Elaine relates to you that she has used birth control pills before but “would keep messing them up.

please note the underlined info below.

Case Study: Contraception

Scenario 3

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options. She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol and tobacco; she reports daily marijuana use. She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad had a history of skin cancer (basal cell). Elaine has one older sister with endometriosis who was told not to have more children because she had blood clots when she was pregnant with her second child. She also has one younger brother with no reported medical problems.

  • Height 5’ 7” Weight 148 (BMI 23.1)   BP 118/72 P 68
  • HEENT:  wnl
  • Neck: supple without adenopathy
  • Lungs/CV: wnl
  • Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
  • Abd: soft, +BS, no tenderness
  • VVBSU: wnl,
  • Cervix: firm, smooth, parous, without CMT
  • Uterus: mid, mobile, non-tender, approximately 8 cm,
  • Adnexa: without masses or tenderness

QUESTION:

What other information do you need?

Elaine relates to you that she has used birth control pills before but “would keep messing them up.”  After that she switched to the patch, which she found worked well but discontinued use for reasons she does not remember. After that she used natural family planning but still conceived her last two children unexpectedly.  She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”

Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative.

In further questioning, you ask her about her sister’s blood clots and her father’s PE.  She shares that her father was 48 years old and “just died one day.” Her sister was on “shots” for her blood clots and then took a pill. She had some blood test done and they said she had something called heterozygous MTHFR and Factor V Leiden.

She has heard about a pill where she will only get her period four times a year and feels now that she’s older she can remember to take the pill daily and plans on putting a reminder in her phone.

QUESTIONS: 

  1. What are your next steps/considerations?
  2. What teaching should you do?
  3. What other information do you need?

Here are the instructions

Case Study Discussion: Gynecologic Health

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, diagnostic approaches, as well as the development of treatment plans.

Photo Credit: Teodor Lazarev / Adobe Stock

For this Case Study Discussion, you will review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.

To prepare:

  • By Day 1 of this week, you will be assigned to a specific case study scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your case study assignment from your Instructor.
  • Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
  • Carefully review the clinical guideline resources specific to your assigned case study.
  • Use the Focused SOAP Note Template found in the Learning Resources to support Discussion.

By Day 3

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests then,

Post your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.

Read a selection of your colleagues’ responses.

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    Discussion3.docx
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    Episodicsoapnote.docx