Elaine Goodwin is a 38-year-old G1P1LC1presenting to your clinic today to discuss contraceptive options.She states that she is not interested in having more children but her new partner has never fathered a child.Her medical history is remarkable for exercise-induced asthma,seizure disorder (her last seizurewas five years ago),and IBS.Her surgical history remarkable only for tonsils as a child.Her social history is negative for alcohol, tobacco, and recreational drugs.She has no known drugallergies andtakesLamictal (lamotrigine) and Trileptal (oxcarbazepine).Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceaseddue to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell).Elaine has one older sister with no medical problems and one younger brother with no reported medical problems. Height 5 7Weight148(BMI 23.1), BP 118/72 P 68 HEENT: wnl Neck: supple without adenopathy Lungs/CV: wnl Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge Abd: soft, +BS, no tenderness VVBSU: wnl, except 1stdegree cystocele Cervix: firm, smooth, parous, without CMT Uterus: RV, mobile, non-tender, approximately8cm, Adnexa: without masses or tendernessQUESTION:What other information do you need?MORE QUESTIONS:1. What has she used in the past? Why did she stop a method? How many partners in past 12 months?2. What are her current cycles like?3. When was her last gyn exam and what were the results ofthe tests?4. What method has she considered.Elaine relates to you that she has used birth control pills before but would keep messing them up.She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is the one.Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day shemustuse a super tampon every hour and get up to changeher pad 2-3 times at night.Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal.The resultsfor the pap wereNILM, HPV negative, and her cultures forGC/CT were negative.She has heard aboutanimplant that is put in yourarm,buther sister had itand she bled all the time.QUESTIONS:;What are your next steps/considerations?;What teaching should you do?What methods would be appropriate for Elaine?your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.
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