| Course | NUR 656 Primary Care of Women |
|---|---|
| Module | Module 2 |
| Paper type | SOAP note for contraceptive counseling using medical eligibility criteria |
| Length | About 1,050 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 656 Module 2
SOAP Note: Contraceptive Counseling for a 26-Year-Old With Migraine With Aura
[Student Name]
Southern New Hampshire University
NUR 656: Primary Care of Women
Module Two SOAP Note
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
SOAP Note: Contraceptive Counseling for a 26-Year-Old With Migraine With Aura
Contraceptive counseling is one of the most common visits in women's primary care, and for most healthy women almost any method is safe. A few conditions change that. Migraine with aura is one of them, because estrogen-containing contraceptives add to an already increased risk of ischemic stroke. The diagnosis is easy to miss if the clinician does not ask what happens before the headache. The note below follows one appointment where a patient requesting combined oral contraceptives was found to have migraine with aura. It argues that careful history, application of the medical eligibility criteria and shared decision making among safe options protect the patient while respecting her choice.
Subjective
Chief concern: "I want to start the pill."
History of present illness: Maya is a 26-year-old who has used condoms inconsistently with her partner of one year and wants more reliable contraception. She asks for the combined pill because friends use it. When asked about headaches, she describes episodes three or four times a year that begin with flashing zigzag lines spreading across her vision for about twenty minutes, after which a pounding headache settles on one side of her head, bringing nausea and a need to avoid light for most of the day. The visual symptoms resolve completely before the headache. She has never had weakness, numbness or trouble speaking. Episodes began at age 17. She takes ibuprofen and rests in a dark room.
Past history: no hypertension, diabetes, clotting disorders or cardiovascular disease. Nonsmoker. Last menstrual period began nine days ago and was normal. Periods are regular, every 28 days, moderately heavy. Gravida 0. One partner; last sexually transmitted infection testing two years ago was negative. Family history: mother with migraine; no known clotting disorders. Medications: ibuprofen as needed. Allergies: none.
Objective
Blood pressure 114/72, heart rate 72, body mass index 23. Neurologic examination normal, including visual fields, cranial nerves, strength and coordination. Urine pregnancy test negative. The remainder of the examination is unremarkable. Using the patient's description, her episodes meet diagnostic criteria for migraine with typical visual aura: fully reversible visual symptoms that spread gradually over at least five minutes and last less than an hour, followed by headache with migraine features.
Assessment
1. Contraceptive counseling in a 26-year-old with migraine with aura. The 2024 US Medical Eligibility Criteria assign combined hormonal contraceptives, including pills, the patch and the ring, a category 4 rating for women with migraine with aura, meaning an unacceptable health risk, while progestin-only methods and both intrauterine devices are category 1, meaning no restriction (Nguyen et al., 2024). The rating reflects stroke risk. Champaloux et al. (2017) analyzed a large insurance claims database and found that women with migraine with aura who used combined hormonal contraceptives had roughly six times the odds of ischemic stroke compared with women who had neither migraine nor combined contraceptive use. Although the absolute risk for an individual young woman remains low, estrogen should be avoided.
2. Migraine with aura, stable, infrequent, no neurologic deficits.
3. Sexually active; STI screening due based on time since last test and patient preference.
Differential Considerations and Other Risks
Before accepting the diagnosis, other causes of transient visual symptoms were considered. A transient ischemic attack typically causes sudden loss of vision or other deficits rather than gradually spreading positive symptoms such as zigzag lines, and is rare at her age without risk factors. Retinal migraine, which affects one eye only, and visual seizures, which are usually brief and colorful, did not fit her description. Her symptoms have been stereotyped for nine years and her examination is normal, so no imaging was needed.
Other factors that would affect eligibility were also reviewed. None of the other common red flags apply: she has never smoked, her pressure sits well within normal range, her clotting history, personal and family, is clean and she is neither postpartum nor nursing. Had she smoked or had hypertension, those would have added further reasons to avoid estrogen. Because the progestin-only methods and IUDs carry no restriction for migraine with or without aura, the choice among them rests on her preferences rather than on medical risk.
Options Discussed
Maya was told why the combined pill is not recommended for her, and the safe options were reviewed with their effectiveness and practical features. The comparison drew on Winner et al. (2012), who followed more than 7,000 women in the Contraceptive CHOICE Project and found that users of pills, the patch or the ring had a rate of unintended pregnancy roughly twenty times that of users of intrauterine devices or the implant, largely because long-acting methods do not depend on daily use. Options discussed were the levonorgestrel IUD, which often lightens periods; the copper IUD, which contains no hormones but may make periods heavier; the etonogestrel implant; the injection every three months; and progestin-only pills, which require consistent daily timing. Maya valued high effectiveness and lighter periods and chose the levonorgestrel IUD.
Plan
Levonorgestrel 52 mg IUD placed today. Reasonable certainty that she is not pregnant was established: her period began nine days ago, she has used condoms, and the pregnancy test is negative. Because placement is more than seven days after the start of her period, she was advised to use condoms or abstain for the next seven days. Placement was uncomplicated; strings were visible. She was taught to check for strings and to return for severe pain, fever, unusual discharge or signs of pregnancy. Gonorrhea and chlamydia testing was performed at the time of placement, with treatment to follow if positive without removing the device.
Migraine: she was advised to keep a headache diary and to seek emergency care for any aura lasting more than an hour, new weakness or numbness or aura without a subsequent headache, since these can signal stroke. Acute treatment was reviewed, and she will return at six weeks to check the IUD and discuss preventive migraine treatment if episodes increase.
Conclusion
A request for the pill became a stroke prevention decision because one question about headaches revealed migraine with aura. Applying the medical eligibility criteria ruled out estrogen, the stroke evidence explained why and a clear comparison of safe options let Maya choose the method that best fit her goals.
References
Champaloux, S. W., Tepper, N. K., Monsour, M., Curtis, K. M., Whiteman, M. K., Marchbanks, P. A., & Jamieson, D. J. (2017). Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. American Journal of Obstetrics and Gynecology, 216(5), 489.e1-489.e7. https://doi.org/10.1016/j.ajog.2016.12.019
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., Baker, C., Dethier, D., Garbarino, S., Gold, H., Halper, E., Kapp, N., Krishna, G., Meurice, M., Ramer, S., Rodenhizer, J., . . . Wright, S. (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
Winner, B., Peipert, J. F., Zhao, Q., Buckel, C., Madden, T., Allsworth, J. E., & Secura, G. M. (2012). Effectiveness of long-acting reversible contraception. New England Journal of Medicine, 366(21), 1998-2007. https://doi.org/10.1056/NEJMoa1110855
What the NUR 656 Module 2 instructions ask for
Contraception SOAP notes in NUR 656 usually ask for a focused reproductive, medical and social history, a relevant examination, an assessment that applies eligibility criteria to the patient's conditions and a plan based on shared decisions. Expect three to five pages in APA 7 in your program's template. Ask about conditions that change eligibility, such as migraine with aura, hypertension, smoking after 35 or clotting history, document pregnancy status and how reasonable certainty was established, name the eligibility category for each method you consider, compare effectiveness honestly and record the patient's own choice along with backup instructions and follow-up. Rule out mimics of the condition that drives eligibility. Include warning signs.
How this NUR 656 Module 2 soap note example is built
This note documents a composite 26-year-old requesting combined pills who describes zigzag visual symptoms before one-sided headaches. The history meets criteria for migraine with aura. The assessment applies the Nguyen 2024 US Medical Eligibility Criteria, category 4 for combined methods and category 1 for progestin-only methods and IUDs, and explains the Champaloux finding of roughly sixfold stroke odds. Options are compared using the Winner CHOICE data on long-acting methods. She chooses a levonorgestrel IUD, placed after documenting pregnancy certainty, with seven days of backup, STI testing and migraine warning signs. A brief differential rules out transient ischemic attack and visual seizures before the diagnosis is accepted. Warning signs for stroke are taught.
Where the NUR 656 Module 2 rubric puts the points
Grading of contraception notes in NUR 656 commonly considers the completeness of the history, correct application of eligibility criteria, documentation of pregnancy status, the quality of options counseling, the plan and education and APA 7 support. The strongest notes identify conditions that change eligibility and cite the specific category for each method discussed. Graders reward honest effectiveness comparisons, a clear record that the patient chose her method and complete placement or start instructions, including backup timing and warning signs. Addressing related care, such as STI testing and management of the underlying condition, shows comprehensive primary care thinking. A focused differential for the key diagnosis adds credit. Accurate category numbers matter.
NUR 656 Module 2 help: the mistakes that cost points
Contraception notes lose points when eligibility is not checked, when a method with an unacceptable risk is prescribed, when pregnancy status is undocumented or when the plan reads as the clinician's choice rather than the patient's. Another gap is omitting backup instructions or warning signs. Ask about conditions that change eligibility, name categories, document pregnancy certainty, compare options, record the patient's decision and give complete instructions. If your case involves postpartum contraception, a patient with hypertension or emergency contraception, send it with your NUR 656 template so the note applies the right criteria. Consider mimics of aura before labeling it. Give backup timing clearly. Record her choice.
Get NUR 656 Module 2 written to your instructions
Send us the NUR 656 case, your SOAP template and how the note is graded. We will check eligibility for every method, document pregnancy certainty, compare options honestly and record the patient's choice with complete instructions, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 656 Module 2 questions, answered
Where can I find a free NUR 656 Module 2 SOAP Note sample?
This page carries the full note: contraception for a 26-year-old with migraine with aura, the 2024 US MEC categories, stroke evidence and a shared IUD choice.
Can women with migraine with aura take combined birth control pills?
No. The US Medical Eligibility Criteria rate combined hormonal methods category 4, an unacceptable health risk, because of increased stroke risk.
Which contraceptives are safe with migraine with aura?
Progestin-only methods, including the implant, injection and pills, and both hormonal and copper IUDs are category 1 with no restriction.
How much more effective are IUDs and implants than the pill?
In the CHOICE study, pill, patch and ring users had an unintended pregnancy rate roughly twenty times that of IUD or implant users.
When is backup contraception needed after a levonorgestrel IUD?
If placed more than seven days after the start of menses, backup or abstinence is advised for the next seven days.