1. What options are appropriate for this patient?
After reviewing Margaret’s objective and subjective data she has different options for
contraception other than the pill. Since she is smoking again it is important to explore other
options than the pill Depo-Provera is a progestogen only contraception method. The depo
injection contains only progestin and is long acting. The shot is only needed every three months.
It has a 99% effectiveness of preventing pregnancy (Woo, 2015). Another birth control option
for Margaret is an IUD. There are different kinds of IUDs that can be used. There is a non-
hormonal option a copper IUD. Mirena is another IUD that does contain only progestin. The
IUD devices are inserted into the uterus and are more than 99% effective at preventing
pregnancy (Woo, 2015). Non-hormonal options of birth control include spermicides, sponges,
diaphragms, cervical caps, and condoms.
2. What contraceptive options are contraindicated?
Patients have increased risk of venous thromboembolism and cardiovascular disease
when using combined oral contraceptives while smoking. Smoking and the patient being over 35
years old increases the risk of stroke and MI while using oral contraceptives. This patient needs
strong education regarding smoking cessation (Woo, 2015).
3. What type of patient education is indicated?
This patient needs education regarding lifestyle changes. She needs to be heavily
educated regarding smoking cessation as this can increase her risk of cardiovascular disease,
stroke, and cancer. She also needs to be educated regarding starting a healthy diet and exercise
plan. Ways to manage and deal with stress is another improtant education topic for this patient.
Margaret also should be educated regarding all of her birth control options and safe sex practices
even though she is not sexually active at this time.
4. Given that she has a normal pelvic exam, does that change would that influence your decision?
Margarets normal exam would not influence my decision to change the form of
contraception that is used. I would just provide the patient education regarding all contraceptive
options so that she can make an informed decision. Like previously stated that patient needs to
be educated not only on birth control methods but safe sex practices.
Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse
prescribers (4th ed.). [South University]. Retrieved from
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