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Case Study I1) A QS should be performed on days 6 to 12 following the onset of the menstrual period. You risk a higher failure rate by doing it at any other time when there is blood in the uterus or a thickened endometrium.
2) Though quinacrine was at one time used to prevent and cure malaria, it is misleading and can be disconcerting to a client to refer to the use of quinacrine in this context.
3) Though much of the dissolved quinacrine accumulates in the uterus, QS works by scarring the fallopian tubes. This scarring blocks the tubes and prevents fertilization. Most of the excess quinacrine in the uterus is either absorbed or discharged through the vagina.
Case Study IIProblem: The provider is aware of the extent of the client's trouble to reach the clinic and desire to have the QS. The client is being less than honest about her bleeding cycle. The provider can satisfy the client by inserting quinacrine at this time and risk a higher chance of failure. This is particularly dangerous since the client does not have easy access to a clinic and is unable to return for a while.
Solution: Provide another effective method of contraception (i.e. Depo or an IUD). Explain why QS cannot be done at this time and the correct time to return to have it performed.
Case Study IIIProblem: By her show of anxiety and distraction, the client is exhibiting symptoms of someone who may not be an appropriate candidate for QS at this time. She may be under pressure to make a hasty decision that will affect her and her family's life.
Solution: Focus on the nature of her anxiety. Ask her questions that can elicit the reasons for her desiring sterilization. Ask about her family; how many children she has, the date of the last birth, her husband's knowledge, interest and support of her decision to be sterilized. In doing so, it may become evident to you and her that temporary pressures are causing her to make a hasty and irreversible decision. Suggest she think about her reason for wanting a QS and return in a few weeks. Offer a method of reversible contraception in the meantime.
Case Study IV1) Opens the blades before the full insertion.
2) Does not attempt to determine the source of the bleeding.
3) Does not clean the cervix and upper vagina with antiseptic.
4) Has completely neglected to sound/measure the length of the uterus.
5) Places inserter at fundus rather than 1/2 cm below.
6) Holds the plunger steady instead of holding the outer sheath, then pulls the outer sheath instead of pushing in the plunger, so that the pellets are deposited too low.
7) Does not check if removal of the tenaculum has caused any bleeding.
8) Asks the client to lie down for 15 minutes instead of the recommended 1 hour.
Case Study VBased on only those symptoms listed, it is highly unlikely that client X has a tubal pregnancy. During the post-procedure counseling, she should have been informed of 2 very important sets of information.
1) The potential side effects that she can expect to have following a QS.
2) The warning signs of a tubal pregnancy.
Having been given this information, client X would have known to expect the headaches, discharge and itching as well as knowing that they are not signs of a tubal pregnancy.
Case Study VI1) The provider removed his gloves too early in the disinfection process. He should remove the gloves only after wiping all the surfaces.
2) The bucket should contain a 0.5% chlorine solution and the instruments should be submerged for 10 minutes.
3) He failed to clean the instruments with detergent and did not use a brush to clean the teeth, joints and surfaces.
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