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
