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FNP 1 > Adolescents & Contraception > Flashcards

Adolescents & Contraception Flashcards

1
Q

GAPS

A

guidelines for adolescent preventative services
- screening, vaccines, counseling to pt (health risk and
guidance)

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2
Q

Interview method used when taking psychosocial history with adolescent

A

HEEADSSS

Home environment
Education and employment
Eating
Activities, peer-related
Drugs
Sexuality
suicide/depression
Safety from injury and violence
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3
Q

How many hours of sleep per night do teenagers need?

A

8-10

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4
Q

Additional history to Ask teens/ parents

A

sleep (causing trouble in school? Driving while sleepy?), food security
healthy eating
exposure to loud music
self & resiliency

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5
Q

PE on teenager

A

PE: scoliosis, breast exam on both genders, height, weight, and BMI, acne, piercings/ tattoos, signs of self injury, acanthosis, visual exam on female genatalia, male = visual inspection + palpate testicles+ inspect for hernia,

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6
Q

What age to start screening for depression?

A

Age 12 (Adolescent PHQ-9)

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7
Q

when should lipids start to be checked?

A

age 9-11

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8
Q

when is hearing usually checked in adolescents?

A

Btw 11-14 using audiometry

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9
Q

risk assessment topics to ask adolescents about?

A 
Risk assessment (HIV, STI, oral health, IPV, violence through social media, tuberculosis, )
Tobacco, alcohol, and drug use (ask first about exposure through family and friends); vaping
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10
Q

when is vision screening done in adolescent years? what chart?

A

around age 12- Snellen Chart

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11
Q

Vaccines to give/ discuss with adolescents?

A

Flu
Tdap (btw ages 11-12)
HPV
MenACWY (meningococcal. Quadrivalent recommended)

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12
Q

What is included in sports physicals?

A

Hx
Cardiac exam
musculoskeletal exam
skin

billing - not covered by health insurance but can be covered if pt has not had a wellness exam within 12 months - usually cash pay with price set by clinic

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13
Q

What to do with adolescent with acne?

A

ID type and severity

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14
Q

treatment for acne

A

Topical: benzoyl peroxide, antibiotics, retinoids
Oral ABX: should see results in 5 days. topical first (should be mixed with benzoyl peroxide). Limit use to 3 months and if no results send to derm (ABX resistance concern)
Hormonal agents → estrogen-containing contraceptives; spironolactone
Oral isotretinoin (Accutane); must be on birth control
Other

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15
Q

Evaluating for precocious puberty

A

Evaluation:

Bone age x-ray - both hand and wrist recommended
LH/FSH and estradiol levels (females)
LH/FSH and testosterone (males) early morning

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16
Q

Lack of features of puberty on exam or failure of progression of changes (Tanner Stages) at least age 14

A

Delayed puberty

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17
Q

how to evaluate for delayed puberty?

A

Bone age x-ray
Free T4 and TSH
Serum prolactin, LH, and FSH`

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18
Q

Girls should have had their first cycle within __ years of getting breast buds?

A

5 years

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19
Q

Boys should get to Tanner stage 5 within ____ years of puberty?

A

4-5 years

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20
Q

6-12 months after menarche
Primary (idiopathic) no underlying pathology
Consider endometriosis if family hx
Sx: cramping, pelvic pain, n/v/d, HA, fatigue
Workup: almost never need pelvic exam
Only really done if family hx or if fail basic tx

A

Dysmenorrhea

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21
Q

Tx options for dysmenorrhea

A

Tx: NSAIDs (do different categories), hormonal contraception may be used
Black cohash, heat, rest

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22
Q

Difference between functional and structural scoliosis

A

Functional: curvature without rotation poor posture, pain. Reversible
Structural: rotation of spine with curvature.

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23
Q

How to diagnose and examine scoliosis

A

Diagnoses by AP/lat x-ray of spine (at least 10 degree curvature for diagnosis)

If less than 20 degree curve just monitor.

Exam spine, scapula, shoulders, waist
Adam’s test: lean completely forward and drop head low. Observe from front and side

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24
Q

TBI d/t biomechanical forces, either direct or indirect trauma
Usu rapid onset of short lived impairment of sx
Neuroimaging is usually normal. Most do not lose consciousness
s/s:
HA, nausea, dizziness, vision changes, light/noise sensitivity, concentration

A

Concussion

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25
Q

How to evaluate and tx concussion

A

Evaluation: ACE or scap tool. LOC, posturing, or balance problem immediate remove from the area for further evaluation
Rest: physical and brain rest for 24-48hrs (some take 7-14 days)
No school, no screens, no reading, no sports
Long term issues: HA, anxiety, sleep problems possible

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26
Q

12-18 years old
May develop into bipolar disorder
PHQ-2 or PHQ-9 modified for adolescents
Suicide #2 cause of death in adolescents → be straightforward

A

Depression

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27
Q

(male sterilization) → interrupts the vas deferens, preventing the passage of sperm into seminal fluid

A

vasectomy

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28
Q

Advantages of vasectomy

A

ADVANTAGES:
Highly effective, non-hormonal. Preformed in clinic with local anesthetic.
Cost effective
No effect on sexual function

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29
Q

disadvantages of vasectomy

A 
DISADVANTAGES
Takes 2-4 months for effectiveness
Requires f/u
Post-procedure discomfort, short term
Procedure complications: infection, hematoma, granulation, swelling, persistent pain
Non-reversible
Not STI protection
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30
Q

surgery to remove or interrupt patency of fallopian tubes
Multiple methods
½ sterilizations completed 48hrs postpartum

A

Female Sterilization`

31
Q

Advantages of Female Sterilization procedure

A

Decreased risk of ovarian cancer

No change in menstrual bleeding or pain

32
Q

DISADVANTAGES of Female Sterilization` procedure

A

Regret
Invasive surgical procedure
Not STTI protection
Complications: Infection, wound separation; hemorrhage viscus injury, anesthesia complications. Vessel injury, mortality
CI: obesity, issues with anesthesia, adhesive disease from prior injury

33
Q

Surge in prolactin inhibits ovulation
Must be exclusively breastfeeding
When menstrual cycle returns patient is fertile, often women ovulates before the return of menses
Effective until baby 6 months old

A

Lactational Amenorrhea Method (LAM) AKA Breastfeeding

34
Q

Fertility beads, calendar methods, cervical mucus, basal body temp method, etc. that help women ID time they are ovulating
Monitor cycle, needs to be regular for this to work
First year failure rate 12-15%
Can be used to help couples become pregnant

A

Fertility Awareness Methods (FAM)

35
Q

decreased risk of cervical cancer, PID, infertility, STI, and ectopic pregnancy

A

Male condoms

36
Q

higher failure rate, bulky; makes noise. Can be inserted up to 8hrs before intercourse

A

Female Condom

37
Q

placed anytime before intercourse, left in for 6-8 hours (up to 48hrs) after intercourse. Used with spermicide. Require fitting, less convenient, less effective after childbirth
Dis: No STI protection. These can develop an odor, may be difficult to insert, may increase UTI

A

Cervical caps and diaphragms

38
Q

sponge filled with spermicide, left in place 6-24 hours after intercourse

A

Contraceptive Sponge

39
Q

higher failure rate when used alone. Attack sperm to reduce motility.
Women HIV positive or at high risk of HIV should NOT use!
Some forms require 15 mins before effectiveness
Unpleasant taste, irritation possible

A

Spermicides

40
Q

Coitus Interruptus

A

Withdrawal method

41
Q

MOA is spermicide
Copper ions inhibit sperm motility. Sperm rarely reach fallopian tube
NOT considered an abortifacient and does not prevent ovulation
Effective for 10-12 years
possible/probable protection against cervical/endometrial cancer
Rapid return to fertility after removal
DISADVANTAGES- may worsen dysmenorrhea

A

ParaGard Copper IUD

42
Q

Causes cervical mucus to thicken, preventing sperm from entering the reproductive tract
May inhibit ovulation in 40% of women

A

Progesterone-Only BC Methods

43
Q

Taken daily, no hormone-free days
Contains no estrogen
Cost is higher than combined; used less in US
Thickening of cervical mucus occurs 2-4 hours after taking pills and lasts 22 hours (if intercourse occurs within 2 hrs of taking pill it is not as effective)
Must take pill same time everyday
Need back up method for first 2 days

A

Mini-Pills/POPS

44
Q

Advantages of Mini-Pills/POPS

A 
↓ menstrual blood loss, cramps, pain
10% amenorrhea
May protect against endometrial cancer
Rapid return to fertility
Poss. reduction in PID
No estrogen
May be used for smoker over 35
May be used while breastfeeding
No thromboembolic complications
45
Q

Disadvantages of Mini-Pills/POPS

A

Irregular menses; amenorrhea- increased spotting days
May lead to higher incidence of ovarian follicles
No STI protection
Unforgiving if pill is late or missed
AVOID with active hepatitis, hepatic failure, or jaundice
CI if taking meds that enhance hepatic clearance (CYP450)
Do not use if conditions that may impair absorption from GI tract (ie coitis)
NO Grapefruit juice

46
Q

IM injection q13 weeks OR SQ injection q14 weeks at home

A

DMPA Injection: Depo

47
Q 
MOA:
suppresses ovulation by inhibiting LH and FSH surge
Thickens cervical mucus
Slows tubal and endometrial activity
Thins lining of endometrium

Low failure rate (0.2-6%)
Costs 4x greater than pills
High discontinuation rate
Preferred start within 7 days LMP (no backup needed)
If started in different point in cycle need backup for 7 days

A

DMPA Injection: Depo

48
Q

Advantages DMPA Injection: Depo

A

Less menstrual blood loss and anemia
↓ menstrual cramps and pain
After 1 yr, 50% have amenorrhea, 80% after 5 yrs
Allows for spontaneity
Reduces endometrial cancer risk
↓ blood loss for women with fibroids
Good option if anticoagulated or bleeding disorder
Good option if taking anticonvulsant (may decrease seizures)
Good option for developmentally and/or physically challenged
Sig. reduction of ectopic pregnancies
Some reduction PID
Private method
May be used while breastfeeding

49
Q

disadvantages DMPA Injection: Depo

A 
Irregular bleeding and spotting *
Return to fertility may be delayed (several years)
No STI protection
Need to return to clinic for injections
Potential for ↓ BMD
If used longer than 2 years
Reversible when d/c’ed
Encourage weight -bearing exercise, optimal calcium intake, don’t smoke
SE: HA, acne, hirsutism
May experience breast tenderness, bloating, and vasomotor sx
Modest weight gain
Metabolic effects: 
Increased glucose & LDL
Decrease HDL
50
Q

Single implant under skin of upper arm
82% continue to use over 2 years
Effective for at least 3 years
No studies evaluating failure rates
Anti Seizure medications may lower effectiveness
Primary MOA: cervical mucus thickening, may also inhibit ovulation
Thins endometrium
Insertion within 7 days of LMP= no backup; otherwise 7 days of backup
Advantages and Disadvantages similar to all other progestin only methods

A

Implanon and Nexplanon (Newer version- radiopaque)

51
Q

Primary MOA: thicken cervical mucus and prevent sperm from entering reproductive tract
Changes in uterotubal fluid can impair sperm motility and ovum migration

A

Levonorgestrel Intrauterine Systems

52
Q

The 52 mg have some anovulatory effects
Does not impact implantation and is not an abortifacient
Highly effective, low failure rate
If inserted within 7 days of LMP no backup needed
Can be used in nulliparous women
Can be used in women with multiple partners (concerns for PID d/t string)

A

Levonorgestrel Intrauterine Systems

53
Q

Mirena: ___ years, ___ mg levonorgestrel

Skyla: ___ years , ___ mg levonorgestrel → lower progesterone marketed for nulliparous women

Liletta: ___ yrs, ___ mg levonorgestrel

Kyleena: ___ years, ___ mg levonorgestrel

A

Mirena: 7 years, 52 mg levonorgestrel

Skyla: 3 years , 13.5 mg levonorgestrel → lower progesterone marketed for nulliparous women

Liletta: 3 yrs, 52 mg levonorgestrel

Kyleena: 5 years, 19.5mg levonorgestrel

54
Q

PAINS

A

early warning signs of concerns
P: period late (copper IUD), abnormal spotting or bleeding beyond expected

A: abd. pain, pain w intercourse

I: infection exposure (STI), abnormal vaginal discharge

N: not feeling well , fever chills

S: string missing or shorter

55
Q

MOA: prevention of ovulation by suppression of FSH and LH secretion
Endometrial lining is kept thin
Cervical mucus thickens
Tubal motility is slowed

The 7 placebo pills at the end of the pill pack is a withdrawal bleed, not a period

A

Combined Hormonal Contraceptives

56
Q

what kind of women should NOT use spermicides?

A

women at high risk of HIV or who are HIV positive

57
Q

Advantages of Combined Hormonal Contraceptives

A

↓ blood loss and anemia
Can manipulate frequency and timing of bleeding
Can ↓ risk of internal hemorrhage from ovulation in women on anticoagulants or with bleeding disorders
Can provide progestin for women with anovulation/PCOS to reduce risk of endometrial cancer
Allows for sexual spontaneity
↓ risk ovarian, endometrial, and colorectal cancer
↓ risk of benign breast masses; reduced risk of corpus luteum cysts (ovarian)
May improve acne (takes up to 6 mos)
↓ vasomotor sx for perimenopausal women
Possible ↑ BMD

58
Q

Disadvantages of Combined Hormonal Contraceptives

A

May spot during first few cycles
Lack of withdrawal bleeding can cause concern
↓ libido and anorgasmia are possible
Daily pill taking
Not as private as other methods
No ↑ risk for squamous cell cervical carcinoma, BUT ↑ risk of adenocarcinoma; recommend routine PAP testing
↑ risk of hepatocellular carcinoma in COC users with > 50 ug formulation
No protection from STI
SE: n/v, weight gain, HA, bloating, breast tenderness, chloasma, varicosities and spider veins

59
Q

COC

A

Combined Oral Contraceptives

60
Q

COC Complications:

A

VTE; less risk than when pregnant. Risk is lower with estrogen doses <35mcg

MI or stroke: no increased risk using low dose, do not smoke, do not have HTN, and do not have migraines with neurological findings
Women at risk: smokers over 35, HTN, DM, dyslipidemia, obesity, migraines with aura (stroke only)

HTN : 1% of users develop. Self-corrects 1-3 months after d/c

Cholelithiasis: Greater risk with 50mcg estrogen formulations. Use cautiously in gallbladder disease

Visual changes: rare retinal thrombosis. Contact lenses may have dry eyes

61
Q

ACHES Mnemonic → warning signs when on COC

A 
A- abdominal pain
C- chest pain
H- headaches
E- eye changes
S- Severe leg pain
62
Q

Initiation of COC:

Typical start

Sunday start

Quick start

A

No pelvic exam needed prior to initiation if asymptomatic
Typical start → first day of next menses, no backup needed

Sunday start → first Sunday after start of menses. Backup needed 7 days

Quick start → preferred method. Backup needed for 7 days

63
Q

when does ovulation occur in menstrual cycle?

A

surge of FSH and LH

This is where combined hormonal contraceptives work

64
Q

Maintains steady state of hormones, unike COCs, which peak and wane daily

one ring up to 42 days
Can be removed for intercourse if reinserted within 3 hrs

A

Vaginal Contraceptive Ring (Nuvaring)

65
Q

Advantages of Vaginal Contraceptive Ring (Nuvaring)

A 
No concerns r/t GI absorption
Less withdrawal bleeding and spotting
Irregular bleeding risk low
↑ compliance
Typically not felt
Lowest serum estrogen and progestin levels of any combined hormonal method
privacy
Little weight gain
66
Q

Disadvantages of Vaginal Contraceptive Ring (Nuvaring)

A

Withdrawal bleeding may continue past ring-free interval (spotting)
May be uncomfortable with placing and removing
Low risk of expulsion

67
Q

Advantages of Weekly Patch (Xulane)

A

No concerns r/t GI absorption
No daily pill
May bathe, swim, etc
Active up to 9 days

68
Q

Disadvantages of Weekly Patch (Xulane)

A 
20% breakthrough bleeding first cycle
No STI protection
Application site detachment or skin irritation
Potential for skin pigment changes
Breast discomfort may be higher
WARNING: higher concentrations of circulating estrogen at steady state than COCs
60% higher than with women on 35 mcg EE
Increased risk of VTE and CV events
Risk estimated to be doubled!
69
Q

Failure rate slightly higher than other methods
Miss 1 pill in 24-48 hrs; just take another
Miss more than 2, use backup method

A

Combined Oral Contraceptives “The Pill”

70
Q

same levels of estrogen and progesterone in each pill → PREFERRED

A

Monophasic

71
Q

amounts of estrogen and progesterone varies

A

Multiphasic

72
Q

Progestin only option when contraception failed or was not used
Behind the counter
If under 18 → require prescription
NOT an abortion pill
MOA: Delay or inhibition of ovulation
Take as soon as possible, up to 5 days after intercourse

A

Emergency Contraception → Plan B

73
Q

Regular vs. Extended Use Contraception

A

Extended use: delay of withdrawal bleeding longer than 28 days
No need for withdrawal bleed week
Less likelihood of ovulation. Less risk of pregnancy
Decreased missed days of work
Avoids s/s a/w hormone withdrawal period

FNP 1 (18 decks)

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