the most commonly prescribed birth control. The patient is currently taking birth control pills and is not satisfied with this option due to her changing work schedule and the possibility of forgetting the pill. Furthermore, hormonal therapy including the pill, ring, implant, shots or patch may also not be beneficial for the patient due to the patient current obese weight, chronic headaches, a family history of breast cancer, and her personal habit of smoking (Chaveepojnkamjorn et al., 2014). Prescribing combined oral contraceptives to obese women may lead to further weight gain as a side effect while combined with smoking raises the risk of deep vein thrombosis and pulmonary embolism (Reifsnider et al., 2013). Intrauterine devices (IUDs) are acceptable for individuals with medical problems or certain risk factors such as smoking (Yoost, 2014). When choosing the IUD, one must be aware of the two types of IUD – hormonal and copper. If the patient wishes to have more children, then the copper is the better choice since the hormonal IUD such as Mirena and Skyla may delay fertility after removal. NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples.
If the patient does not agree with the recommendation of the copper IUD, the provider could facilitate the selection by offering clear insight on the risks of other methods with the patient’s given medical history and other influencing risk factors. Providing proper education and information may help the patient understand the provider’s selection and may facilitate agreement. It is important to offer insight on the potential risk factors of the patient and the potential complications of taking hormonal birth control. This does not only reduce the liability for the provider but also gives reassurance that the patient fully understands her health risks. This will also help building a trusting relationship to her provider while meeting her reproductive goals as collaboration (Yoost, 2014). If otherwise, and the patient has decided that she does not seek any further pregnancies a provider may offer and discuss a tubal ligation as a contraceptive method. NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples
References
Chaveepojnkamjorn, W., Pichainarong, N., Thotong, R., Sativipawee, P., & Pitikultang, S.
(2017). Relationship between Breast Cancer and Oral Contraceptive Use among Thai Premenopausal Women: a Case-Control Study. Asian Pacific journal of cancer prevention : APJCP, 18(5), 1429-1433. doi:10.22034/APJCP.2017.18.5.1429
Johnson, S., Pion, C., & Jennings, V. (2013). Current methods and attitudes of women towards
contraception in Europe and America. Reproductive health, 10, 7. doi:10.1186/1742-4755-10-7
Yoost J. (2014). Understanding benefits and addressing misperceptions and barriers to
intrauterine device access among populations in the United States. Patient preference and adherence, 8, 947-57. doi:10.2147/PPA.S45710 NURS 6551 – A 33-year-old Caucasian female is being seen in clinic for contraception discussion post essay examples