Princess Levie Ceniza BSN 2A GROUP 1 CASE STUDY 120

SCENARIO

K.W. is an 18-year-old woman who comes to Planned Parenthood for a pregnancy test
because a con- dom 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, because their last intercourse was the night before and a woman’s ovulation is for
atleast 8 days so it wouldn’t be accurate if I am going to run a pregnancy test.

A pregnancy test will not be positive for a conception that occurred only the previous
evening. A pregnancytest detects human chorionic gonadotropin (HCG); a serum
HCG test can detect a pregnancy as soon as8 days postconception. A urine pregnancy
test can detect as little as 25 mIU of HCG, which can be detected as soon as 10 to 14
days postconception. A pregnancy test could be performed to rule out previous
pregnancy.
This is optional if the patient is a reliable historian and has had a normal period in the
past 30 days.

2. K.W. asks whether she is at risk for pregnancy. How will you respond?

Yes, she is. Throughout a woman's menstrual cycle, there is not a single day when the
statistical risk of pregnancy is zero. Given that this patient has a regular monthly cycle
28 to 30 days apart, she is likely to ovulate in the middle of her cycle, day 14 or 15 .
Because her unprotected intercourse is on day 13, her risk of pregnancy from even a
single act of coitus is high. Sperm are viable for about 72 hours, so if unprotected
intercourse occurred as much as 3 days before ovulation, there may be sperm in the
reproductive tract capable of fertilizing an egg.

3. She asks what contraceptive options are available to her at this point. How will you
answer?

Morning-after pill Plan B is 75 to 89% effective if taken within 72 hours after

unprotected intercourse.
The progestin only pill contains levonogrestel works by preventing the release of an
egg from the ovary or preventing fertilization of the egg by sperm (male reproductive
cells).

4. K.W.says,“Are you talking about having an abortion?” Formulate a response

No. All types of EC work by preventing or delaying what has not yet occurred in the
series of events leading up to an established pregnancy. They can prevent or delay
ovulation or prevent fertilization. However, EC may prevent implantation of a
fertilized egg, which some persons find objectionable. No EC disrupts or harms an
established pregnancy.

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?

Plan B and ELLA

If taken within 72 hours, Ella is still 42% more effective than Plan B. Emergency
contraceptives always work best the sooner you take them. However, Ella can
work five days after unprotected sex, while Plan B only works three days after
unprotected sex.ELLA’s efficacy is about 1-2% higher than Plan B's and this
advantage is maintained throughout the 5-day timeframe after unprotected sex. One
very important thing to note: ella is more effective than Plan B for people with BMIs
greater than 25; it can work for people whose BMIs reach up to 35.
Take ella as soon as you can within five days (120 hours) after you have unprotected
sex. Simply swallow the tablet the way you would any other pill.

Contraceptive pills containing estrogen and progesterone

Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and
progestin are two female sex hormones. Combinations of estrogen and progestin work
by preventing ovulation (the release of eggs from the ovaries). They also change the
lining of the uterus (womb) to prevent pregnancy from developing and change the
mucus at the cervix (opening of the uterus) to prevent sperm (male reproductive cells)
from entering. Oral contraceptives are a very effective method of birth control, but
they do not prevent the spread of human immunodeficiency virus (HIV, the virus that
causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted
diseases.
The copper intrauterine device, or IUD
Is a long-term, reversible contraceptive first introduced by Howard Tatum and Jamie
Zipper in 1967. Health care providers place an IUD inside a woman’s uterus to
prevent pregnancy. Copper IUDs are typically made of T-shaped plastic with some
portion covered with exposed copper. Prior to the invention of the first IUDs, women
had few long-term options for safe and reliable birth control. Those options mostly
consisted of barrier methods and the oral birth control pill, which were only effective
if used correctly and consistently. For women seeking to control their fertility, a
copper IUD was one of the first forms of long-term birth control that was highly
effective and did not require consistent and regular action on the woman’s part to
remain effective.

6. She asks you about side effects. What will you tell her?

- Plan B is available in generic form. Common side effects of Plan B include: nausea,
vomiting, abdominal or stomach pain, tiredness, dizziness.
People who take Ella may also experience a disruption or delay in their period, says
Fitzgerald. But not everyone is going to react to the pill the same way. For others, Ella
may not impact their period at all.

- Oral contraceptives may cause side effects. Tell your doctor if any of these
symptoms are severe or do not go away:
 nausea
 vomiting
 stomach cramps or bloating
 diarrhea
 constipation
 gingivitis (swelling of the gum tissue)
 increased or decreased appetite
 weight gain or weight loss
 brown or black skin patches
 acne
 hair growth in unusual places
 bleeding or spotting between menstrual periods
 changes in menstrual flow
 painful or missed periods
 breast tenderness, enlargement, or discharge
 swelling, redness, irritation, burning, or itching of the vagina
 white vaginal discharge

- Other hormonal IUD side effects can include:

Pain when the IUD is put in, and cramping or back aches for a few days after

spotting between periods
 irregular periods

These usually go away within 3–6 months, once your body gets used to the new
visitor in your uterus. And they don’t happen to everyone — many people use
hormonal IUDs with no problems at all.

7. What past medical information will you need to ask K.W. about?

Past Medical History

Smoking History
Alcohol
Sexual Activity
Family History

8. K.W. has no contraindications to the use of hormones. Which of the previous

methods of EC will you offer this patient?

Pregestin because it help prevent pregnancy. It is effective up to 72 hours and

after unprotected intercourse and it is available over the counter, no restriction
nor prescriptions needed.

9. How will you counsel K.W.?

Safe sex.
Be in control
Talk with your partner
Know how to protect yourself
Keep yourself healthy
Be selective when you choose a sex partner
Risks, benefits, alternative
Methods of contraception
Give information