NR 508 Week 2 Case Study Discussion: Original Post, Responses 75 Pages (Multiple Versions)

NR 508 Week 2 Case Study Discussion: Original Post, Responses 75 Pages (Multiple Versions) Claudia is a 36-year-old mother of two G2P2, she recently delivered her last child 9 months ago, and has been using condoms for birth control for the last 7 months. Today she is requesting a more reliable birth control, she is not sure of her current pregnancy plans, however, she does not wish to discuss sterilization. No religious contraindications for treatment. Previous methods include condoms, and oral contraceptive pills. She thought about an IUD but is concerned her husband may feel it during intimacy. PMH: positive for mild hypertension with first pregnancy, seasonal allergies. Surgeries: Left inguinal hernia and tonsillectomy. Family history: Mother HTN and Father colon CA both deceased Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week. Drug allergies-Sulfa causes a rash. Current medications-MVI with Fe, Calcium chews, prn Allegra for allergies. Height 67 inches, weight 157 pounds, BP 110/75, P 70, R 16. PAP collected today, breast exam WNL, urine pregnancy negative. Physical exam is normal. • What are your treatment goals for Claudia today? • What are two possible contraceptive methods for Claudia? Please give brief rationale for each. • Pick one method and list five (5) patient-centered teaching points for the method you chose today. • What would your contraceptive choice be if Claudia smoked 10-15 cigarettes per day? Explain your answer. Treatment goals for Claudia today are to assist her in determining a safe, reliable form of birth control that is acceptable to her and her husband that will provide for excellence coverage as well as suitable compliance. Claudia’s history, including familial, along with evidence based guidelines will assist in determining the best birth control method for Claudia (Halloran, 2014). Ruling out contraindications is the first step for the new nurse practitioner when advising a patient on contraceptive methods and determining preexisting medical conditions is critical (Halloran, 2014). Fortunately, Claudia’s history is straightforward. The potential for contraindication for Claudia is in her mild hypertension during previous pregnancy, familial history of hypertension (mother), mild increase for weight, lack of exercise and age (Woo & Robinson, 2016). Aside from these risk parameters, Claudia still has several options. Oral contraceptives are not completely out of the question (method A), however, given her age (greater than 35) and predisposition for HTN, a better option may be the IUD (method B). Motivational interviewing during Claudia’s visit will assist in helping Claudia develop, decipher and express her needs (Woo & Robinson, 2016). Because she knows she does not want sterilization and is unsure of future desire for additional children, IUD (Copper) is an option. The Copper IUD is the most widely used IUD in the world with few contraindications, all of which Claudia is negative for-namely pregnancy, disease (pelvic inflammatory), undiagnosed vaginal bleeding or gynecological cancers (Iklaki, Agbakwuru, Udo & Abeshi, 2015). Claudia’s husband will not feel the IUD during intercourse, however, there are side effects that must be expressed to Claudia such as bleeding, pain and increased risk for pelvic infection (Iklaki, Agbakwuru, Udo & Abeshi, 2015). Positives to the IUD are in that they are easily inserted (or removed) through the cervical canal during an office visit, do not use hormones and provide contraception for up to ten years (Iklaki, Agbakwuru, Udo & Abeshi, 2015). At this time, the benefits of oral contraceptives for Claudia likely outweigh the risks and may also have their own benefits (Woo & Robinson, 2016). A combination oral contraceptive with lowest hormone doses possible will provide contraception and may offer regular menstrual cycles, lighter bleeding and decreased menstrual cramps. If Claudia decides in favor of oral contraceptives, teaching points today would include increasing her exercise, eating a healthy diet, striving to lose 5-10 pounds, monthly monitoring of her blood pressure at home and instructions to take her pills every day as well as what to do should she miss a dose (Woo & Robinson, 2016). Even though risks associated with low dose (less the 50 mcg/day) estrogen oral contraceptives are low in those who smoke, risk for cardiovascular events, stroke and clots are increased with age (greater than 35) and smoking in those who use oral contraceptives and must not be minimized, but expressed, to the patient (Woo & Robinson, 2016). Claudia should be encouraged to quit smoking, however, one option is an ultra-low dose pill (less than 20 mcg) such as Aviane. It is worth noting that most oral contraceptives today are what is considered low dose.