ch. 8 contraception/abortion Flashcards
contraception
the intentional prevention of pregnancy during sexual intercourse
birth control
the device and/or practice that decreases the risk of conceiving or bearing offspring
family planning
the conscious decision on when to conceive or to avoid pregnancy throughout the reproductive years
informed consent: BRAIDED
B: benefits
R: risks
A: alternatives
I: inquires; chance to ask questions
D: decisions
E: explanations
D: documentation
education is the cornerstone of the nursing care plan and planned interventions
methods of contraception: coitus interruptus
withdrawal
methods of contraception: fertility awareness based methods (FABs)
1) natural family planning
2) only contraceptive practices acceptable to the roman catholic church
3) rely on avoidance of intercourse during fertile periods (DAY 11-18)
4) combine charting menstrual cycle with abstinence or other contraceptive methods
natural family planning methods of contraception: fertility awareness based methods (FABs)
1) calendar based methods:
- calendar rhythm method
- standard days method
2) symptoms based method:
- two day method: did I note secretions today? yesterday?
- cervical mucus ovulation detection method (billings method): strips on cervical secretion, secretions become more fluid in ovulation
- basal body temperature (BBT) method: will increase 1/2 degree before ovulation
- symptothermal method: awareness of increased libido, spotting, mittelschmerz(cyst in ovary ruptures)
3) biological marker methods:
- home ovulation predictor kits: marquette model (MM) -> estrogen increased until ovulation
- urinary markers of estrogen and LH+ cervical monitoring
4) Apps for FAB’s
- dynamic optimal timingL naturalcycles
4)
methods of contraception: spermicides
1) nonoxynol 9 (N-9): reduces sperm motility
- typical failure rate in the first year of spermicidal use alone is 21%
TIP:
- place in vagina
- dental dan: oral sex
- film releases spermicides
methods of contraception: barrier methods
1) condoms: male and female (vaginal sheath)
2) diaphragm: 4 types of traditional diaphragms (6-8 hours)
3) cervical caps: femcap available in US
4) contraceptive sponge: today sponge (wet, pull out after intercourse)
5) toxic shock syndrome:
- risks are present with diaphragms, cervical caps, and sponges
methods of contraception: hormonal methods
1) available in varying formulations and administration; >100 different formulations available
2) combined estrogen progestin oral contraceptives (COCs):
(a) oral contraceptives:
- side effects
- advantages & disadvantages
(b) combined estrogen and progestin injection
(c) oral contraceptive 91 day regimen (seasonique)
(d) transdermal contraceptive system (can’t weigh >200 Ibs, normal/lower BMI)
(e) vaginal ring
methods of contraception: warning signs (ACHES)
A: abdominal pain (may indicate a problem with the liver or gallbladder)
C: Chest pain or SOB (may indicate a possible clot problem within the lungs or heart)
H: Headaches (sudden or persistent, may be caused by cardiovascular accident or hypertension)
E: Eye problems (may indicate vascular accident or HTN)
S: Severe leg pain (may indicate a thromboembolic process)
methods of contraception: progestin only contraception
1) oral progestins (minipill)
- effectiveness is increased if minipills are taken correctly
- must be taken same time every day
2) injectable progestins:
- depot medroxyprogesterone acetate (DMPA or Depo-Provera): 2 types available
- educate on side effects (Q12 weeks)
- return to fertility may be delayed (may take 1 year to conceive, progestin - menopausal state)
- may be in quasimenopausal state: weight gain, insomnia, hot flashes, etc.
3) implantable progestins:
- nexplanon: single rod implanted
- incision/capsule implanted -> removed
- 3/5 year method
methods of contraception: emergency contraception (EC)
1) oral EC should be taken by a woman asap but within 5 days of unprotected intercourse, or birth control mishap
2) available in US:
- levonorgestrel tablets: (plan B one step, take action, aftera, next choice, etc.) are the only EC method available in the US without prescription
- ulipristal acetate: (ella, elleone, fibristal) available by prescription
- IUD (copper IUD): insertion as emergency contraception (toxic uterine environment, less able to implant in endometrium)
methods of contraception: IUDs
1) small t-shaped device with bendable arms for insertion through the cervix
2) 5 FDA approved IUDs:
- paragard copper T 380A (effective up to 10 years)
- mirena (releases levonorgestrel, effective for up to 6 years)
- liletta (releases levoneogestrel, effective for up to 6 years)
- skyla (releases levonorgestrel, effective for up to 3 years)
- kyleena (releases levonorgestrel, effective for up to 5 years)
3) typica; failure rate in the first year is 0.1%
4) offers no protection against STIs pr HIV
5) important client education; signs of potential complications (ACHES)
methods of contraception: sterilization
permanent sterilization: surgical procedures intended to render a person infertile
(a) female sterilization:
- tubal occlusion
- electocoagulation and ligation are considered permanent methods
- tubal reconstruction: success varies
(b) male vasectomy: surgical interruption of man’s vas deferens
- 2 methods available
- low risk, local anesthesia; often done in clinic setting
- tubal reconstruction (reanastomose) issues
- laws and regulations regarding sterilization
- much less invasive + safer procedure for couples
(c) for both males/females sterilization, restoration of tubal continuity (reanastomosis) and function is technically feasible, however costly and uncertain
methods of contraception: breastfeeding
lactational amenorrhea method (LAM):
- highly effective, temporary method
- more popular in underdeveloped and traditional societies
future trends: techniques in development
- biodegradable implants
- self administered injectables (home version)
- once a month oral contraceptives
- a pill taken only at the time of intercourse
induced abortion
1) purposeful interruption of pregnancy before 20 weeks of gestation
- elective abortion
- therapeutic abortion
2) controversial social issue:
- legislation varies from state to state
3) incidence in US:
- estimated by age 20, about 1 in 20 women in the US will have an abortion; by age 30, 1 in 5; by age 45, 1 in 4
- non-hispanic white women 39%
- non-hispanic black women 28%
- hispanic women compromised 25%
- women of other races accounted for 9% of induced abortions
4) first trimester abortion (1-12 weeks):
- aspiration: most common abortion procedure in 1st trimester
- medical abortion: methotrexate/misoprostol, mifepristone/misoprostol
5) second trimester abortion (13-27 weeks):
- dilation and evacuation: can be performed at any point up to 20 weeks of gestation, although more commonly performed between 13-16 weeks gestation
- suction out fetal parts
- dusting and cleaning
6) nursing interventions and education:
- need to educate women to allow for informed decision
- birth control methods increase
- educate about importance
an induced abortion client calls the nurse to report postprocedural symptoms. which condition is not an indication for the nurse to ask her to come into the office for care?
return of her period in less than 6 weeks
