Marquez, Caren Joy B.

Case Study 120

SCENARIO
K.W. is an 18-year-old woman who comes to Planned Parenthood for a pregnancy test because a
condom broke during intercourse the night before. Her last menstrual period (LMP) was 13 days ago and
was normal. She always has a monthly menstrual cycle. She is extremely nervous about pregnancy
because she is beginning college on a scholarship soon. She states there have been no other acts of
unprotected intercourse since her LMP. She did take oral contraceptives briefly in the past but
discontinued use because of weight gain and mood swings.

1. As the nurse working in the clinic, should you run a pregnancy test?
No. It is too early to detect pregnancy. K.W. had her menstrual period 13 days ago and it was normal.
For the best accurate result, the patient should wait until the week following her missed menstruation
to take a pregnancy test. If she doesn’t want to wait till her period is missed, wait at least one to two
weeks after she had intercourse. If she is pregnant, it takes time for her body to produce measurable
quantities of HCG. If she takes the test too early in her cycle, she can get an inaccurate result.

2. K.W. asks whether she is at risk for pregnancy. How will you respond?
Yes. Any woman who is having intercourse is at risk for pregnancy. Ovulation usually occurs 11-21 days
after your last period. Therefore, you may be pregnant, but you cannot take a pregnancy test until at
least a week after your missed period. If you have unprotected sex, you need to know how a pregnancy
test works, when to take a pregnancy test, and what the signs and symptoms of pregnancy are. It is also
advisable to get tested for STIs.

3. She asks what contraceptive options are available to her at this point. How will you answer?
Emergency contraception is a way to prevent pregnancy after unprotected sex.
 Emergency contraceptive pills (ECPs), often called "morning after” pill, can be taken up to 120 hours
or 5 days after having unprotected sex. It works by delaying ovulation or the release of an egg during
the monthly cycle. You don’t need to wait until morning to take ECPs. You should take them as soon
as possible after unprotected intercourse. The sooner you take it, the better it will work.
 The intrauterine device (IUD) is a small, T-shaped plastic device that is placed into your womb
(uterus) by a healthcare professional. It releases copper to stop fertilization. To prevent pregnancy
after unprotected sex, the IUD can be inserted up to five days after the earliest time you could have
ovulated or released an egg.

4. K.W. says, “Are you talking about having an abortion?” Formulate a response.
No. Emergency contraception pills work by preventing or delaying possible pregnancy, delay ovulation
or fertilization and implantation of fertilized egg. The morning-after pill and the abortion pill are not the
same thing. The morning-after pill does not result in a miscarriage. If you're already pregnant, it won't
work, but it won't hurt your baby. Birth control, not abortion, is the goal of emergency contraception
(including the IUD). It does not result in a pregnancy; rather, it prevents one.
CASE STUDY PROGRESS
There are three emergency contraceptive (EC) options: Plan B and ELLA, contraceptive pills containing
estrogen and progesterone, and the copper intrauterine device (IUD).

5. She asks you to explain the differences among the various options. What will you tell her?
The “morning after pill” is a popular name for hormonal emergency contraception. It is the most
commonly used emergency contraceptive method. It reduces the risk of pregnancy by up to 95%,
according to Planned Parenthood. Hormonal emergency contraception options include: Plan B and ELLA.
 Plan B is a pill with levonorgestrel, a synthetic progestin similar to the hormone progesterone, which
the body makes to regulate the menstrual cycle. Most drugstores and pharmacies sell this over-the-
counter without a prescription. This must be taken within 72 hours of sex that was not protected.
Levonorgestrel morning-after tablets may not work if you weigh 155 pounds or more because those
with a BMI of 30 or higher had a considerably lower level of levonorgestrel in their bloodstream
than people with a BMI of 18.5 to 25. Plan B One-Step usually costs about $40-$50.
 ELLA is a pill with ulipristal acetate. One single, oral dose that should be taken within five days of
unprotected intercourse. You can use ella for up to 120 hours (five days) following unprotected
intercourse, but it's ideal if you take it right away. Ella is more effective than Plan B, regardless of
when it is taken. To buy ella emergency contraception, you'll need a prescription from a nurse or
doctor. If you weigh more than 195 pounds, ella may not work as well for you. Ella generally costs
$50 or more at the pharmacy or drugstore, but if you have health insurance, it's usually free.
Do not use two different types of morning-after pills (such as Plan B and ella) at the same time or within
five days of each other, as they may interfere with each other's effectiveness.
 Copper Intrauterine Device (IUD) is the most effective method of contraception in an emergency.
The copper IUD is effective on day one as it does on day five. No matter how much you weigh, the
copper IUD works just as well. Because you require an appointment with a nurse or doctor to put
the copper IUD in, it can be difficult to get within five days. Because sperm does not like copper,
the IUD prevents conception for up to five days following unprotected sex. As a result, the copper in
the IUD makes it difficult for sperm to reach your egg. An IUD can cost anywhere from $0 to $1300.
That's a big range, but the good news is that many health insurance policies cover IUDs for free or at
a modest cost. Even though an IUD is expensive up front, it usually saves you money in the long run
because it provides effective birth control for up to 12 years.

6. She asks you about side effects. What will you tell her?
Common side effects of hormonal emergency contraception include:
 nausea
 abdominal pain
 unexpected bleeding or spotting, sometimes up until your next period
 fatigue
 headache
 dizziness
 vomiting
 breast tenderness
Common side effects of copper IUD insertion include:
 discomfort during insertion
 cramping
 spotting, and heavier periods
 dizziness

7. What past medical information will you need to ask K.W. about?
 Menstrual history (Last menstrual period (LMP), Cycle length and frequency - eg, 5/28, 5 days of
bleeding every 28 days, Heaviness of bleeding)
 Contraceptive history (use of contraception, any recent unprotected intercourse, reliability of
method and user, potential contra-indications to different methods)
 Medical and surgical history (past diseases, surgeries, injuries)
 Psychosocial history (how the person interacts with others, employment, finances, education,
religion, stress and support network, including friends and family)
 Health history (gather subjective data from the patient so that the health care team and the patient
can collaboratively create a plan that will promote health, address acute health problems, and
minimize chronic health conditions.)
 Family health history (can identify people with higher chance of inheriting genetic disorders)

8. K.W. has no contraindications to the use of hormones. Which of the previous methods of EC will
you offer this patient?
I would recommend Plan B since this type of morning-after pill works best when taken within 72 hours
(3 days) of unprotected sex, and can be taken up to five days later. It is also the easiest to purchase
because it is available over the counter with no restrictions or prescriptions required.

9. How will you counsel K.W.?

Practice safe sex. Unsafe sex can put you or your partner at risk for sexually transmitted infections (STIs)
like chlamydia, gonorrhoea, syphilis, Mycoplasma genitalium, HIV, or hepatitis B, as well as an
unintended pregnancy. Inform yourself about contraceptive techniques and discuss with your
healthcare practitioner to avoid an unintended pregnancy. If you are sexually active, your doctor may
discuss STIs and your risk of contracting or transmitting an infection with you. These conversations will
teach you about sexually transmitted infections (STIs) and the necessity of getting screened and treated
if you do have one. They'll also assist you in developing skills that can help you lower your chances of
contracting a STI. These skills include wearing condoms correctly and consistently, discussing safe sex
with partners, problem-solving, and making goals. It is important to prioritize your sexual health.
References:
Better Health Channel. (2018). Safe sex. Retrieved from
https://www.betterhealth.vic.gov.au/health/healthyliving/safe-sex#other-tips-for-safer-sex
Danylchenko, Y. (2020). Yes, Plan B Has a Weight Limit — Here’s What It Means for You. Retrieved from
https://www.healthline.com/health/healthy-sex/plan-b-weight-limit#why-it-happens
Healthline Media a Red Ventures Company. (2017). When You Should Take a Pregnancy Test. Retrieved
from https://www.healthline.com/health/pregnancy/five-signs-to-take-pregnancy-test#when-
to-test
Hirsch, L. (2021). Emergency Contraception. Neumors Children Health. Retrieved from
https://kidshealth.org/en/teens/contraception-emergency.html
NHS. (2018). Emergency contraception (morning after pill, IUD). Retrieved from
https://www.nhs.uk/conditions/contraception/emergency-contraception/
Planned Parenthood. (n.d.) Which kind of emergency contraception should I use? Retrieved from
https://www.plannedparenthood.org/learn/morning-after-pill-emergency-
contraception/which-kind-emergency-contraception-should-i-use
U.S. Preventive Services Task Force. (2014). Behavioral Counseling Interventions to Prevent Sexually
Transmitted Infections. Retrieved from
https://www.uspreventiveservicestaskforce.org/home/getfilebytoken/Ef6gKK24buSrsGfJhnAYKk