Week 3 Discussion Forum

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Maria, 49-year-old female, annual exam.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. 

In your peer replies, please reply to at least one peer who chose a different case study.

1. Jill is a 24-year-old female G1 P0.  She had a surgical pregnancy termination at seven weeks EGA at the age of 18.  She is sexually active in a mutually monogamous relationship with her male partner of three months and has engaged in unprotected vaginal intercourse. She and her partner have been practicing coitus interruptus, but now desire a more effective form of birth control.  She has tried the combination birth control pill in the past, but had difficulty remembering to take it every day and became pregnant at age 18. She reports no adverse symptoms during her prior pill use and reports no current medical conditions and no other surgical history, but she takes St. John’s Wort daily because she heard from a friend that it helps to improve mood.  She denies a  history of depression and she is not currently depressed. Her LMP was two days ago. Her VS are all WNL. She is 5’6” and weighs 135 lbs.

• Review the WHO Medical Eligibility Criteria and Contraceptive Use and select an appropriate BCM (select between Depo Provera, Ortho Evra, Nuva Ring, or IUD) for Jill.
• Describe any possible side effects, possible warning signs, and contraindications associated with the selected BCM.

Please refer to evidence-based guidelines to support your decision-making.

2. Maryis a 35-year-old G3P3 who wants to use an IUD as her method of birth control (BCM).  She reveals that she has heavy menses lasting for up to 7 days each cycle and suffers from endometriosis.  She asks for advice on which IUD you would suggest. Her BMI is 24 and all VS are WNL.  She just finished her menses two days ago and has not had any intercourse since before her menses began and her partner has been consistently using condoms.  She has no contraindications for IUD insertion.

• Describe the IUD options for Mary, explaining the mechanism of action (MOA) for each, length of use, possible side effects, and danger signs, as well as correct and consistent use of her selected method. 
• Describe your plan of care for Mary along with your rationale.

Please refer to evidence-based guidelines to support your decision-making.

3. Veronica, a 25-year-old nulligravida woman presents for birth control needs. Her last physical was 2 years ago, and she thinks everything was okay since she did not get a phone call to return to the clinic. She has had 3 partners in her lifetime. She and her boyfriend of 6 months use condoms but not consistently. Her LMP was 3 weeks ago. She tells you that she has used birth control pills in the past but finds it difficult to remember taking them. Her physical exam is normal, BP 110/70, height 5′ 5″, weight is 135, and urine pregnancy test is negative.

• What procedures and/or lab tests will you order at this time?
• What birth control method would you offer and what patient education will you provide?

Please refer to evidence-based guidelines to support your decision-making.