Contraception Case Study

Contraception Case Study

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?

According to Pillitteri (2014), we need to ask about a history of smoking, valvular

m
er as
heart disease, diabetes, liver disease, retroflexed or irregular shaped uterus,

co
undiagnosed vaginal bleeding, infection, cystocele, rectocele, osteoporosis,

eH w
thrombophlebitis, or polycystic ovarian syndrome. The following information

o.
should also be obtained: vital signs, possibly a pap smear, pregnancy test,
rs e
gonococcal and chlamydial screening, and perhaps hemoglobin for detection of
ou urc
anemia; obstetric history, including STIs, past pregnancies, previous elective
abortions, failure of previously used methods, and compliance history with
o

previously used methods; subjective assessment of the client’s desires, needs,

aC s

feelings, and understanding of conception; sexual practices, such as frequency,

vi y re

number of partners, feelings about sex, and body image (Pillitteri, 2014).

2. Are there any other conditions that would influence the choice of a
ed d

contraceptive method?
ar stu

The conditions of smoking, valvular heart disease, diabetes, liver disease,

retroflexed or irregular shaped uterus, undiagnosed vaginal bleeding, infection,
cystocele, rectocele, osteoporosis, or thrombophlebitis will influence the choice of a
is

contraceptive method (Pillitteri, 2014). Her current financial and lifestyle situations
Th

also will also influence her decision of contraceptive method. As of right now, they
don’t have any insurance, so that may really narrow down their options.
sh

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

Everyone is at risk for STDs, and in order to decrease P.B.’s risk for contracting a
sexually transmitted disease, we need to obtain a sexual health history from P.B.
(Pillitteri, 2014). We need to know if she used protection, how many previous

This study source was downloaded by 100000823755904 from CourseHero.com on 08-31-2021 03:16:26 GMT -05:00

https://www.coursehero.com/file/22134397/contraceptive-case-study/
 partners she has had, and if they were monogamous relationships; this information
also should be obtained from her fiancé as well (Pillitteri, 2014). We also need to
educate her on how to practice safe sex (Pillitteri, 2014).

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

We need to know about her daily routine and lifestyle. We need to find out if she
would be able to remember to take something every day, if she would be able to
take it at the same time every day, and does she have a preference for what kind of
contraception she would like to use. We also need to know about her health habits,
like diet and exercise.

5. P.B. asks you about the effectiveness rating of available birth control

m
er as
methods. Categorize your response according to the following efficacy ratings:

co
most effective (more than 99%), highly effective (97% to 99%), and moderately

eH w
effective (less than 90%).

o.
rs e
Birth control options that are the most effective include abstinence, transdermal
ou urc
patch, vaginal ring, combination oral contraceptives, progestin-only pills, injectable
progesterone, intradermal implant, IUD, Mirena IUD, female sterilization, male
sterilization, and postcoital IUD (Pillitteri, 2014). Options that are highly effective
o

include Cyclebeads, basel body temperature, ovulation method, symptothermal,

aC s

two-day method, withdrawal, spermicide, male condoms, female condoms,

vi y re

diaphragm, and postcoital pills (Pillitteri, 2014). Options that are moderately
effective include sponge and cervical cap (Pillitteri, 2014).
ed d

6. P.B. asks you to explain the main advantages and disadvantages of the most
ar stu

effective methods.

The main advantages of abstinence is it’s acceptable to all religious groups and it
is

has no cost; the main disadvantages are it requires high motivation and periods of
Th

abstinence (Pillitteri, 2014). The main advantages of the transdermal patch is it’s
easy to apply; the main disadvantages are it may cause irritation at the location site
(Pillitteri, 2014). The main advantages of the vaginal ring is it’s easy to insert; the
sh

main disadvantages are she may need a reminder to insert it (Pillitteri, 2014). The
main advantages of combination oral contraceptives is coitus independent; the
main disadvantages are continual cost and possible side effect of thrombophlebitis
(Pillitteri, 2014). The main advantages of progestin-only pills are coitus independent
and no side effects of combination oral contraceptives; the main disadvantages is

This study source was downloaded by 100000823755904 from CourseHero.com on 08-31-2021 03:16:26 GMT -05:00

https://www.coursehero.com/file/22134397/contraceptive-case-study/
 its continual cost (Pillitteri, 2014). The main advantages of injectable progesterone
are coitus independent and it’s dependable for 12 weeks; the main disadvantages
are continual cost and continual injections (Pillitteri, 2014). The main advantages of
the intradermal implant are coitus independent and it’s dependent for 5 years; the
main disadvantages are the initial cost and its appearance on the arm (Pillitteri,
2014). The main advantages of an IUD are no memory or motivation needed; the
main disadvantages are cramping, bleeding, and the possibility of expulsion
(Pillitteri, 2014). The main advantages or Mirena IUD are no memory or motivation
needed; the main disadvantages are cramping, bleeding, and the possibility of
expulsion (Pillitteri, 2014). The main advantages of female sterilization are
permanent and highly reliable; the main disadvantages are the initial cost and it is
irreversible (Pillitteri, 2014). The main disadvantages of male sterilization are
permanent and highly reliable; the main disadvantages are the initial cost and it is

m
irreversible (Pillitteri, 2014). The main advantages of the postcoital IUD are it can be

er as
inserted up to 5 days after unprotected coitus and it can be left in place as a

co
contraceptive measure; the main disadvantages are the need to visit a healthcare

eH w
provider as needed within 5 days of unprotected coitus (Pillitteri, 2014).

o.
7. rs e
What are the main advantages and disadvantages of the contraceptive
ou urc
methods in the highly effective category?
o

The main advantages of Cyclebeads are visual aid can improve compliance and
aC s

it is available as an iPhone app; the main disadvantages are the initial cost and
vi y re

there may be a need to mark on a calendar that a bead was moved and not rely on
memory (Pillitteri, 2014). The main advantages of basel body temperature is the
cost of the thermometer; the main disadvantages are it requires motivation and
ed d

cooperation by the mail partner (Pillitteri, 2014). The main advantages of ovulation
ar stu

method is it has no cost; the main disadvantages are it requires motivation and
cooperation from male partner (Pillitteri, 2014). The main advantages of
symptothermal are it has no cost; the main disadvantages are it requires
is

motivation and cooperation from the male partner (Pillitteri, 2014). The main
advantages of the two-day method are it has no cost; the main disadvantages are it
Th

requires motivation and cooperation from the male partner (Pillitteri, 2014). The
main advantages of withdrawal are it is a male controlled method; the main
disadvantages are sperm may be present in pre-ejaculatory fluid (Pillitteri, 2014).
sh

The main advantages of spermicide are it is easy to use and is sold over the
counter; the main disadvantages are it may leave an annoying vaginal discharge
(Pillitteri, 2014). The main advantages of male condoms are they protect against
STIs, the male is responsible, and no prescription is necessary; the main

This study source was downloaded by 100000823755904 from CourseHero.com on 08-31-2021 03:16:26 GMT -05:00

https://www.coursehero.com/file/22134397/contraceptive-case-study/
 disadvantages are it requires interruption of sexual activity (Pillitteri, 2014). The
main advantages of female condoms are they protect against STIs; the main
disadvantage is insertion may be difficult (Pillitteri, 2014). The main advantage of a
diaphragm is it’s easy to insert; the main disadvantages are a prescription is needed
and measurements are necessary to avoid toxic shock syndrome (Pillitteri, 2014).
The main advantage of postcoital pills is they can be purchased over the counter;
the main disadvantage is they may cause nausea (Pillitteri, 2014).

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

The main advantages of a sponge are it’s easy to insert and there is no
prescription needed; the main disadvantages are it may cause leakage and
measurements are necessary to avoid toxic shock syndrome (Pillitteri, 2014). The

m
er as
main advantage of a cervical cap is it can be left in place for several days if desired;

co
the main disadvantages are it may be difficult to insert, can irritate the cervix, and

eH w
measurements are necessary to avoid toxic shock syndrome (Pillitteri, 2014).

o.
9. rs e
She wants to know about cost with each method because she will be on a
ou urc
tight budget, with limited insurance coverage.

A few methods are free, and these include abstinence, ovulation method,
o

symptothermal, and two-day method. Some of the methods are able to be

aC s

obtained over the counter without a prescription. These options are spermicide,
vi y re

male condoms, female condoms, sponge, and postcoital pills. Depending on

frequency of coitus, some of these may be the cheapest options. Pills, injections,
implants, and sterilizations reach the higher end of the price scale. Birth control can
ed d

be obtained for free from Planned Parenthood.

ar stu

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

I would tell her that I would choose combination oral contraceptives because
Th

they are taken daily at the same time every day, and I would find that easiest and
least invasive. They would be more dependable that just a male or female condom
and easier to try and keep up with then abstinence, Cyclebeads, basel body
sh

temperature, or ovulation.
Preusser, B. A. (2009). Winningham and Preusser’s critical thinking cases in
nursing (4th ed.). St. Louis, MO: Mosby Elsevier

This study source was downloaded by 100000823755904 from CourseHero.com on 08-31-2021 03:16:26 GMT -05:00

https://www.coursehero.com/file/22134397/contraceptive-case-study/
 References

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

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

m
er as
co
eH w
o.
rs e
ou urc
o
aC s
vi y re
ed d
ar stu
is
Th
sh

This study source was downloaded by 100000823755904 from CourseHero.com on 08-31-2021 03:16:26 GMT -05:00

https://www.coursehero.com/file/22134397/contraceptive-case-study/
Powered by TCPDF (www.tcpdf.org)