Case Study 122

Name: Mary Joy S. Franco

Class/Group Date BSN 2D/ 10/07/21
Group Members
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?
Patient’s medical reproductive and contraceptive history
Physical exam, general medical information
Gynaecological exam
Routine diagnostic testing

2. Are there any other conditions that would influence the choice of a contraceptive method?
Relationship factors, including marital status, number of sexual partners, how often she
have sex and partner preferences. Religious beliefs. Differences between birth control
methods, including how effective they are at preventing pregnancy, side effects, cost and
whether they prevent sexually transmitted infections.
3. Is P.B. currently at risk for sexually transmitted infections (STIs)?
Most everyone is at risk for STD. only abstinence provides total protection. Monogamous
relationship, if both partners are faithful, reduces the risk. The use of female and male
condoms is very effective in preventing STD.

4. What lifestyle information will help you assist P.B. in choosing an appropriate method for
her?
Does she think she can remember to take a pill at the same time every day—that is, does
she have a consistent schedule? Does she think she would remember to change a patch
on a weekly basis? Does she think she would remember to change a ring on a monthly
basis? Would she be able to go to her health care provider's office for an injection on a
monthly or quarterly basis? Does she feel comfortable with a method that requires
 touching her genital area? If a method interrupts lovemaking, would she remain
motivated to use it?

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%).

• The most effective methods are abstinence, sterilization, injectables, implants and IUDs. These
are all more than 99.7% effective. That means that if 1000 women are using these methods, 3 or
fewer per 1000 will become pregnant during the first year.
• The highly effective category includes pills. These are all typically 97% to 99% effective.
• Barriers such as the cervical cap, diaphragm, condoms (both male and female), natural family
planning, withdrawal (coitus interruptus); and spermicides are all moderately effective, with
rates around 80%.

6. P.B. asks you to explain the main advantages and disadvantages of the most effective
methods.
 Sterilization (vasectomy and tubal ligation) is an operative procedure that permanently
prevents fertilization.
 Neither procedure affects sexual function. Risks are those related to surgery: bleeding,
infection, and reaction to anesthesia.
 Vasectomy is done with local anesthetic, can be performed in the office, and is
significantly cheaper than a tubal ligation.
 Tubal ligation is performed with the patient under regional or general anesthesia in
inpatient surgical suite.

7. What are the main advantages and disadvantages of the contraceptive methods in the
highly effective category?

The pill (estrogen and progestin) - failure rate is less than 1 in a 100 users per year, less than 8 in
100 is more typical, rates as highly effective at about 62_99% effective.. The three month pill
(Sesonale) - failure rate is less than 1 in 100 users per year, it is too new for typical statistics,
rates as highly effective at about 99%. The patch (Ortho Evra) - failure rate is less than 1 in 100
users per year, it is too new too new for typical statistics, rates as highly effective at about 99%..
The mini pill (progestin only) - failure rate is less than 1 in a 100 users per year, is more than 8 in
100 is more typical, rates as highly effective at about 92-99% effective.
Implantable progestin (Implanon) - research to date shows that no pregnancies have occurred
using this method, rated as most effective at more than 99%. Injection (Devprovera) - failure rate
is less than 1 in 100 users per year, less than 3 in 100 is more typical, and rates as highly effective
at 97-99%.
 8.What about the moderately effective birth control methods? What are the main advantages
and disadvantages?
1. cervical cap
A:It does not affect future fertility for either the woman or the man. It is used only at the time of
sexual intercourse. It is safe to use while breastfeeding. It is less expensive than hormonal
methods of birth control.
D: The cervical cap is more difficult for women to learn to insert and remove than the
diaphragm. If worn for more than two days (48 hours), you run the risk of toxic shock syndrome
or unpleasant vaginal odor and discharge.
2. Diaphragm
A:you only need to use a diaphragm or cap when you want to have sex. you can put it in at a
convenient time before having sex (use extra spermicide if you have it in for more than 3
hours) there are usually no serious associated health risks or side effects.
D: it's not as effective as other types of contraception, and it depends on you remembering to
use it and using it correctly.
 it does not provide reliable protection against STIs.
 it can take time to learn how to use it.
 putting it in can interrupt sex.
3. condoms (both male and female)
A:When used correctly and consistently, they are a reliable method of preventing pregnancy and
protecting both partners from STIs, including chlamydia, gonorrhoea and HIV.
D:Some people are embarrassed to use condoms or feel they may interrupt foreplay or
intercourse. Both partners must be comfortable with using a condom and be prepared to use
one every time they have sex. Condoms may decrease sexual sensation. Some people are allergic
to latex (rubber).
4. natural family planning
A:most women can use them, provided properly trained by a teacher in fertility awareness and
keep accurate records. You do not need any further help from a healthcare provider once you
have learnt how to use them.
D:Natural family planning does not protect against STIs such as chlamydia or HIV. You'll need to
avoid sex, or use contraception such as condoms, during the time you might get pregnant, which
some couples can find difficult.
5. withdrawal (coitus interruptus)
A:Advantages include immediate availability, no devices, no cost, no chemical involvement, and a
theoretical reduced risk of transmission of sexually transmitted diseases (STDs).
D:Aside from the risk of not withdrawing in time, the other major disadvantage regarding coitus
interruptus as a contraceptive involves the pre-ejaculatory fluid that appears after the penis
becomes erect; a few drops of semen, containing sperm, may be deposited into the vagina
without the knowledge of either partner.
6. Spermicides
A: are easy to use;
 don’t require a prescription;
 do not affect the menstrual cycle; and
  increase lubrication during sex.
D: do not provide protection from sexually transmitted infections (STIs);
 are not considered an effective form of contraception when used alone;
 may produce side effects such as vaginal or penile irritation;
 may increase the risk of developing urinary tract infections (UTIs);
 must be applied at the correct time, and reapplied with subsequent sex acts; and
 must remain in place for 6-8 hours after ejaculation to make sure all sperm are killed.

9. She wants to know about cost with each method because she will be on a tight budget, with
limited insurance coverage.
 Most, but not all, insurance companies cover prescription contraceptives and
procedures. Some Methods available over the counter (OTC) are not covered by
insurance.
 Natural family planning and withdrawal are free. In all states, federal money is available
to assist low-income women in obtaining contraceptive care. Contact local agencies to
determine where this funding is available in your area.

10. She asks you which method you would pick. What do you tell her?
 This is her decision, so it is important she find the right fit for her lifestyle, medical profile,
and preferences.
 Ask her questions such as,
 1. "What attributes in a contraceptive are most important to
 you?"
 2. "What side effects could you tolerate, and which would you not want?"
 3. "What role does your partner want to play in preventing pregnancy?“

CASE STUDY PROGRESS

CASE
CC

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.?

Explain how OC pills work.
Biphasic pills vary the amount of estrogen, progestin, or both over the active pill days in an
attempt to mimic the normal menstrual cycle and minimize side effects.

Show her a pill package and explain how to use it. OCs can be started one of three ways:
1) Same-day start: She starts that day. A backup method of birth control (e.g., condoms,
spermicides, diaphragm, abstinence) is recommended during the first week of initial use.
2) First-day start: She can start within 24 hours of the onset of her menses.
3) Sunday start: She starts on the first Sunday after the menses begins. Backup contraception for
7 days is necessary if menses did not begin on a Sunday. The only advantages of the traditional
Sunday start are avoidance of periods on the weekend and convenience, in that many
manufacturers label the first pill in a pack as a "Sunday" pill.

12. A few months later, K.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
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.”