What I need you to know about Nexplanon Counseling | New Nurse Practitioners
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And as a general rule, I don’t really have pet peeves in practice. Most of the time I let things slide.
On my crankier days, though, here’s one of mine:
Nexplanon counseling confusion.
Sooooo many providers are mystified by or disinterested in gynecology/women’s health topics.
Which leads to totally preventable extra visits, testing, waiting, patient frustration…(could be said about any topic in medicine, really)
So whether you’re obsessed with GYN, or you’d rather pass it off to another provider (lovingly, this is especially for you!)-- this week’s video breaks it down simply:
What I need you to know about Nexplanon counseling. Short, sweet and to the point.
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well hey there it's liz rohr from real
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world np
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and you're watching np practice made
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simple the weekly videos to help save
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you time frustration
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and hope you learn faster so you can
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take the best care of your patients
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so i have very few pet peeves i'm pretty
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chill
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and i don't even feel like this is a pet
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peeve necessarily but if i had to
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consider it
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it has to be around um next split on uh
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kind of knowledge and counseling because
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really what happens is that um so i do
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next one on insertions and removals i
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love women's health
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reproductive justice is really important
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to me um and
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i definitely find that some providers
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feel very squeamish about it and i don't
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know if it's from lack of
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knowledge or just disinterest but
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basically what happens is that either
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one
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i will have a patient who comes to the
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visit for their next one on insertion
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and hasn't really been counseled at all
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and so they don't really know what
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they're getting themselves into
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and then my my very small my i have 30
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minutes for that procedural visit
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but that takes an entire half an hour
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typically i can i'm pretty fast now but
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it still takes a lot of time and so what
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happens is that i'll do the counseling
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and the procedure in the same visit and
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then i
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tend to run behind i don't even care
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about that quite honestly the pet peeve
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is just that is is really more the
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second scenario that i see
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they have patients who are coming to me
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for a next one on removal that i didn't
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place
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that i didn't know about the counseling
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i wasn't involved in any of that and so
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they're coming to me being like i want
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to take this out i just had a place last
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week because of these side effects
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and really that should never happen let
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me backtrack so
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usually that's totally fine the way that
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i frame my next one on
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um counseling is that they have complete
Overview
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control
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over their bodies and they get to decide
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when it gets inserted when it gets
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removed that whole thing
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but the the scenario was more talking
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about like i had no idea this was gonna
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happen like that's the thing that really
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um frustrates me and so in this video
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i'm gonna be talking about kind of
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everything
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uh that i recommend keeping it short and
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sweet so that you feel comfortable when
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patients come to you asking about an
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exponent so that you can kind of give
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them an overview you don't have to be an
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expert it's really pretty
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straightforward i'll just tell you
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exactly what i tell my patients and then
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you can hopefully bring that to your
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back to your practice
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whether or not you feel like you like
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gynecology or not or if you feel
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comfortable or not hopefully we'll make
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it really simple so
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first i just want to talk about the
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procedure itself so it's a 30 minute
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procedure typically it depends on your
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clinic and what your policies are
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30 to 45 minutes are scheduled for
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insertions and removals
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if there's an informed consent form that
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you go through the risks benefits
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alternative side effects
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hopefully again you've been a
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pre-counsel those that you kind of know
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what you're getting into and you're just
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kind of like reaffirming those
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patients will sign that you'll um clean
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off the area it's a sterile procedure
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so cleaning it off with iodine giving an
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injection of lidocaine usually with
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with or without epinephrine it's up to
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the personal preference of the provider
Pain
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and that is actually the worst part
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because a lot of patients are asking
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like oh is it painful and uncomfortable
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it's basically feels like a stinging
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like a bee sting um that's what i've
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been told
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i haven't experienced it myself but
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that's the worst part because everyone's
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numb
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after that and so once the numbness
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takes over the device is injected
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through a very um
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kind of large needle so i usually ask
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patients if they want to watch or not
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but it's just an applicator device kind
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of like two seconds it's really easy to
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insert
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and then i just wrap up the um the the
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site of insertion with a band-aid
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and um some of that pressure um gauze
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that kind of
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keeps it wrapped up so that you can um
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reduce the the bruising uh afterwards
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and then the patients are just advised
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to watch out for
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you know pain infection and bleeding
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those are the main kind of risks of the
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procedure
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and then coming back if they have
Removal
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anything like redness or discharge or
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fever or anything like that
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hopefully avoid it because it's a
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sterile procedure and then the removals
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are the same thing the removals are our
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informed
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consent anesthetic and then the main
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difference is that
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um there's this very small incision with
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a scalpel about one to three
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millimeters again everything is numb so
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they really don't feel anything and then
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same thing we just wrap it up afterwards
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um and then the main thing about
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insertions is that it takes about seven
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days
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until they are fully effective so they
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need some sort of backup method
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one other thing to consider is that
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patients will frequently come to their
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visits if they if they are a female
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patient with a male partner a cis male
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partner
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they will um and they are not using
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other contraceptives if it's been within
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10 days that they've had unprotected
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intercourse
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they could possibly be pregnant without
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having a positive pregnancy test if you
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remember that one but
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i do recommend having those
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conversations with patients before they
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come in
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and i'm not necessarily like a fond of
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the of the
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they have to come in for they have to
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come in for the counseling visit like if
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they can't
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and they come to the procedure and i do
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the counseling that's fine because i
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really don't want to make a barrier to
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access to
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contraception but just kind of keeping
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that in mind um that those are kind of
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the recommendations if you can kind of
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if they bring it up in the appointment
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or if you're offering uh contraceptive
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options for them just kind of mentioning
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that and then the only other thing is
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is the main other thing i guess i should
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say is about side effects and this is
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the number one thing i want you to keep
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from this video
Side Effects
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is that um it's it's you don't have to
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be an expert it can kind of just be
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quick and easy so
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this is the way that i tell my patients
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so basically when it comes to the next
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one on it's good for three years
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um you can take it out anytime but uh
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and it's
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really really effective against
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protecting you from pregnancy
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but there are a couple of side effects
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most people are really thrilled most
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people love the next one on in my
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anecdotal experience
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however there are some side effects to
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be uh to consider before deciding
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if this is right for you right so number
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one is bleeding absolutely number one
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across the board most common side effect
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and there's four different options one
Most Common Side Effect
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your periods stay the same
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two you get no period at all
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three you can get this kind of a regular
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spotting meaning small amounts of
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bleeding here and there kind of
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erratically or maybe a full-fed
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full-fledged period um just here and
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there kind of like not really on a
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schedule
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and then the worst case scenario which
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is very rare but i do have to tell you
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this could be an option
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is that somebody gets their period and
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it never goes away
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so like they literally have a period
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every single day until you remove the
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next one on again
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um and i let patients know that like
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most of the time when patients get the
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next one on and they have some side
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effects their body will get used to it
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so i usually recommend
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giving it a trial about one to three
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months to see how they feel
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and if they get that intense uh kind of
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like daily bleeding that doesn't go away
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to please call me because there are
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things that we can do about it for them
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so far and away that is the most common
Other Common Side Effects
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side effect that i definitely hope that
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you can take away from this in your
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counseling
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um and then the other there are other
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kind of less common side effects so
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one is headaches so if somebody has
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headaches already there is a risk that
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it could get worse or they could get
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like new headaches that they didn't have
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before so that's just up to their
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discretion if they're willing to risk
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that for the benefits of
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having like a long-term long long term
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uh
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uh reversible contraceptive uh the lark
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factor
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um that they don't have to think about
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taking as a pill every day um
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so there's the headaches and then the
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other one is mood definitely so patients
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who have depression where it's not
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managed
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completely or bipolar that's not managed
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completely um
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could definitely get worse or even if
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it's you know under control or
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well-managed it can kind of get worse
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and then there's a couple of other
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questions so acne and weight gain so
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weight gain is not necessarily as much
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as for example like the depo um uh
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provera injection um but there is about
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a 14
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of weight gain risk and i don't
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necessarily have data on the amount of
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weight gain um
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and then acne is again about like 14 so
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if somebody had really bad acne you
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might want to consider like not
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you would i offer that to them as a risk
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and they get to make that decision right
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and so there is a chance that your acne
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could get worse so you can kind of have
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to weigh it from there so that's not the
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only those are not the only side effects
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but those are like the main ones
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definitely the bleeding is the most
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important one that i feel like it's just
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so
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super easy to get off off the bat and
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see if they're even willing to entertain
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any abnormalities in their menstrual
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cycle because some people are and some
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people aren't so
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um so that's it so hopefully this video
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was helpful um and if you've made it
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this far
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all the way to the end thank you so so
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much for making my dreams come true of
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provider collaboration
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um if you like this video hit like and
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