Chapter 31 & 32 Flashcards
Important considerations when choosing contraceptive methods (14)
- safety (risk for stroke)
- protection for STDs
- effectiveness
- acceptability
- convenience
- Education needed
- Benefits (benefit outweighs risk?)
- side effects
- effects on spontaneity
- availability (prescription needed)
- expense
- preference
- religious beliefs (Catholics use family planning rather than contraceptives)
- culture (large families gain respect, African cultures prefer to bleed out/menses)
Top 5 contraceptive use in America
- Sterilization
- oral contraceptives
- condoms
- diaphragm (yuck!) with spermicide
- family planning
Special needs of perimenopausal women regarding contraception and best method for them
- contraception should be used up to 1 year following lase menses
- sterilization is most common in older women
- may not understand risk of pregnancy with older age
- progestin only is best (Mirena IUD, Depo-Provera, progestin only oral)
Differentiate between copper IUD and hormonal
- Mirena is hormonal and last 5 years and is smaller
- Paraguard is copper and last 10 years
Which hormonal birth control is weight sensitive
- Transdermal Patch
- weight more than 90 kg its less effective
Which hormonal birth control is lactation safe
-Implanon
Oral contraception teaching
- if N/V/D use back up method for 7 days, this usually indicates altered absorption
- take progestin same time every day, if 3 hours off use back up method for 7 days
- Passes in breast milk-Drug interactions include St Johns Wort, anticonvulsants, and some antibiotics (not broad spectrum or antifungals) or anything that stimulates liver metabolism
- not for diabetics or smokers, high blood pressure,clots, migraines
Chemical Barriers vs Mechanical
-spermicides vs condoms, diaphragm and cervical caps
Calender Family Planning Method
- timing of ovulation
- about day 14 after menses
- unreliable
Standard Family Planning Method
- using string of colored beads to keep tract of fertile vs infertile days
- Day 8-19 considered sterile
Cervical Mucus/ Two day Family Planning Method
- spinnbarket is when mucus becomes stretching
- indicated ovulation
- intercourse is allowed every other day when there is no mucus present
Sympothermal Family Planning Method
- assessmentof body temp with cervical mucus in addition of bloating, weight gain, mittelschmerz, or increased libido
- avoid intercourse if these are present
ACHES
- warning signs of oral contraceptives complications
- A: Abdominal pain
- C: chest pain, dyspnea, hemoptysis, or cough can indicate PE or MI
- H: Headache, weakness or numbness of extremity, hypertension can indicate migraines and stroke
- E: eye problems can indicate migraine, stroke or retinal vein thrombosis
- S: severe pain or swelling, heat or redness to calf can indicate DVT
Women health initiative
- preventing breast CA, colerectal CA, osteoporosis and CV disease
- health maintenance and screening
Trich discharge
- thin or frothy
- malordorous
- yellow-green or brownish grey
Bacterial Vaginosis Discharge
-thin, grayish white with fishy odor
Bacterial Vaginosis Treatment
-metronidazole (zole) and clindamycin
Chlamydia treatment
- azithromycin or doxycycline
- ofloxacin, levofloaxacin or erythromycin
Gonorrhea Treatment
- dual with chlamydia
- ceftriaxone
- cephalosporins
Syphilis Treatment
- Penicillin G or ceftriaxone
- doxycycline
- tetracycline
TSS S/S
- toxin alters capillary permeability, which allows fluid to leak from blood vessels, leading to hypovolemia, hypotension, and shock
- direct tissue damage to organs and precipitates serious defects in coagulation
- flue like symptoms, sudden fever, hypotension, rash resembling sunburn, skin peeling from feet and hands
TSS Treatment
- vasopressors
- antimicrobial theray
- corticosteriods
- fluid replacement
PID Treatment
- cefoxitin or cefaotan, Doxycycline, Clindamycin, gentamycin
- IV fluids to PO after 25 hours of treatment
- antibiotics for 14 days
PID nursing considerations
- UA to rule out UTI
- advise to seek medical attention after having unprotected sex with someone having STD or when unusual vaginal discharge/genital lesion
Woman are _____ as likely as men to get STD
twice
Most common symptoms of STDs
- unusual vaginal discharge
- vulvar itching or swelling
- pelvic pain, painful coitis, painful urination, and abdominal tenderness
- skin eruptions or changes (lesions, ulcers, warts, or blisters)
- flu like symptoms
- presence of symptoms in sexual partner
Measures that provide comfort and prevent secondary infections
- keep vulva clean but aoid strong soaps, creams and ointments
- keep vulva dry
- wear absorbent panties. cotton
- avoid tight stuff
- take analgesics
- cool or tepid sitz bath
- wipe vulva from front to back and practice hand hygiene
Special instructions for Fecal Occult Blood Testing (FOBT)
- avoid asa and nsaids for 7 days prior
- avoid red meats, raw fruits, vegies, horseradish and vit c for 72 hours prior
- collect specimen from 3 consecutive poops
- return slides as directed within 4-6 days
Secondary Amenorrhea
- cessation of menstruation for 6 months +
- caused by DM, TB, hypothryoidism, CNS lesions, birth control, ovairan tumors, stressers, pregnancy
- treatment is focused at underlying cause
Abnormal Bleeding
- abnormal frequency, lenght of time, irregularity or excessive bleeding
- can be caused by pregnancy (spntaneous abortion), breakthrough bleeding, DM, fibroids, hypothyroidism, coagulation issues, failure to ovulate
- treatment is combination oral contraceptives, hysterectomy, pregnancy test, coagulation test, laser ablation
- have women keep diary of episodes, amount, and number of pads
Endometriosis manifestations
- cyclic pain and infertility
- deepunilaterla/bilateral sharp/dull pain
- dyspareunia (painful intercourse)
- rectal pain during defecation
- diarrhea, constipation, sensation of rectal pressure or urgency
Endometriosis treatment
- oral contraceptive to supresse endometrial proliferation 6-12
- progestins to inhibit growth of excessive endometrial tissue
- testosterone or GmRH to interfere with hormones needed for ovulation and mentration- causes pseudomenopause
- aromatase inhibitors to inhibit estrogen production in endometrial tissue such as Arimidex or Femara
Endometriosis Nursing Considerations
- varies from mild to incapacitating pain
- suggest nonpharmacological relie such as rest periods, application of heat to lower abdomen, moderate excercise, well balance diet
Therapeutic management for PMS
-zoloft
-prozac
-oral contraceptives
-BG
-Danazol to relieve mastalgia
carb rich foods
What should be considered if postmenopausal woman has vaginal bleeding?
-uterine cancer
Differentiate between endometriosis pain onset and PMS pain onset
-pain occurs at end of follicular phase and goes until period begins vs pain occurring before bleeding starts
Symptoms that must always be investigated
- irregular bleeding
- unusual postmenopausal bleeding
- unusual discharge
- dyspareunia
- persistent vulvar or vaginal itching
- blood in stools
- lesions on vulva
- abdominal bloating or constipation (persistent)
- anorexia and vomiting
