CHAPTER 12 WOMEN'S HEALTH DISORDERS CASE

STUDY 122

Case Study 122

INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information
that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and
you will need to rewrite it.

Scenario
You are working in a busy OB/GYN office, and the last patient of the day is P.B., a 36-year-old who is
planning to get married soon. She wants to use birth control but is not sure what to choose. Her fiancé is in
law school, and they do not have health insurance, so she is anxious not to get pregnant right away. She
asks you to review the various methods and help her explore what is best for her.

1. What past medical information will you need to ask P.B. about?

History of smoking, heart disease, diabetes, liver illness, irregularly shaped uterus,
undetected vaginal hemorrhage, infection, cystocele, rectocele, osteoporosis, and

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thrombophlebitis are all questions need to ask.

2. Are there any other conditions that would influence the choice of a contraceptive method?

Smoking, heart disease, diabetes, liver illness, irregularly shaped uterus, undetected
vaginal hemorrhage, infection, cystocele, rectocele, osteoporosis, and

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thrombophlebitis will all have an impact on the form of contraception chosen.

3. Is P.B. currently at risk for sexually transmitted disease (STDs)?

Yes so we need to get a sexual health history from P.B. in order to lower his chance
of getting a STD by asking if she used protection, how many previous partners she
had, we need also get this information from her fiancé, and we need to educate her
on how practice safe sex.

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.

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 4. What lifestyle information will help you assist P.B. in choosing an appropriate method for her?

We need to know if she can remember that she should take something on a daily
basis and what kind of contraception she should take. We also need to know what
she does on a daily basis.

5. P.B. asks you about the effectiveness rating of available birth control methods.
Categorize your response according to the following efficacy ratings: most effective
(more than 99%), highly effective (97% to 99%), and moderately effective (less than
90%).

Abstinence, transdermal patch, vaginal ring, combination oral contraceptives,

progestin-only tablets, injectable progesterone, intradermal implant, IUD, Mirena
IUD, female sterilization, male sterilization, and postcoital IUD are the most effective
birth control alternatives. Cyclebeads, basel body temperature, ovulation method,
symptothermal, two-day method, withdrawal, spermicide, male condoms, female
condoms, diaphragm, and postcoital pills are all highly effective options. Sponge and
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cervical cap are two moderately effective options.

6. P.B. asks you to explain the main advantages and disadvantages of the most
effective methods.

The main advantages of abstinence are it is acceptable to all religious groups and
that it is free or no cost and the main disadvantages are it requires a lot of motivation
and is highly unreliable. The main advantage of the transdermal patch is it is simple
to use and the main disadvantage is it may irritate the application or location site.
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The main advantage of the vaginal ring is it is simple to put on and the main
disadvantage is she may need a reminder to do so. The main advantage of
combination oral contraceptives is they are coitus-independent and the main
disadvantage is the ongoing cost. The main advantages of progestin-only pills are
coitus-independent and have no of the side effects associated with combination oral
contraceptives and the main disadvantage is they are expensive. The main advantage
of injectable progesterone is coitus independent and it lasts for 12 weeks and the
main disadvantages are it is expensive and requires frequent injections. The
intradermal implant's main advantages are it is coitus independent and it is
dependent for 5 years and the main disadvantages are the initial cost and the
appearance on the arm. The main advantages of an IUD are it does not require any
memory or motivation and the main disadvantages are cramping, bleeding, and the
risk of expulsion. The main advantages of female sterilization are it is permanent and
extremely reliable and the main disadvantages are the high initial cost and it is
irreversible. Male sterilization's main disadvantages are it is permanent and highly
reliable and the main disadvantages are the initial cost and it is irreversible. The main
advantages of the postcoital IUD are it can be inserted up to 5 days after unprotected
coitus and it can be left in place as a contraceptive measure and the main
disadvantages are it must be checked by a healthcare provider every 5 days after
unprotected coitus.
7. What are the main advantages and disadvantages of the contraceptive methods in the highly
effective category?

The main advantages of Cyclebeads are they are a visual aid that can improve
compliance and it is available as an Android or iPhone app; the main disadvantages
are the initial cost and the need to mark on a calendar that a bead was moved
rather than relying on memory. The cost of the thermometer is one of the main
advantages of basal body temperature and the main disadvantage is it requires
motivation and cooperation from the male partner. The main advantage of the
ovulation method is it is free however it does require motivation and cooperation
from the male partner. The main advantages of symptothermal are it is free and the
main disadvantages are it requires the male partner's motivation and cooperation.
The two-day method has main advantages including the fact that it is free and the
main disadvantage is it does require motivation and cooperation from the male
partner. The main advantages of withdrawal are it is a male-controlled method and
the main disadvantage is sperm may be present in pre-ejaculatory fluid. The main

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advantages of spermicide are it is simple to use and can be purchased over-the-
counter and the main disadvantages are it can cause an unpleasant vaginal
discharge. Male condoms have several advantages: they protect against STIs, the
male is responsible, and no prescription is required and the main disadvantage is it
requires interruption of sexual activity. The main advantage of female condoms is
they protect against STIs and the disadvantage is insertion can be difficult. The main
advantage of a diaphragm is it is simple to insert and the main disadvantages are it
requires a prescription and measurements to avoid toxic shock syndrome. The main

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advantage of postcoital pills is they are available over the counter and the main
disadvantage is they may cause nausea.

8. What about the moderately effective birth control methods? What are the main advantages
and disadvantages?

The main advantages of a sponge are it is simple to insert and it does not
require a prescription and the main disadvantages are it may cause leakage
and measurements are required to avoid toxic shock syndrome. A cervical cap's
main advantage is that it can be left in place for several days if desired and
the main disadvantages are it can be difficult to insert, irritate the cervix, and
measurements are required to avoid toxic shock syndrome.
 9. She wants to know about cost with each method because she will be on a tight budget,
with limited insurance coverage.

Abstinence, ovulation method, symptothermal, and two-day methods are among

the free methods. Some of the methods are available without a prescription over the
counter. Spermicide, female condoms, sponge, male condoms, and postcoital pills
are all options. Some of these may be the cheapest options depending on the
frequency of coitus. Pills, injections, implants, and sterilizations are among the most
expensive procedures. 

10. She asks you which method you would pick. What do you tell her?

I will tell her that I will choose the combination of oral contraceptives because she
will only take the contraceptive every day and it is easier than other contraceptives.
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It is more reliable than male or female condoms.

CASE STUDY PROGRESS

P.B. comes back in a week and tells you that she can get a low-cost oral contraceptive through a local store.
You convey this information to the nurse practitioner, who examines P.B. and writes a prescription for a
biphasic pill containing ethinyl estradiol and norethindrone. You are asked to discuss the use of the pill
with P.B.

11. What key factors should you address with P.B.?

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By thickening the vaginal fluid and preventing sperm from reaching the egg, the
biphasic pill prevents fertilization. Furthermore, these pills assist in the regulation of
periods, the reduction of blood loss, and the alleviation of painful periods. The
importance of continuing to take these pills as prescribed, because estrogen and
progestin levels vary by tablet, and pregnancy can occur if pills are missed, are key
factors to discuss with the client. In the event of vomiting or diarrhea, the pills may
not work as well as they should, necessitating the use of backup birth control
methods. In addition, the time of medication should be the same every day with a
24-hour difference. However, taking these pills after the evening meal may help in
controlling stomach upsets and nausea. The doctor should also address how to
switch from other birth control forms to the biphasic pill. Side effects of taking these
pills are also addressed, such as vomiting, nausea, bloating, headache, and weight
change. This medication may further caused a rise in blood pressure, and for that,
blood pressure is checked regularly. The client must take serious precaution
measures before taking this medication. A discussion with the client about his/her
medical history or any form of allergic reactions to estrogens or progestins to prevent
side effects.
 12. A few months later, P.B. calls the clinic because she realized she missed a dose of her
oral contraceptive. What will you tell her? (Select all that apply.)
a. “Take the missed pill now, along with today's pill, then resume the pack.”
b. “It is okay, you are still protected from pregnancy if you take two now.”
c. “Just throw that pill away; restart taking your pills tomorrow.”
d. “Please make an appointment so we can insert a temporary IUD.”
e. “Wait until the start of your next menses, then begin a new pack of pills.”
f. “You should use a backup form of contraception until you start your menses.”

Pillitteri, A. (2014). Maternal & child health nursing care of the childbearing & childrearing

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family. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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