Her request for a familiar pill, her gastric bypass and the CDC's 2024 eligibility tables meet in this NU576 counseling plan, which ends on a method her history permits. Searches like "nu 576 unit 2 assignment example", "nu576 unit 2 sample" and "nu576 unit 2 example" land here.
Restarting the Pill After Gastric Bypass? A Contraceptive Counseling Plan Tested Against the 2024 Eligibility Tables
[Student Name]
Purdue University Global
NU576: NP II - Primary Care of Women's Health
Unit 2 Contraceptive Counseling Plan
[Instructor Name]
[Date]
The patient is a composite; values, product names and dates in brackets are illustrative.
1. Case Summary
Ms. [R.], 31, had a Roux-en-Y gastric bypass 14 months ago. BMI now [33], down from [46]. Iron deficiency anemia, on oral iron. Periods regular but heavy since surgery. No history of venous thromboembolism, migraine with aura or hypertension; blood pressure [118/74]. Does not smoke. Does not want to conceive for at least 18 months.
2. Goals and Timing
Bariatric surgery guidance advises delaying pregnancy for 12 to 24 months after surgery, while weight loss is rapid and nutritional deficiencies are most likely (American College of Obstetricians and Gynecologists [ACOG], 2009; Mechanick et al., 2020). At 14 months, she is inside that window, and her own plan is to wait at least 18 more months. Effective contraception is the goal.
3. Her Preferences, in Her Words
1. "Something I know." She liked the pill for nine years.
2. "Bleeding I can predict." Her periods have been heavy and irregular in timing since surgery.
3. "No procedure if I can avoid it."
4. Eligibility Table, 2024 U.S. MEC
Each method is classified for each of her conditions (Nguyen et al., 2024). The four categories run from no restriction on use, through benefit generally exceeding risk and risk usually exceeding benefit, to a risk too great to accept.
1. Combined oral contraceptive. Malabsorptive bariatric procedure: 3. Obesity, BMI 30 or more: 2. Overall: 3. Meaning: absorption after a Roux-en-Y bypass is uncertain, and effectiveness may be reduced.
2. Progestin-only pill. Malabsorptive procedure: 3. Overall: 3. Same reason.
3. Combined vaginal ring. Malabsorptive procedure: 1. Obesity: 2. Overall: 2. Meaning: the vaginal route bypasses the gut.
4. Combined patch. Malabsorptive procedure: 1. Obesity: 2. Overall: 2. Meaning: the patch may be less effective in people with higher body weight, which is noted.
5. Depot medroxyprogesterone acetate. Malabsorptive procedure: 1. Overall: 1. Note: bone density and weight effects discussed.
6. Etonogestrel implant. Malabsorptive procedure: 1. Overall: 1.
7. Levonorgestrel IUD, [52 mg]. Malabsorptive procedure: 1. Overall: 1. Note: would reduce heavy bleeding and help her anemia.
8. Copper IUD. Malabsorptive procedure: 1. Overall: 1. Note: may worsen heavy bleeding and anemia.
The bypass, not her weight, is what moves the pill into category 3: the concern is whether enough of it is absorbed, not whether it is safe.
Why Absorption Matters After This Surgery
A Roux-en-Y gastric bypass reroutes food past most of the stomach and the first part of the small intestine, where many drugs are absorbed. Studies of oral drug levels after bypass show variable and sometimes reduced absorption, and there is little direct evidence on oral contraceptive levels. The eligibility category reflects that uncertainty rather than a proven failure rate. Restrictive procedures, such as a sleeve gastrectomy, do not carry the same concern, and oral methods remain category 1 after them. Vomiting or diarrhea, which some patients have after bypass, would reduce oral absorption further. Non-oral methods sidestep all of this.
5. Counseling
Her first request, restarting the combined pill, was explained as category 3: not dangerous, but possibly less effective after her surgery, with an unplanned pregnancy during a period of rapid weight loss the main risk.
Two options were then set against her preferences. The combined vaginal ring met two of three: it uses the same kind of hormones she knows, with a monthly cycle and predictable withdrawal bleeding, and needs no procedure. The 52 mg levonorgestrel IUD met one: it would lighten her heavy bleeding and help her anemia, and it is among the most effective methods, but it requires placement. She chose the ring for now and asked to revisit the IUD at her next visit if bleeding stays heavy. The implant and the injection were also described; she declined the injection because of its effect on bone, which matters after bypass surgery, where calcium and vitamin D absorption are already reduced. She was reassured that choosing the ring today does not close any other option.
6. Starting the Ring, 2024 U.S. SPR
Following the Selected Practice Recommendations (Curtis et al., 2024):
1. Reasonably certain she is not pregnant: last menstrual period [nine] days ago, no intercourse since, negative urine hCG today.
2. Start the [etonogestrel/ethinyl estradiol] ring today.
3. Backup: condoms or abstinence for the next seven days, because she is starting more than five days after the start of her period.
4. Use: three weeks in, one week out.
Other Points Discussed
Folic acid and her bariatric vitamins continue, since she may plan a pregnancy later and nutritional deficiencies after bypass affect early pregnancy. Her iron deficiency is being treated; heavy periods add to iron loss, which is part of why the IUD remains on the table. Condoms were recommended for STI protection with any new partner.
7. Follow-Up
Visit in [three] months: bleeding pattern, blood pressure, satisfaction. Hemoglobin and ferritin at the same visit. Revisit the IUD if bleeding remains heavy.
References
American College of Obstetricians and Gynecologists. (2009). ACOG Practice Bulletin No. 105: Bariatric surgery and pregnancy. Obstetrics & Gynecology, 113(6), 1405-1413. https://doi.org/10.1097/AOG.0b013e3181ac0544
Curtis, K. M., Nguyen, A. T., Tepper, N. K., Zapata, L. B., Snyder, E. M., Hatfield-Timajchy, K., Kortsmit, K., Cohen, M. A., & Whiteman, M. K. (2024). U.S. selected practice recommendations for contraceptive use, 2024. MMWR Recommendations and Reports, 73(3), 1-77. https://doi.org/10.15585/mmwr.rr7303a1
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., Urman, R. D., Adams, S., Cleek, J. B., Correa, R., Figaro, M. K., Flanders, K., Grams, J., Hurley, D. L., Kothari, S., ... Still, C. D. (2020). Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures: 2019 update. Surgery for Obesity and Related Diseases, 16(2), 175-247. https://doi.org/10.1016/j.soard.2019.10.025
Nguyen, A. T., Curtis, K. M., Tepper, N. K., Kortsmit, K., Brittain, A. W., Snyder, E. M., Cohen, M. A., Zapata, L. B., & Whiteman, M. K. (2024). U.S. medical eligibility criteria for contraceptive use, 2024. MMWR Recommendations and Reports, 73(4), 1-126. https://doi.org/10.15585/mmwr.rr7304a1
How this NU576 Unit 2 example is structured
The plan runs in an order that keeps preference and eligibility separate. Goals and timing come first, including the pregnancy interval bariatric teams commonly advise after surgery. Preferences follow before any method is named, so the reader can later see which ones were honored. The eligibility table is the center: one row per method, one column per condition, the category in each cell and a line on what the category means. Categories are cited from the 2024 U.S. MEC, not its 2016 predecessor. Counseling is summarized next, showing how the ring met two of her three preferences and how the IUD was offered and declined for now. The last section belongs to the 2024 U.S. SPR: being reasonably certain she is not pregnant, starting the [etonogestrel/ethinyl estradiol] ring the same day, and seven days of backup.
Get an NU576 Unit 2 example written to your instructions
Counseling cases in NU576 differ in the condition that decides eligibility, so the composite patient in your prompt matters most, along with its rubric. The plan that returns classifies every method against every listed condition under the 2024 CDC guidance and records preferences before the recommendation. The first request is free and arrives in 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU576 Unit 2 questions, answered
Do I need to classify every method, or only the one recommended?
Most rubrics reward a full table, because showing that alternatives were checked demonstrates the reasoning behind the final choice. At minimum, classify the requested method, the recommended one and any method the patient raised. Leaving a condition out of the table suggests it was overlooked, even when the final recommendation happens to be eligible.
What is the difference between the U.S. MEC and the U.S. SPR?
The Medical Eligibility Criteria answer whether a method is safe for someone with a given condition, using categories 1 to 4. The Selected Practice Recommendations answer how to use a method once chosen: when to start, whether backup is needed, what examinations or tests are required and how to manage side effects. Both were updated in 2024.
Should a plan override a patient's preference when eligibility allows it?
No. When a preferred method is eligible, the plan supports it and records any additional information offered. A preference is set aside only when a listed condition makes the method unsafe, and even then the plan should explain the reason in plain terms and offer alternatives matched to what the patient said mattered.