Chapter 29Family Planning Flashcards
Exam 4 (Final)
Family Planning:
What kind of interventions does it include?
Family planning includes any educational, social, or healthcare interventions that allow people to plan reproduction.
Family Planning
What else does it include?
Family planning includes contraception, abortion, and interventions and education when subfertility or infertility is identified.
Family Planning:
Nurses in Family Planning must be how?
Nurses participating in family planning must be respectful of patient’s choice and careful not to interject their own biases
Contraception: What is the goal of it?
The goal of contraception is to prevent unwanted or mistimed pregnancy.
Contraception:
Major types of contraception include:
Long-acting reversible contraception (LARC)
Combined oral contraceptives (COCs)
Progestin-only pills (POPs)
Hormonal patches
Hormonal vaginal rings
Barrier methods
Spermicide
Natural family planning (NFP)
Withdrawal
Contraceptive injections
Sterilization
Contraception Considerations:
What are the most effective methods of birth control?
The most effective methods of birth control are sterilization (bilateral tubal ligation [BTL] and vasectomy), and methods of contraceptive implants and intrauterine contraception (LARC).
Contraception Considerations:
What are the two forms of sterilization?
sterilization (bilateral tubal ligation [BTL] and vasectomy),
Contraception Considerations:
What do contraceptive decisions involve?
Contraception decisions involve evaluating family planning goals.
Contraception Considerations:
How effective are contraceptive methods?
A contraceptive method is only as good as the patient’s adherence to and continued, consistent use of the method once adopted.
Hormone-Containing Birth Control: COCs
COCs generally contain what?
COCs generally contain 21 hormone-containing pills followed by 7 placebo pills.
Hormone-Containing Birth Control: COCs
When taken correctly, what is failure rate?
With typical combined oral contraceptives are how effective?
When taken correctly, failure rate is 0.1%. With typical use, combined oral contraceptives (COCs) are 92% effective.
Hormone-Containing Birth Control: COCs
How does it work?
Works by increasing viscosity of cervical mucus, suppressing ovulation, and thinning the uterine lining.
Hormone-Containing Birth Control: COCs
How long can healthy non smokers take the pill? What can it help with?
Healthy, nonsmokers may take the pill until the age of probable menopause (which may help control discomforts of perimenopause).
Hormone-Containing Birth Control: COCs
What is an alternative method known as?
What is an example?
An alternative method is known as extended cycling. (An example of alternative method packaging is 84 hormone pills followed by 7 placebo pills.)
Hormone-Containing Birth Control: COCs
What are contraindications for birth control?
Contraindications for birth control containing estrogen include migraine with aura, history of blood clots, and hypertension.
Hormone-Containing Birth Control: POPs
What are they?
Progestin-only pills (POPs) contain only progestin (artificial form of progestin).
Hormone-Containing Birth Control: POPs
Who are they usually prescribed for?
Usually prescribed for patients when estrogen is contraindicated (e.g., migraine with aura and hypertension)
Hormone-Containing Birth Control: POPs
Who is it safe for?
Safe for breastfeeding mothers
Hormone-Containing Birth Control: POPs
What is contained in the pack?
All 28 pills in a pack contain progestin (no placebo pills)
Hormone-Containing Birth Control: POPs
How must it be taken to be effective?
Must be taken within a 3-hour window every day to be effective
Hormone-Containing Birth Control: POPs
What is a primary side effect?
Primary side effect is a less regular period and more breakthrough bleeding.
Hormone-Containing Birth Control: POPs
How would a pregnancy be if it occurred while taking this? Why?
If pregnancy does occur, more likely to be ectopic due to slowing of motility of cilia in fallopian tube in response to progestin.
Hormone-Containing Birth Control: Contraceptive Ring
What are they?
Contraceptive rings are flexible silicone rings impregnated with estrogen and progestin.
Hormone-Containing Birth Control: Contraceptive Ring
Who places it? For how long? Why?
The female places the ring inside her vagina for 3 weeks, removes it for a week to create a withdrawal bleed, and then replaces it with a new ring.
Hormone-Containing Birth Control: Contraceptive Ring
How long can a new ring be used?
New ring can be used for up to a year (13 menstrual cycles) left in for 21 days and removed for 7 and then repeated.
Hormone-Containing Birth Control: Contraceptive Ring:
When can the ring be removed? How long can it be left out per day?
Ring can be removed for intercourse and left out for up to 2 hours per day.
Hormone-Containing Birth Control: Contraceptive Ring
Where is the ring located when in the body?
The location of the ring in the vagina is not important as long as it touches vaginal mucosa.
Hormone-Containing Birth Control: Contraceptive Ring
What can occur (wrong) with the ring? What should the nurse teach patients?
The ring can be dislodged during a bowel movement. The nurse should teach the patient to check placement of the ring after a bowel movement.
Hormone-Containing Birth Control: Contraceptive Patch #1
A contraceptive patch contains what?
When is it applied? What happens after?
A contraceptive patch contains estrogen and progestin and is applied weekly for 3 weeks. Followed by a patch-free week, which will cause a withdrawal bleed.
Hormone-Containing Birth Control: Contraceptive Patch #1
Where is the patch applied? Where should it not be applied?
The patch should be applied on the upper back, upper arm, upper buttock, or lower abdomen, but not on the breast.
Hormone-Containing Birth Control: Contraceptive Patch #1
What should a female do with the patch site? Why?
The female should rotate the site weekly to avoid skin irritation.
Hormone-Containing Birth Control: Emergency Contraception
How is emergency contraception available?
Emergency contraception (EC) is available as medication or a hormonal or copper intrauterine contraception (IUC).
Hormone-Containing Birth Control: Emergency Contraception
There are two primary options in the United States. What are they?
Levonorgestrel (Plan B):
Ulipristal (Ella):
Hormone-Containing Birth Control: Emergency Contraception
There are two primary options in the United States.
Levonorgestrel (Plan B): How is it available? When is it most effective?
Available over the counter or by prescription and is most effective when taken within 72 hours of unprotective intercourse.
Hormone-Containing Birth Control: Emergency Contraception
There are two primary options in the United States.
Levonorgestrel (Plan B): How does it work?
Works by preventing ovulation.
Hormone-Containing Birth Control: Emergency Contraception
Levonorgestrel (Plan B): How does it affect an established pregnancy?
Does not affect an established pregnancy.
Hormone-Containing Birth Control: Emergency Contraception
Ulipristal (Ella): How is it available? How soon must it be used to be effective?
Available by prescription only.
May be used within 120 hours of unprotected intercourse.
Hormone-Containing Birth Control: Emergency Contraception
Ulipristal (Ella): How does it work?
Works as a progestin blocker and may affect an existing pregnancy.
Hormone-Containing Birth Control: Emergency Contraception
Ulipristal (Ella): Who is it most effective in?
More effective in patients who weight over 165 pounds (75 kg).
Hormone-Containing Birth Control: Contraceptive Injection
What is an example?
Depot medroxyprogesterone acetate (DMPA, brand name: Depo Provera)
Hormone-Containing Birth Control: Contraceptive Injection
Depot medroxyprogesterone acetate (DMPA, brand name: Depo Provera): What is it?
is a progestin-only injection administered every 3 months until and unless pregnancy is desired.
Hormone-Containing Birth Control: Contraceptive Injection
What are benefits of this?
Benefits include less frequent, scant, or absent menses.
Hormone-Containing Birth Control: Contraceptive Injection
How does DMPA work?
DMPA works by suppressing follicle-stimulating hormone and luteinizing hormone, therefore inhibiting follicle maturation and ovulation.
Hormone-Containing Birth Control: Contraceptive Injection
When should a female start DMPA?
Optimally, a female should start DMPA within 7 days of the start of her last menstrual cycle.
Hormone-Containing Birth Control: Contraceptive Injection
What are concerns with DMPA?
Concerns with DMPA include weight gain.
Hormone-Containing Birth Control: Contraceptive Implant
How is the implant placed? Where?
A 4-cm rod of nonestrogen etonogestrel is inserted under the skin of the inner upper arm.
Hormone-Containing Birth Control: Contraceptive Implant
How long is it approved for? How much can it release?
Although approved for use for 3 years, implant time-releases etonogestrel for at least 5 years.
Hormone-Containing Birth Control: Contraceptive Implant
How does it work?
Works by creating changes to cervical mucus and to fallopian tube motility that impede fertilization.
Also suppresses follicle maturation and ovulation.
Hormone-Containing Birth Control: Contraceptive Implant
What is a common side effect?
Unscheduled bleeding is a common side effect.
Hormone-Containing Birth Control: Contraceptive Implant
When do a majority of patients ovulate after implant removal?
A majority of patients ovulate within a month of removal.
Hormone-Containing Birth Control: Intrauterine Contraception #1
What are they?
Intrauterine contraception (IUCs or IUDs) are T-shaped plastic devices wrapped in copper or containing progestin that are inserted into the uterus.
Hormone-Containing Birth Control: Intrauterine Contraception #1
What is the probability of getting pregnany after 1 year of use?
The probability of getting pregnant after 1 year of use less than 1% with an IUC.
Hormone-Containing Birth Control: Intrauterine Contraception #1
How does the copper IUC inhibit fertilization?
The copper IUC inhibits fertilization by inhibiting sperm motility, capacitation, survival, and phagocytosis.
Hormone-Containing Birth Control: Intrauterine Contraception #1
When can it be inserted in?
The copper IUC can be inserted as emergency contraception within 5 to 7 days of unprotected intercourse.
Hormone-Containing Birth Control: Intrauterine Contraception #1
What does the progestin IUD cause?
The progestin IUD also causes inhospitable changes to the cervical mucus, endometrial atrophy, and variable effects on ovulation.
Hormone-Containing Birth Control: Intrauterine Contraception #1
What is there no evidence of?
There is no evidence of any ICU acting as an abortifacient or disrupting an existing pregnancy.
Intrauterine Contraception #2
What is a side effect of IUCs? (both copper and progestin)
The side effect of IUCs is a change in bleeding patterns.
Intrauterine Contraception #2
What is a side effect of the copper IUCs?
The copper IUC may result in longer, crampier, and heavier bleeding while the
Intrauterine Contraception #2
What is a side effect of progestin IUCs?
progestin IUC may cause spotting, unscheduled bleeding, and amenorrhea.
Intrauterine Contraception #2
What is there a risk of occurring with IUCs?
Risks include perforation of the IUC at the time of insertion.
Spontaneous expulsion of the IUC may occur (typically within the first year of use).
Intrauterine Contraception #2
What should patients report?
Patients should report new acute cramping, which may indicate the IUC has slipped into the cervix.
Intrauterine Contraception #2
What is no longer done by patients with IUCs?
Patients used to be advised to check for string placement monthly to verify placement, but this is not longer recommended teaching.
Intrauterine Contraception #2
Which each IUC placement, what is done? What does this do?
With IUC placement, patients are screened for STIs.
With this practice, the incidence for pelvic inflammatory disease is the same for patients with IUCs as for patients without them.
Barrier Methods of Birth Control: Male Condom
How effective are male condoms? What are they the best at?
Male condoms are generally less effective as contraceptives but the best protection against STIs (other than abstinence).
Barrier Methods of Birth Control: Male Condom
With typical use, the male condom has what failure rate?
With typical use, the male condom has a contraception failure rate of 18% over 1 year.
Barrier Methods of Birth Control: Male Condom
When should a new condom be used?
A new condom should be used with each episode of oral, rectal, or vaginal sex with a partner whose STI status is unknown.
Barrier Methods of Birth Control: Male Condom
When should the condom be applied?
The condom should be applied prior to genital contact.
Barrier Methods of Birth Control: Male Condom
What should be done if the condom is placed upside down?
If the condom is placed upside down (evident when the condom cannot be unrolled), a new condom should be used to minimize the risk of STI exposure.
Barrier Methods of Birth Control: Male Condom
What should be done with condoms after use?
Condoms should be removed and discarded immediately after ejaculation.
Barrier Methods of Birth Control: Female Condom
How does the female or internal condom compare to the male condom?
The female or internal condom is expensive and more cumbersome than a male condom.
Barrier Methods of Birth Control: Female Condom
What does the female condom contain?
The female condom contains two semirigid rings attached to the opening of a nitrile tube.
Barrier Methods of Birth Control: Female Condom
How is the female condom placed?
Placement of the female condom is similar to the placement of a tampon.
Barrier Methods of Birth Control: Female Condom
When should a new female condom be used?
A new female condom should be used with each episode of rectal or vaginal sex.
Barrier Methods of Birth Control: Diaphragm
What is it? What does it not protect against?
The diaphragm is a flexible saucer that is placed into the vagina to cover the cervix. It does not protect against STIs.
Barrier Methods of Birth Control: Diaphragm
What is the diaphragm failure rate?
The diaphragm has a 12% failure rate within a year.
Barrier Methods of Birth Control: Diaphragm
When should fit be checked?
Fit should be checked if the patient gives birth, has a miscarriage or abortion, or gains or loses more than 10 pounds (4.5 kg).
Barrier Methods of Birth Control: Diaphragm
How often should diaphragms be replaced?
Diaphragms should be replaced every 2 years.
Barrier Methods of Birth Control: Diaphragm
How popular is the diaphragm? Why?
The diaphragm has decreased in popularity due to easier methods of contraception.
Barrier Methods of Birth Control: Contraceptive Sponge
What is it? How is it available?
A contraceptive sponge is a 2-inch round, spermicide-infused, foam disk that fits over the cervix, and is available over the counter.
Barrier Methods of Birth Control: Contraceptive Sponge:
What is its failure rate? (birth and no birth)
The sponge has a 12% failure rate over 1 year in patients who have never given birth and a 24% failure rate in patients who have given birth.
Barrier Methods of Birth Control: Contraceptive Sponge:
What must be done prior to insertion?
Prior to insertion, the patient wets the sponge, squeezes it, and inserts it with the fingers into the top of the vagina.
Barrier Methods of Birth Control: Contraceptive Sponge
When may the sponge be place? How long can it stay in?
The sponge may be placed up to 24 hours before sexual intercourse but should stay in no more than 30 hours.
Barrier Methods of Birth Control: Cervical Cap
What is it similar to? How?
Cervical cap is similar to the diaphragm, holds spermicide against the cervix to prevent passage of sperm.
Barrier Methods of Birth Control: Cervical Cap
What is its failure rate? (birth and no birth)
The cervical cap has a 16% failure rate over 1 year in patients who have never given birth and a 32% failure rate in patients who have given birth.
Barrier Methods of Birth Control: Cervical Cap
What do the sizes depend on?
Three sizes depending on if patient has never been pregnant; had an abortion, miscarriage or cesarean; or gave birth vaginally
Barrier Methods of Birth Control: Cervical Cap
When may it be inserted? When should it be removed?
May be inserted up to 6 hours prior to sex and should removed 6 to 48 hours after intercourse.
Barrier Methods of Birth Control: Spermicide or Contraceptive Gel
What are the two types?
Spermicide
Contraceptive gel
Barrier Methods of Birth Control: Spermicide or Contraceptive Gel
Spermicide- what is it?
Over-the-counter jelly, cream, or suppository that kills sperm
Barrier Methods of Birth Control: Spermicide or Contraceptive Gel
Spermicide- when should it be inserted?
Should be inserted 10 minutes prior to intercourse
Barrier Methods of Birth Control: Spermicide or Contraceptive Gel
Spermicide- What is the failure rate?
20% failure rate if used alone
Barrier Methods of Birth Control: Spermicide or Contraceptive Gel
Contraceptive gel: How is it gotten?
Prescription only
Barrier Methods of Birth Control: Spermicide or Contraceptive Gel
Contraceptive gel: What does it do?
Does not skill sperm but alters pH of vagina to decreased sperm motility
Barrier Methods of Birth Control: Spermicide or Contraceptive Gel
Contraceptive gel: What is the failure rate?
About 14% failure rate
Natural Family Planning (NFP): What else is it known as?
NFP also known as fertility awareness, rhythm method, and timed intercourse
Natural Family Planning (NFP): What does it rely on?
relies on the predictability of fertile and infertility of the menstrual cycle to avoid contraception.
Natural Family Planning (NFP)
What methods are there?
Methods include the standard days, cervical secretion (thinning cervical mucus), symptothermal (a slight temperature decrease just before ovulation), and symptohormonal (measuring hormones in urine) methods.
Natural Family Planning (NFP)
How does the standard days method work?
Using the standard days method, a couple avoids intercourse on days 8 through 19 of the menstrual cycle.
Abortion #1
How many pregnancies are unintended?
In 2019, how many pregnancies ended in abortion?
Half of all pregnancies are unintended. In 2019, approximately 21% of pregnancies ended in abortion.
Abortion #1
Who are most abortions performed on?
Most abortions are performed on women in their 20s.
Abortion #1
What are reasons for an abortion?
Reasons patients cite for abortion include inability to afford care for a child, not wanting to be a single parent, or problems with the partner.
Abortion #1:
When are the majority of abortion performed? (What gestational age)
The majority of abortions (79%) are performed prior to 9 weeks (92.7% are completed prior to 13 weeks gestation).
Abortion #1
Abortion #1:
What do nurses do prior to an abortion?
Prior to an abortion, nurses take a thorough health history and attempt to determine if the patient is seeking an abortion due to coercion.
Abortion #1
What should nurses do in these situations? (When patients seek options)
If a patient is seeking other options, nurses should answer questions but not be directive.
Abortion #2:
Medical abortions can be performed when?
Medical abortions can be performed within 77 days of conception.
Abortion #2:
What is a common regimen for a medical abortion?
A common regimen for a medical abortion includes 200 mg of mifepristone followed by 800 mcg of misoprostol 6 hours later.
Abortion #2:
What is a surgical abortion? What is it called
Surgical abortion is typically done by uterine aspiration and is also called dilation and curettage.
Abortion #2:
What is done in a later abortion?
Later abortion is generally by dilation and evacuation.
Abortion #2:
What should the nurse observe for in patients? What should they be monitoring?
The nurse should observe patients for signs of hemorrhage and intraabdominal bleeding by monitoring vital signs, pain, and bleeding, for at least 30 minutes after the procedure.
Abortion #2:
What should patients females who are RH negative be given?
Females who are Rh negative should be given Rho (D) immune globulin if they have a medical or surgical abortion.
Infertility
Infertility is defined as lack of pregnancy after 12 months of well-timed intercourse (6 months if the patient is over 35 years old).
Infertility is related to what?
Infertility may be related to male factors or female factors.
Infertility: Clomid
Clomiphene citrate (Clomid) is a selective estrogen receptor modulator and common first-line medication to induce ovulation.
Infertility: Clomid
When is Clomiphene citrate (Clomid) started?
Clomiphene citrate is usually started 5 days after the start of menses.
Infertility: Clomid
How is the risk of miscarriage or ectopic pregnancy compared with spontaneous pregnancies?
The risk of miscarriage or ectopic pregnancy is the same as with spontaneous pregnancies.
Infertility: Clomid
How is the risk of multiple gestation in clomiphene citrate compared to spontaneous pregnancies?
The risk of multiple gestation is increased 9% with clomiphene citrate compared to spontaneous pregnancies.
Artificial Reproductive Technology (ART)
What is it used for?
ART is used to treat infertility due to male, female, or mixed or unknown causes.
Artificial Reproductive Technology (ART)
What is Intrauterine insemination?
Intrauterine insemination is a procedure where sperm is washed and then introduced into the upper uterine cavity.
Artificial Reproductive Technology (ART)
What is IVF used for?
In vitro fertilization (IVF) is used to treat infertility due to tubal factors, severe male factors, uterine, or ovarian factors.
Artificial Reproductive Technology (ART)
What occurs in IVF?
With IVF, ovaries are stimulated and eggs retrieved by ultrasound-guided follicle aspiration and then mixed with cleaned sperm.
Artificial Reproductive Technology (ART)
When can successful fertilization be identified?
Successful fertilization can be identified after 17 hours and transplanted into the uterus or frozen.
