Assignment Instructions

Margaret is a 40-year-old white female for her annual examination.

Margaret is a 40-year-old white female in for her annual examination. She states she has been under increased stress in her life for the past few months. She and her husband are currently separated and considering divorce.

Margaret is a 40-year-old white female for her annual examination

Guidelines: Support your responses with scholarly academic references using APA style format. Assigned course reading and online library resources are preferred. Weekly lecture notes are designed as overviews to the topic for the respective week and should not serve as a citation or reference.

In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and also examples; demonstrates a clear connection to the readings
In your participation responses to your peers, comments must demonstrate thorough analysis of postings and extend meaningful discussion by building on previous postings.

Note: Review South University’s Substantive Participation Policy Criteria, Helpful Tips, ad Late Policy available by clicking on the South University Policy and Guidelines navigation tab. The late policy applies to late discussion question responses.

Discussion 1:

Margaret is a 40-year-old white female in for her annual examination. She states she has been under increased stress in her life for the past few months. 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 also states “I know that I am not eating right.”

Margaret has been on the “pill” for almost 20 years and has always liked the method. She states the she has heard that smoking and taking the pill are not good, and she is worry 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 also her pregnancies were full term and uncomplicated at ages 24 and 26. Family history is significant for both parents with HTN and mom has type 2 diabetes.

Her paternal grandfather died at age 64 years from type 2 diabetes, HTN, and also coronary artery disease. Her other grandparents died in their late 70s early 80s and she is unaware of any medical issues.

Assessment:

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 also 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. Pelvic examination reveals normal vulva and negative Bartholin’s and Skene’s glands; 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 also ovaries palpable bilaterally, mobile, without masses. Lower extremities were without edema or varicosities.

Firstly, what options are appropriate for this patient?

Secondly, what contraceptive options are contraindicate d?

Thirdly, what type of patient education is indicate d?

Finally, given that she has a normal pelvic exam, does that change would that influence your decision?

 

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