Peer 1 what options are appropriate for this patient    

1. Peer 1
What options are appropriate for this patient?
Margaret is a 40-year-old female smoker that has taken
oral contraceptives for the last twenty years and reports recent
marital problems; and she does not feel like she would need
birth control but probably should be on something just in case.
One of the first steps in determining what contraception to
prescribe is to exclude the methods that are contraindicated.
IUD with Levonorgestrel (Mirena) is one of the best choices for
patients over 35 years old and for patients who smoke cigarettes
(Woo, 2019). IUDs are not the only estrogen-free choice;
however, if the patient is not planning to become pregnant
within the next five years, this is a good choice because it
would be maintenance-free and confidential. The healthcare
provider inserts this IUD in an office setting. Other options for
progestin-only contraception are Depo-Provera injection every
three months, Implanon rods are implanted into the arm and last
for three years, and Progestin-only pills (POP) Micronor and
Nor-QD that are taken daily (Woo, 2019).
What contraceptive options are contraindicated?
Estrogen is contraindicated in patients over the age of
35 and those who smoke more than 15 cigarettes per day. Oral
contraceptive is generally not prescribed to smokers over 35
years of age (Woo, 2019).
What type of patient education is indicated?
Follow up appointment should be made with the
provider that inserted the IUD between 3 to 6 weeks to check
placement. Education will be provided on this contraception
method does not prevent STIs. Serious side effects of IUDs are

2. uterine perforation, expulsion, and uterine infection. The patient
should also contact the provider if she changes her mind and
wants to use different contraception.
Given that she has a normal pelvic exam, does that change
would that influence your decision?
A normal pelvic exam would make this a better choice
for this patient since the device will go through the cervix and
into the uterus. The cervix did not look irritated on the exam
and would have a better chance of placing the device without
any difficulties.
References
Lippincott Williams & Wilkins & Lippincott Williams &
Wilkins. (2021). Nursing2022 drug handbook(42nd ed.).
Wolters Kluwer Health.
Woo, T. M. (2019). Pharmacotherapeutics for advanced practice
nurse prescribers with 3-yr access to davis edge (5th ed.). F. A.
Davis Company.
Peer 2
Discussion 1:
1. What options are appropriate for this patient?
Margaret is a 40-year-old female that is under increases stress
and a smoker. Margaret meets criteria to take Progestin only
pills, IUD, implant or injection (CDC, 2016). Prior to starting
any hormonal contraceptives, it is good practice to rule out
pregnancy (Woo et al., 2020).
2. What contraceptive options are contraindicated?
Although Venous Thromboembolism (VTE) occurrence while
taking oral Contraceptive is low, her age and smoking history

3. places her in higher risk. Risk factors such as inherited clotting
disorders, strong family history of inherited clotting disorders,
being older than 35 years, smoking more than 10 cigarettes per
day, or obesity increase the risk 3 to 10 times (Woo et al.,
2020). According to the CDC 2016, a female older than 35 years
old that smokes more than 15 cigarettes a day is a category 4
(Unacceptable health risk, method not to be used) for CHC
(Combined Hormonal Contraceptives; pill, patch or ring) (CDC,
2016).
3. What type of patient education is indicated?
Smoking cessation is key for any patient, along with education
on the contraceptives she meets criteria for do not prevention
STI’s. F/u between 3 to 6 months if IUD is pt’s contraceptive
choice. Breakthrough bleeding frequently occurs in the initial
cycle of use of any Progestin only contraceptive (Woo et al.,
2020). Injection (Depo) is taken every 12 weeks with very
reliable efficacy. Women should not take Depo longer than 2
years consecutively due to loss of bone mineral density (Woo et
al., 2020).
4. Given that she has a normal pelvic exam, does that change
would that influence your decision?
A normal pelvic exam is important. If Margaret had a hx of PID
(Pelvic inflammatory disease) she would not meet criteria for
any IUD placement due to risk for STI’s. This is not in her
history, there are no changes in what contraceptives she is
eligible for.
Reference:
National Center for Chronic Disease Prevention and Health
Promotion. (2016). Summary chart of U.S. medical eligibility
criteria for ... CDC. Retrieved October 10, 2021, from
https://www.cdc.gov/reproductivehealth/contraception/pdf/sum
mary-chart-us-medical-eligibility-criteria_508tagged.pdf.
Woo, T. M., Wynne, A. L., & Robinson, M. V.
(2020). Pharmacotherapeutics for Advanced Practice Nurse
prescribers. F.A. Davis Company.