Running head: Family Planning 1

Family Planning Case Study

Sierra Todd

East Tennessee State University

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 Family Planning 2

Family Planning Case Study

Family planning is defined as the practice of controlling the number of children in a

family and the intervals between their births [ CITATION Mer21 \l 1033 ]. The case study

discussed below covers a 24-year-old patient who currently has the Nexplanon implant. This

case was interesting because the patient wanted to have the implant removed due to side effects.

The patient received a consultation with the provider the removal to form a plan to prevent

pregnancy.

Subjective data

The patient is a 24-year-old female patient who presented to the clinic on July 26th, 2021

for a consultation. The patient is a G00000 who would like to discuss other methods of family

planning. The patient is currently using the Nexplanon implant but is experiencing side effects.

Her Nexplanon was first planed in 2017 and then replaced in 2020, but since then the side effects

have gotten worse. She states that she has gained at least 60 pounds since it was first placed and

had no period during this time other than a few episodes of spotting. She has no other complaints

or concerns at this time.

Her past medical history includes La Fort II December of 2014 and a Cholecystectomy

September of 2016. The patient has been diagnosed with asthma and obesity. Her last physical

was May of 2021, and she has no significant obstetric history. The patient is up to date on all her

vaccines including her COVID-19 vaccine which she received in January of 2021. She started

her period at age 11 and her last menstrual period was July of 2017 right after having the

Nexplanon implant placed. She has only had spotting twice since the implant was placed.

The patient states that she lives with her husband and her dog in a rental house. She

works as a registered nurse in an ICU. The patient exercises by walking 30 minutes a day around

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 Family Planning 3

the block and is trying to eat healthier. She denies tobacco use and states that she drinks 1 drink a

week if any. Pertinent family medical history regarding women’s health is her mother had a

hysterectomy at 52 and there is a history of hypertension on both sides of the family.

Objective Data

The patient’s vital signs are temperature of 97.9 degrees Fahrenheit orally, heart rate 67,

blood pressure 102/58, respirations 18, height 5’3”, weight 238, and BMI 42.2. All systems were

within normal limits. No diagnostic tests were performed during this evaluation.

Assessment

All systems were within normal limits when assessing the patient. The patient has gain a

significant amount of weight since the last visit of 30lbs in a year. Since the patient is concerned

that the Nexplanon is the cause of the weight gain and lack of ability of lose weight, the implant

is being removed. The patient was counseled in plan on removal and ways to prevent pregnancy

after (Z30.02). The patient had a well woman exam preformed to ensure there were no

gynecological issues before removal (Z01.419). Then the Nexplanon was then removed per

patient request (Z30.46).

Plan

A yearly well woman exam was preformed on the patient during the visit (Z01.419).

During this time, we discussed the risks and benefits of the removal of the Nexplanon implant. A

full exam was completed per the American College of Obstetricians and Gynecologists

guidelines [ CITATION The181 \l 1033 ]. Education to return in one year for another exam was

given and if the patient had concerns to return before then.

During the examination and consultation, the patient the removal of the Nexplanon and

the steps after to prevent pregnancy (Z30.02). The plan was formed to remove the implant that

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 Family Planning 4

day and then have the patient on no hormonal contraceptive for three months. During this time

condoms or spermicide should be used to prevent pregnancy. After three months if the patient

desires hormonal contraceptive pills can be started per the provider. However, if the patient was

very concerned about preventing pregnancy the pill could be started a week before removal to

prevent a gap of contraceptive effectiveness [ CITATION Ame11 \l 1033 ].

After discussion with the provider the patient decided to have the implant removed that

day (Z30.46). Because of this there was no overlap of contraceptive methods, so the patient was

encouraged to use condoms or spermicide during this time to prevent pregnancy. Education to

keep the area clean and dry after removal was given. What to expect in regards to menstruation

was also discussed and if they had concerns, especially after extended menstruation, they should

call the provider [ CITATION The17 \l 1033 ].

Follow Up Plan

The patient had a normal well woman exam. The patient should return in 3 months to

assess the patient for any concerns she may have after the removal of the Nexplanon implant,

and to possibly start oral contraceptive pills. During this time the patient was also educated on

when to call and come into the office. The patient was educated for signs of infection: the site

warm to touch, fever, discharge from the site, chills, swelling, pain, or redness around the site

should all be evaluated [ CITATION Cen209 \l 1033 ]. If the patient continues to menstruate for

longer than 14 days, if there is pelvic pain, or if she has other concerns the patient should be

evaluated in the office.

References

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 Family Planning 5

American Family Physician. (2011, March 1). How to Switch Birth Control Methods. Retrieved

from American Family Physician: https://www.aafp.org/afp/2011/0301/p575.html

Centers for Disease Control and Prevention. (2020, November 10). Know the Signs and

Symptoms of Infection. Retrieved from Centers for Disease Control and Prevention:

https://www.cdc.gov/cancer/preventinfections/symptoms.htm

Merriam-Webster. (2021, July 30). Family Planning. Retrieved from Merriam-Webster:

https://www.merriam-webster.com/dictionary/family%20planning

The Amerian College of Obstetricians and Gynecologists. (2018, October). Well-Woman Visit.

Retrieved from The Amerian College of Obstetricians and Gynecologists:

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/well-

woman-visit

The Americna College of Obstetricians and Gynecologists. (2017, November). Long-Acting

Reversible Contraception: Implants and Intrauterine Devices. Retrieved from The

Americna College of Obstetricians and Gynecologists.

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