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Case Study
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Nursing: Elaine's Contraceptions

Case Study Instructions:

PLEASE DO NOT ACCEPT THIS ASSIGNMENT UNTIL YOU ARE AN OBGYN WRITER. YOU WILL NOT BE ABLE TO DO THIS PAPER UNLESS YOU ARE. PLEASE REMEMBER TO HAVE CITATIONS in the writing and also a REFEFRENCE PAGE.
Case Study: Contraception
Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options. She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol and tobacco; she reports daily marijuana use. She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with endometriosis who was told not to have more children because she had blood clots when she was pregnant with her second child. She also has one younger brother with no reported medical problems. 
• Height 5’ 7” Weight 148 (BMI 23.1)   BP 118/72 P 68 
• HEENT:  wnl 
• Neck: supple without adenopathy 
• Lungs/CV: wnl 
• Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge 
• Abd: soft, +BS, no tenderness 
• VVBSU: wnl,  
• Cervix: firm, smooth, parous, without CMT 
• Uterus: mid, mobile, non-tender, approximately 8 cm, 
• Adnexa: without masses or tenderness 

QUESTION:

What other information do you need? 


Elaine relates to you that she has used birth control pills before but “would keep messing them up.”  After that she switched to the patch, which she found worked well but discontinued use for reasons she does not remember. After that she used natural family planning but still conceived her last two children unexpectedly.  She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”   

Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative. 

In further questioning, you ask her about her sister’s blood clots and her father’s PE.  She shares that her father was 48 years old and “just died one day.” Her sister was on “shots” for her blood clots and then took a pill. She had some blood test done and they said she had something called heterozygous MTHFR and Factor V Leiden. 

She has heard about a pill where she will only get her period four times a year and feels now that she’s older she can remember to take the pill daily and plans on putting a reminder in her phone. 

QUESTIONS: 

1. What are your next steps/considerations? 
2. What teaching should you do? 

RESOURCES
Name at least3 differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples.
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones and Bartlett Publishers.
• Chapter 8, “Women’s Health After Bariatric Surgery” (pp. 151 – 159)
Agency for Healthcare Research and Quality (AHRQ). Intimate partner violence screening: Fact sheet and resources. https://www(dot)ahrq(dot)gov/ncepcr/tools/healthier-pregnancy/fact-sheets/partner-violence.html
Fanslow, J., Wise, M. R., & Marriott, J. (2019). Intimate partner violence and women’s reproductive health. Obstetrics, Gynaecology & Reproductive Medicine, 29(12), 342–350. https://doi-org(dot)ezp(dot)waldenulibrary(dot)org/10.1016/j.ogrm.2019.09.003
Lockwood, C. J. (2019). Key points for today’s ‘well-woman’ exam: A guide for ob/gyns. Contemporary OB/GYN, 64(1), 23–29. https://ezp(dot)waldenulibrary(dot)org/login?url=https://search(dot)ebscohost(dot)com/login.aspx?direct=true&db=rzh&AN=134229869&site=eds-live&scope=site
Clinical Guideline Resources
American College of Obstetricians and Gynecologists (ACOG). (2020). https://www(dot)acog(dot)org/
American Cancer Society, Inc. (ACS). (2020). Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin. https://www(dot)cancer(dot)org/
American Nurses Association (ANA). (n.d.). https://www(dot)nursingworld(dot)org/
Centers for Disease Control and Prevention. (CDC). (n.d.). https://www(dot)cdc(dot)gov/
HealthyPeople 2030. (2020). Healthy People 2030 Framework. https://www(dot)healthypeople(dot)gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
Kelly K. G. (1990). Chapter 179: Tests on vaginal discharge. In: Walker H. K., Hall W.D., & Hurst J.W., (eds.). Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.). https://www(dot)ncbi(dot)nlm(dot)nih(dot)gov/books/NBK288/
Note: This chapter is considered Seminal to this week’s topics.
The American Association of Nurse Practitioners (AANP). What’s happening at your association. (2020). https://www(dot)aanp(dot)org/

Case Study Sample Content Preview:

Case Study: Contraception
Student Name
Institutional Affiliation
Case Study: Contraception
Elaine Goodwin is a patient who is at risk of various contraception-related complications.
1.
Information required is on complete blood count to identify the risk of anemia associated with heavy menstrual bleeding. There is an increased risk factor for thromboembolism in Elaine Goodwin, as shown by her sister, who had blood clots, and her father, who died due to pulmonary embolism. Her sister’s tests demonstrate the presence of Factor V Leiden and MTHFR mutations, which reflect a combined risk factor for hypercoagulability. According to Ehsani, Imani, & Moravveji (2018), venous thrombosis's risk factors are often linked to hypercoagulability, which can be genetic or acquired, or and venous stasis. The authors cite critical genetic biomarkers of polymorphisms and mutations in the genes that code Factor V Leiden and methylenetetrahydrofolate reductase.
Both factor V Leiden and MTHFR C677T polymorphisms are linked to recurrent pregnancy loss (RPL) (Jusić et al.,2018)); this could probably indicate the loss of pregnancy in Elaine’s sister was due to mutations of these factors. Thus, there is a need to get information on Factor V Leiden and MTHFR in Elaine Goodwin through diagnostic testing. GenoFlow Thrombophilia Array Test Kit can do this test to detect mutations in Factor V Leiden and MTHFR (Aytekin et al.,2014). It must be noted that the use of contraception may aggravate this risk for thromboembolism if this patient is found to have genetic markers that illustrate mutations in the genes coding for Factor V Leiden and methylenetetrahydrofolate reductase (MTHFR).
2.
The differential diagnosis of excessive uterine bleeding is quite broad. Thus, it requires in-depth medical history and examinations to rule out some disorders. The causes of uterine bleeding are broad, including disorders affecting the reproductive system and non-gynecologic reasons. Menorrhagia, or abnormal uterine bleeding, has nine categories of causative factors represented by the PALM-COEIN acronym with two primary classes, i.e., abnormal uterine bleeding (AUB) structural and non-structural causes (Walker & Borger, 2019). These nine factors include polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia, coagulopathy, ovulatory dysfunction due to hypothyroidism, hyperthyroidism, prolactin-secreting tumors, PCOS, endometrial factors, Iatrogenic causes such IUDs, chemotherapeutic agents, anticoagulants, and factors not yet classified (Walker & Borger, 2019). For instance, fibroids or polyps constitute another possible cause of menorrhagia (Kolhe, 2018). Fibroid can be identified via pelvic or abdominal ultrasound or an MRI, and polyps can be diagnosed using a Hysterosalpingogram, to mention a few diagnostic approaches. Elaine Godwin has prolonged menstrual bleeding lasting 5-8 days marked by heavy bleeding on some occasions, where she uses super tampon each hour and 2-3 pads during a night. Heavy menstrual bleeding is arbitrarily defined as a menstrual blood loss of 80 ml or greater or more (Sriprasert et al.,2017). Excessive menstrual bleeding can lead to anemia. Anemia can be assessed via complete blood count. Howeve...
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