Case Study #1

Directions

Read and analyze this case study individually. When others in your group have finished reading it, answer the questions. When all the groups have finished, we will discuss the case study and the answers each group developed.

Case Study

The client is a 19-year-old mother of two, the younger of which is 9 months old. Her last pregnancy was a difficult one and she does not want another child for several years. She came to the clinic 2 months ago and after initial counseling decided to use oral contraceptives as her family planning method.

She has now returned to the clinic complaining of spotting and nausea since she began taking her first packet of pills. She is very worried that she is losing too much blood from the spotting and she is also losing weight because she isn’t eating due to the nausea. She is thinking about switching to another method.

Questions

1. What are the possible causes of her spotting and nausea?

2. What else do you need to know to identify the cause of her spotting and nausea? What questions would you ask her and what examinations would you perform?

3. Finding no other causes, what would you tell her about spotting and nausea and use of COCs?

4. How would you manage this client?

5. If the client decides she would prefer to use another family planning method, which one(s) may be appropriate for her? Why?

Case Study #2

Directions

Read and analyze this case study individually. When others in your group have finished reading it, answer the questions. When all the groups have finished, we will discuss the case study and the answers each group developed.

Case Study

The client is a 31-year-old mother of five. While she is not certain that she has all the children she wants, she does know that she in not interested in having another child for at least several years. She is frightened of injections and her husband does not like to use condoms. She has heard that COCs are easy to use and effective; she’d like to give them a try.

You conduct some basic screening and obtain the following information: BP 140/90; she was diagnosed with tuberculosis 8 months ago; she smokes 6–8 cigarettes a day, you observe mild varicosities on both lower legs.

Questions

1. What other information do you need to obtain in order to assess whether COCs are the best choice for her?

2. The rest of the client’s history and assessment do not reveal any precautions for COC use. Are COCs an appropriate choice for this client? Why or why not?

3. IF she does use COCs, what counseling and information does she need?

4. If COCs are not an appropriate choice, what other method(s) might be? Why?

Case Study #3

Directions

Read and analyze this case study individually. When others in your group have finished reading it, answer the questions. When all the groups have finished, we will discuss the case study and the answers each group developed.

Case Study

The client is 22 years old and has one child. She began taking COCs 3 months ago when her baby was 6 months old and she began introducing foods other than breastmilk. She had not yet had a period when she started COCs, but she experienced a menses with the first two packets of pills. In the first couple of months of taking the COCs she had some difficulty remembering to take a pill every day. Once she missed more than 1 day before she remembered to start taking them again.

She has now returned to the clinic very worried because she has missed a period, her breasts are tender and full, and she fears she may be pregnant.

Questions

1. What are the possible causes of her symptoms?

2. What other information do you need to identify the actual cause? What questions would you ask? What examinations do you need to do?

3. How would you manage this client? What information and counseling does she need if she:

   • is pregnant?

   • is not pregnant?

4. How might this situation have been avoided?

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