Adeline, a 24-year-old graduate student presents to her Family Medicine Clinic for contraceptive counseling. She and her fiancé, Josh, are planning to be married in approximately 3 months, but they’re not ready for kids just yet. Adeline states that they have been in a monogamous sexual relationship for the past 2 years; their primary method of contraception was inconsistent use of male condoms. She is here today to be evaluated for the use of hormonal contraceptives. The patient states she began menses at age 14, with irregular cycles of 25–36 days in length. Her last menses was 2 weeks ago. The patient states she has heard about contraceptive options that “keep you from having a period,” and she wants to know more about those options, and if they would be okay for her to try. She has a history of migraine headaches without aura or focal neurologic symptoms, but it is well controlled for the past 6 months on prophylactic therapy. Her mother is 52 years old, has HTN and osteoporosis. Her grandmother died from complications of breast cancer, which was diagnosed at age 60. Her father is 53 years old, has osteoarthritis, hypothyroidism, and hyperlipidemia. While her grandfather died at age 74 due to MI. She currently lives in a house on campus, which she rents with three other graduate students. Once she and Fritz are married, they plan to rent an apartment together until she finishes graduate school. She admits to occasional social use of tobacco and alcohol (“a few drinks and a couple of cigarettes at parties on the weekends”). Otherwise, she denies regular smoking or alcohol use during the week, and she denies illicit drug abuse. Medications: Propranolol LA 160 mg PO once daily for migraine prophylaxis Naproxen 220 mg, one to two tablets PO Q 8 h PRN menstrual cramps Allergies:  NKDA ROS: Patient states she has not had a migraine for more than 6 months; however, prior to being placed on propranolol for migraine prophylaxis, she reported experiencing menstrual-related headaches in addition to frequent migraines.   Physical Examination: Gen: WDWN female in NAD VS: BP 116/74, P 66, RR 14, T 37°C; Wt 56 kg, Ht 5'6'' Skin: Mild facial acne Breasts: Equal in size without nodularity or masses, nontender Abd: Soft, NT, no masses or organomegaly Genit/Rect: Normal vaginal exam w/o tenderness or masses   Laboratory Tests Negative Pap smear and UPT   Impression Young, generally healthy, sexually active female with history of migraine headache disorder that has been well controlled with prophylactic medication is requesting hormonal contraceptives for birth control. Question: What medical problems are relative contraindications to hormonal contraceptive use, and do any of these apply to this patient?

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
icon
Related questions
Question

Adeline, a 24-year-old graduate student presents to her Family Medicine Clinic for contraceptive counseling. She and her fiancé, Josh, are planning to be married in approximately 3 months, but they’re not ready for kids just yet. Adeline states that they have been in a monogamous sexual relationship for the past 2 years; their primary method of contraception was inconsistent use of male condoms. She is here today to be evaluated for the use of hormonal contraceptives. The patient states she began menses at age 14, with irregular cycles of 25–36 days in length. Her last menses was 2 weeks ago. The patient states she has heard about contraceptive options that “keep you from having a period,” and she wants to know more about those options, and if they would be okay for her to try.

She has a history of migraine headaches without aura or focal neurologic symptoms, but it is well controlled for the past 6 months on prophylactic therapy.

Her mother is 52 years old, has HTN and osteoporosis. Her grandmother died from complications of breast cancer, which was diagnosed at age 60. Her father is 53 years old, has osteoarthritis, hypothyroidism, and hyperlipidemia. While her grandfather died at age 74 due to MI. She currently lives in a house on campus, which she rents with three other graduate students. Once she and Fritz are married, they plan to rent an apartment together until she finishes graduate school. She admits to occasional social use of tobacco and alcohol (“a few drinks and a couple of cigarettes at parties on the weekends”). Otherwise, she denies regular smoking or alcohol use during the week, and she denies illicit drug abuse.

Medications:

Propranolol LA 160 mg PO once daily for migraine prophylaxis

Naproxen 220 mg, one to two tablets PO Q 8 h PRN menstrual cramps

Allergies:  NKDA

ROS:

Patient states she has not had a migraine for more than 6 months; however, prior to being placed on propranolol for migraine prophylaxis, she reported experiencing menstrual-related headaches in addition to frequent migraines.

 

Physical Examination:

Gen: WDWN female in NAD

VS: BP 116/74, P 66, RR 14, T 37°C; Wt 56 kg, Ht 5'6''

Skin: Mild facial acne

Breasts: Equal in size without nodularity or masses, nontender

Abd: Soft, NT, no masses or organomegaly

Genit/Rect: Normal vaginal exam w/o tenderness or masses

 

Laboratory Tests

Negative Pap smear and UPT

 

Impression

Young, generally healthy, sexually active female with history of migraine headache disorder that has been well controlled with prophylactic medication is requesting hormonal contraceptives for birth control.

Question:

What medical problems are relative contraindications to hormonal contraceptive use, and do any of these apply to this patient?

Expert Solution
steps

Step by step

Solved in 3 steps

Blurred answer
Similar questions
  • SEE MORE QUESTIONS
Recommended textbooks for you
Phlebotomy Essentials
Phlebotomy Essentials
Nursing
ISBN:
9781451194524
Author:
Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:
JONES+BARTLETT PUBLISHERS, INC.
Gould's Pathophysiology for the Health Profession…
Gould's Pathophysiology for the Health Profession…
Nursing
ISBN:
9780323414425
Author:
Robert J Hubert BS
Publisher:
Saunders
Fundamentals Of Nursing
Fundamentals Of Nursing
Nursing
ISBN:
9781496362179
Author:
Taylor, Carol (carol R.), LYNN, Pamela (pamela Barbara), Bartlett, Jennifer L.
Publisher:
Wolters Kluwer,
Fundamentals of Nursing, 9e
Fundamentals of Nursing, 9e
Nursing
ISBN:
9780323327404
Author:
Patricia A. Potter RN MSN PhD FAAN, Anne Griffin Perry RN EdD FAAN, Patricia Stockert RN BSN MS PhD, Amy Hall RN BSN MS PhD CNE
Publisher:
Elsevier Science
Study Guide for Gould's Pathophysiology for the H…
Study Guide for Gould's Pathophysiology for the H…
Nursing
ISBN:
9780323414142
Author:
Hubert BS, Robert J; VanMeter PhD, Karin C.
Publisher:
Saunders
Issues and Ethics in the Helping Professions (Min…
Issues and Ethics in the Helping Professions (Min…
Nursing
ISBN:
9781337406291
Author:
Gerald Corey, Marianne Schneider Corey, Cindy Corey
Publisher:
Cengage Learning