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.