This essay is about Margaret who is a 40-year-old white female in for her annual examination. She states she has been under increase of stress in her life for the past few months. She and her husband are currently in separation and considering divorce. Her teenaged sons are acting out and she is working extra hours to make ends meet.
Margaret is a 40-year-old white female in for her annual examination.However, She states she has been under increased stress in her life for the past few months.Moreover, She and her husband are currently separated and considering divorce. Her teenaged sons are acting out and she is working extra hours to make ends meet. Secondary to the increased stress she has started smoking again, “about a pack per day” and states “I know that I am not eating right.”
. She states the she has heard that smoking and taking the pill are not good, and she is worried about that. “I really do not need birth control since I am separated but just in case I probably need something.” She states that she has been in a mutually monogamous relationship (as far as she knows) since her marriage 18 years ago. She denies a new partner since her separation. Menarche was at 11 years, her cycles when on the pill are regular and very light. Her menstrual period should start tomorrow as she just finished her active pills. She denies a personal history of abnormal Pap smears, gynecological issues, hypertension (HTN), or diabetes. She is G2P2002, and her pregnancies were full term and uncomplicated at ages 24 and 26.
Her paternal grandfather died at age 64 years from type 2 diabetes, HTN, and coronary artery disease. Her other grandparents died in their late 70s early 80s and she is unaware of any medical issues.
Margaret’s examination finds her height 5’5″, weight 172 lb (up 10 lb. from last year), current body mass index (BMI 28.6), and blood pressure (BP) 148/88. Head, eyes, ears, nose, and throat (HEENT) are grossly within normal limits (WNL). No thyromegaly or lymphadenopathy. Heart rate is regular and rhythm is without murmurs, thrills, or rubs. Lungs are clear to auscultation in all lobes. Breasts are without masses, nipple discharge, asymmetry, or lymphadenopathy; self breast examination techniques and frequency reviewed during examination. Abdomen is soft, nontender, with no masses or hepatosplenomegaly; bowel sounds present in all four quadrants.
vagina is pink, rugated, with minimal white nonodorous discharge; cervix is pink, multiparous os. Pap smear collected during speculum examination was normal. Bimanual examination reveals a retoverted, firm, mobile, nonenlarged, nontender uterus with negative cervical motion tenderness; adnexa nontender; and ovaries palpable bilaterally, mobile, without masses. Lower extremities were without edema or varicosities.
1.Firstly, What options are appropriate for this patient? 2. Secondly, What contraceptive options are contraindicated? 3.Thirdly, What type of patient education is to indicate? 4.Finally, Given that she has a normal pelvic exam, does that change would that influence your decision?