Nursing Discussion Questions
Margaret has various options available. First, she can opt for an intrauterine device (IUD) that is levonorgestrel-releasing or even copper-containing. According to Klein, Arnold, and Reese (2015), the age of the patient often determines the eligibility category of a particular contraceptive method. The intrauterine device is appropriate considering that the woman is 40 years old.
In addition, the patient has recently started smoking a pack every day. For those who smoke, intrauterine devices fall into the first eligibility category that implies that there is no restriction of their use (Curtis et al., 2016). The patient can also opt for contraceptive implants. They avert pregnancy through the release of progestogen in the woman's body. The contraceptive method is appropriate for this particular patient because a contraceptive implant is found to fall into the first eligibility category. As such, it is not restricted even for patients who smoke.
Another contraceptive alternative that the patient can use is depot medroxyprogesterone acetate (DMPA). According to Curtis et al. (2016), it is recommended for persons aged 18-45 years and falls into eligibility category 1, which suggests that no restrictions exist regarding the use of this method for those within this age bracket. The current patient is aged 40 years, which means that she falls within the age group mentioned above. In addition, DMPA applies to patients aged 35 years who smoke more than 15 cigarettes every day (Curtis et al., 2016). As already noted, Margaret smokes one pack of cigarettes every day. The patient can also opt for condoms or even diaphragms/cervical caps.
Some contraceptive options may be contraindicated for this patient. First, it is a vaginal ring considering that Margaret is above 35 years and a current smoker. According to Klein et al. (2015), using estrogen-containing contraceptives increases the risk of developing cardiovascular diseases for smokers above this age. Their use is particularly discouraged among those who smoke more than 15 cigarettes every day. The vaginal ring is contraindicated because it involves the release of estrogen alongside progesterone. A combined pill is also contraindicated for this patient considering that this contraceptive method entails the use of estrogen together with progesterone.
The former hormone is detrimental to the health of patients above 35 years because it can cause cardiovascular or thromboembolic events in such patients (Klein et al. 2015). A contraceptive patch is also contraindicated for Margaret because this contraceptive method is not appropriate for smokers aged above 35 years. In addition, combined hormonal contraceptives that often comprise the vaginal ring, combined oral contraceptives, and hormonal patches can cause unacceptable health risks for this patient (Curtis et al., 2016).
As already noted, Margaret has multiple risk factors that include smoking, advancing age, and hypertension. These conditions predispose her to cardiovascular diseases, with the use of combined hormonal contraceptives increasing this possibility to unacceptable levels.
The type of patient education that is indicated for Margaret involves an appropriate method to address contraception needs. It should address misinformation about contraception options and focus on the benefits and risks of the selected contraceptive method. Indicated patient education should also address medication side effects and efficacy, including whether the chosen contraceptive method contributes to the prevention of HIV/AIDS and STIs or not.
It should focus on effects on the menstrual pattern and bleeding (Kaunitz, 2017). Patient education should involve supportive care services available to the patient.
The presence of a normal pelvic exam influences certain decisions. For example, it suggests the absence of pelvic inflammatory disease. As such, this influences the decision to suspend IUD placement up to the time when the patient receives appropriate treatment (Klein et al., 2015). However, a normal pelvic exam does not affect decisions regarding the use of oral contraceptives.
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