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Exam (elaborations)

NR 508 Week 2 Discussion Thread 1

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NR 508 Week 2 Discussion Thread 1

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Week 2: Discussion
2 2 unread replies. 2 2 replies.
Claudia is a 26-year-old mother of two G2P2, she recently delivered her last child 9
months ago, and has been using condoms for birth control for the last 7 months. Today
she is requesting a more reliable birth control, she is not sure of her current pregnancy
plans, however, she does not wish to discuss sterilization. No religious contraindications
for treatment. Previous methods include condoms, and oral contraceptive pills.
PMH: positive for mild hypertension with first pregnancy, seasonal allergies.
Surgeries: Right inguinal hernia and tonsillectomy.
Family history: Mother HTN and Father colon CA both living
Social History: Denies tobacco use, wine one to two glasses a week, denies
recreational drugs, exercises twice a week.
Drug allergies-Sulfa causes a rash. Current medications-MVI with Fe, Calcium chews,
prn Allegra for allergies. Height 65 inches, weight 137 pounds, BP 110/75, P 70, R 16.
PAP collected today, breast exam WNL, urine pregnancy negative.
Physical exam is normal.

 What are your treatment goals for Claudia today?

 What are two possible contraceptive methods for Claudia? Please give brief
rationale for each.

 Pick one method and list five (5) patient-centered teaching points for the method
you chose today.

 What would your contraceptive choice be if Claudia smoked 10-15 cigarettes per
day? Explain your answer.


Dr. Hall and class,

Treatment goals for Claudia include finding an appropriate form of pregnancy

prevention. There are different forms of contraception including: intrauterine device (IUD),

progestin-only pills, implants, and injectables (Loewenberg Weisband, Keder, Keim, & Gallo,

2017). Knowing that Claudia has been using condoms for the past 7 months, it is important to

ask her what her preference is and what form of birth control she may want to use. It is noted



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, that Claudia used oral contraceptives in the past, but it doesn’t investigate further. Birth control

contains hormones and the side effects of these hormones may be less than appeasing like weight

gain, mood swings, or bleeding which leads to women discontinuing the contraception (Stevens,

2016). As Claudia has a 9-month old, it is important to consider if she is breastfeeding.

Progesterone only pill is an appropriate method of contraception as it seems to be okay to use 6

weeks after delivery and has not be shown to affect lactation or infant growth and development

(Garad, McNamee, Bateson, & Harvey, 2012). The downfall to this medication is that it needs to

be taken at the same time everyday and if not, then it is important to utilize another contraceptive

measure such as condoms for the next 7 days. This may be difficult for Claudia as her sleep

wake cycle with three children may be out of kilt and the purpose was to find a more reliable

method of pregnancy prevention. The other safe form of contraception is the IUD. An IUD is

classified as long-acting reversible contraception and is effective immediately after insertion.

Some IUDs may be used for up to 10 years (Dole & Martin, 2017).

IUD- 5 Teaching points as found in an article by Dole & Martin (2017):

1. There are no effects on lactation.
2. As soon as the device is inserted, it will work to prevent pregnancies.
3. As soon as the device is removed, the ability to carry a baby will return.
4. It is 80% effective in preventing pregnancies.
5. If it is a copper containing IUD, it may last up to 10 years.
6. Cost effective compared to implant or a live birth.

Although the IUD sounds like a great method, Claudia needs to be informed about the risks, too.

Risk include uterine perforation, pain, postpartum infection, and dysmenorrhea. Her bleeding

pattern may change, and taper form a heavy to normal flow over 6 months. However, this is a

reliable method and she should have worry free intercourse in relation to becoming pregnant.




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