Recоrdings: sоurces tо look for, reseаrch. Identify 25 of the "must hаve" oboe recordings for а library (yours, your students', or your school libraries if you have a college teaching job)
HPI: Eliniа is а 24 y/о F whо presents fоr discussion of pregnаncy prevention methods. She presents because she has a new partner of 4 months with whom she is now sexually active and would like to know her pregnancy prevention options. She desires no pregnancy for at least 5 years. She denies any prior pregnancy. She reports her LMP was 3 weeks ago. She denies any unusual vaginal bleeding or discharge. No reported dysuria, hematuria, or change in urinary frequency reported. She denies any unusual or atypical symptoms currently. She reports that she has never been on oral birth control previously, noting that her mom wouldn’t let when she was younger. Pt reported taking a pregnancy test this morning, which was negative, and was last sexually active 10 days ago with contraceptive use at that time. Medications: Escitalopram 10 mg PO daily Zyrtec 10 mg PO PRN daily during allergy season Allergies: NKDA Seasonal allergies only (tree pollen) Past Medical History: Chronic conditions: Anxiety (diagnosed in 2020) Surgeries: Appendectomy (2013) Tonsillectomy (2009) Immunizations: Pt opted out of HPV vaccine. Otherwise, she is up-to-date on recommended, age-appropriate vaccines including COVID, influenza, Tdap. OB-GYN Hx: Menarche 14 yrs old. G0P0. History of chlamydia cervicitis in 2019 and again in 2021, treated to resolution on both occasions. Normal pap smears up to present, with most recent pap smear being last year. Menstrual periods reported to be 27-29 days in length normally. No reported interval bleeding between periods within the last few years. No prior mammogram reported. Family History: Father: alive, 59 years old. Known hx of hypertension, CKD Mother: passed away at 45 years old. Known hx of HTN (since age 40). Passed away from complications of recurrent pulmonary embolisms first diagnosed at age 32. She had a hx of DVT, as well. Sister: alive, age 29, reported history of DVT (at age 28) on blood thinners since diagnosis. Reports that her sister also had a spontaneous abortion at age 26 at approximately 16 weeks’ gestation (in her second trimester). Children: none Social History: Tobacco/Vape: Pt reports use of cigarettes or vape daily, typically for stress relief. Pt reports prior to vaping more recently, that she smoked 1/2 pack of cigarettes per day for the past 4-5 years. Alcohol: Drinks 3-5 glasses of red wine or mixed drinks on Friday or Saturday nights each week. Illicit drugs: Pt reports using THC-based edible gummies as a sleep aid but denies other drug use. Marital/Sexual: Pt is not married but notes recently entering into a new sexual relationship with her new boyfriend of 4 months. Living situation: Lives with her friend in a rental home just outside Pacific Beach Job: Tech industry sales Hobbies: Sailing, pickleball, soccer Diet: Pescatarian diet Religion: Baptist Sleep: Averages 6-7 hours of sleep per night ROS: Constitutional: Denies fever, chills, night sweats, unintentional weight loss or weight gain recently. Skin: Denies hair loss, nail pitting, rashes, lesions, or skin discoloration. HEENT: Denies rhinitis, sore throat, congestion, ear pain or discharge, eye pain or change in vision, headache. Denies hearing loss, tinnitus, or nasal discharge. No lymph node or gland swelling reported. CV/PV: Denies chest pain or tightness, palpitations, swelling or edema of lower extremities. No syncope or presyncope reported. Pulmonary: Denies shortness of breath, coughing, wheezing, dyspnea, orthopnea, or pain with inspiration. GI: Denies constipation, diarrhea, abdominal pain or distention, nausea or vomiting. No blood in stool or dark stools reported. GU: Denies dysuria, urinary frequency, urgency, or hematuria. Denies urinary incontinence. No unusual vaginal bleeding or discharge. MSK: Denies trauma, joint swelling or joint pain, arthralgias or myalgias. Neuro: Denies headache, dizziness or lightheadedness, dysarthria, slurred speech, or weakness. Denies seizures, tremors, or confusion. No other weakness observed. Psych: Denies depression, mania, suicidal ideation, homicidal ideation or hallucinations. Endocrine: Denies heat or cold intolerance, polyuria, polydipsia, or polyphagia. Heme/Lymph: Denies easy bruising or bleeding. (A.) Given the provided history above, please identify 10 (ten) aspects of this patient’s history that could affect the choice of contraception for this patient. (15 points) [PLO 1] (B.) For each aspect of the patient’s history provided, please identify at least one (1) reason why you have listed that item. For each item that you choose to list, please detail how that item would affect the treatment plan or selection of treatment. Note: Do not use the same reasoning more than once when answering part B of this question. (15 pts)
HPI: Eliniа is а 24 y/о F whо presents fоr discussion of pregnаncy prevention methods. She presents because she has a new partner of 4 months with whom she is now sexually active and would like to know her pregnancy prevention options. She desires no pregnancy for at least 5 years. She denies any prior pregnancy. She reports her LMP was 3 weeks ago. She denies any unusual vaginal bleeding or discharge. No reported dysuria, hematuria, or change in urinary frequency reported. She denies any unusual or atypical symptoms currently. She reports that she has never been on oral birth control previously, noting that her mom wouldn’t let when she was younger. Pt reported taking a pregnancy test this morning, which was negative, and was last sexually active 10 days ago with contraceptive use at that time. Medications: Escitalopram 10 mg PO daily Zyrtec 10 mg PO PRN daily during allergy season Allergies: NKDA Seasonal allergies only (tree pollen) Past Medical History: Chronic conditions: Anxiety (diagnosed in 2020) Surgeries: Appendectomy (2013) Tonsillectomy (2009) Immunizations: Pt opted out of HPV vaccine. Otherwise, she is up-to-date on recommended, age-appropriate vaccines including COVID, influenza, Tdap. OB-GYN Hx: G0P0. History of chlamydia cervicitis in 2019 and again in 2021, treated to resolution on both occasions. Normal pap smears up to present, with most recent pap smear being last year. Menstrual periods reported to be 27-29 days in length normally. No reported interval bleeding between periods within the last few years. No prior mammogram reported. Family History: Father: alive, 59 years old. Known hx of hypertension, CKD Mother: passed away at 45 years old. Known hx of HTN (since age 40). Passed away from complications of recurrent pulmonary embolisms first diagnosed at age 32. She had a hx of DVT, as well. Sister: alive, age 29, reported history of DVT (at age 28) on blood thinners since diagnosis. Reports that her sister also had a spontaneous abortion at age 26 at approximately 16 weeks’ gestation (in her second trimester). Children: none Social History: Tobacco/Vape: Pt reports use of cigarettes or vape daily, typically for stress relief. Pt reports prior to vaping more recently, that she smoked 1/2 pack of cigarettes per day for the past 4-5 years. Alcohol: Drinks 3-5 glasses of red wine or mixed drinks on Friday or Saturday nights each week. Illicit drugs: Pt reports using THC-based edible gummies as a sleep aid but denies other drug use. Marital/Sexual: Pt is not married but notes recently entering into a new sexual relationship with her new boyfriend of 4 months. Living situation: Lives with her friend in a rental home just outside Pacific Beach Job: Tech industry sales Hobbies: Sailing, pickleball, soccer Diet: Pescatarian diet Religion: Baptist Sleep: Averages 6-7 hours of sleep per night ROS: Constitutional: Denies fever, chills, night sweats, unintentional weight loss or weight gain recently. Skin: Denies hair loss, nail pitting, rashes, lesions, or skin discoloration. HEENT: Denies rhinitis, sore throat, congestion, ear pain or discharge, eye pain or change in vision, headache. Denies hearing loss, tinnitus, or nasal discharge. No lymph node or gland swelling reported. CV/PV: Denies chest pain or tightness, palpitations, swelling or edema of lower extremities. No syncope or presyncope reported. Pulmonary: Denies shortness of breath, coughing, wheezing, dyspnea, orthopnea, or pain with inspiration. GI: Denies constipation, diarrhea, abdominal pain or distention, nausea or vomiting. No blood in stool or dark stools reported. GU: Denies dysuria, urinary frequency, urgency, or hematuria. Denies urinary incontinence. No unusual vaginal bleeding or discharge. MSK: Denies trauma, joint swelling or joint pain, arthralgias or myalgias. Neuro: Denies headache, dizziness or lightheadedness, dysarthria, slurred speech, or weakness. Denies seizures, tremors, or confusion. No other weakness observed. Psych: Denies depression, mania, suicidal ideation, homicidal ideation or hallucinations. Endocrine: Denies heat or cold intolerance, polyuria, polydipsia, or polyphagia. Heme/Lymph: Denies easy bruising or bleeding. Based on your review of this patient’s case, please provide 4 (four) contraceptive methods that can be recommended safely for this patient. (12 pts) [PLO 4] Then, please provide one pro and one con for each of the recommended contraceptive methods. (8 pts) Lastly, for each of the 4 (four) recommended contraceptive methods, please provide the pertinent patient education for each recommendation. (22 pts)