Chapter 31: Family Planning Flashcards
1
Q
role of the nurse in family planning
A
- counseling and education
- women are more likely to use contraception if they have received counseling that is directed to their own needs instead of general information about contraception
- must be comfortable discussing contraception and sensitive to the woman’s feelings
- counseling should include:
- types available
- risks/benefits
- how to ensure proper use of each method
- what to do if an error is made
- emergency contraception
- backup methods and when to use
- what to do if the woman wants to change methods
- questions/concerns
2
Q
what are the most popular contraceptive methods in the US?
A
- oral contraception
- tubal sterilization
- male condoms
- vasectomy
3
Q
considerations when choosing a contraceptive method
A
- safety
- protection from STDs
- effectiveness: depends on use, fertility, and freq of intercourse
- acceptability
- convenience
- education needed
- benefits
- side effects
- effect on spontaneity
- availability
- expense
- preference
- religious and personal beliefs
- culture
4
Q
which women should not use oral contraceptives?
what type of method of contraception should women with a history of toxic shock syndrome not use?
A
- thrombophlebitis or stroke
- diaphragm or cervical cap
5
Q
what is the best protection from STDs?
A
male condom
6
Q
effectiveness of contraception
A
- determined by how often the method prevents pregnancy
- reflects 2 types of contraceptive failure:
- ideal, perfect effectiveness rate refers to perfect use w/ every act of intercourse. Failures are caused by the method itself and not with the use of the method.
-
typical, actual, or user effectiveness: most useful, refers to occurrence of pregnancy under typical use of the method
- difference b/w the 2 is how forgiving a method is–how lilely pregnancy is to occur if the use is occasionally imperfect
7
Q
what are the most effective long acting reversible contraceptives?
A
IUDs and contraceptive implants
8
Q
what types of contraceptives may lead to amenorrhea in some women?
A
- hormone implants or injections
- IUDs
9
Q
what are some benefits to oral contraceptives besides prevention of pregnancy?
A
- reduction of acne
- decreased bleeding during periods
- prolonged amenorrhea
10
Q
contraceptives and their effects on spontaneity
A
- some contraceptive methods are related to coitus (sexual intercourse)
- barrier methods
- withdrawal
- periodic abstinence
- these methods must be readily available and interrupt sexual intercourse
11
Q
which types of contraceptives are available OTC without prescription?
A
- condoms
- spermicides
12
Q
some methods of contraception require informed consent about the risks and benefits, what are they?
A
- surgical sterilization
- oral contraceptives
- hormone injections
- implants
- IUDs
13
Q
adolescents and contraception
A
- misinformation and erroneous beliefs are common among teens
- many do not understand that pregnancy can result from any intercourse near ovulation
- common methods used by teens:
- douching–ineffective b/c sperm may enter cervix very soon after ejaculation
- coitus interruptus (withdrawal)–unrealiable
14
Q
current recommendations from American Cancer Society about pelvic exams and Pap smears
A
- pelvic exams are not required for a prescription for oral contraceptives
- Pap Smears should be done every 3 years beginning at 21 and every 5 years beginning at 30
15
Q
what contraceptive methods are most popular with adolescents and why? why is a disadvantage?
A
- oral contraceptives (OCs) and condoms
- OCs are popular b/c they are safe, not difficult/messy, inc bone density, regulate menses, reduce menstrual flow and cramping, and may dec acne
- but adolescent girls may be inconsistent in taking pills every day, so a method like a patch (changed 1x a month) may be more useful
16
Q
when does fertility begin to decline in women? how long should women use contraception to prevent pregnancy?
A
- fertility begins to decline when a woman reaches 35-40 yo
- should use contraception until 1 year after a woman’s last menses
17
Q
smoking and peripausal women use of OCs
A
–Heavy smoking and over 35 = no estrogen in BCP’s
–Any smoking and over 40 = no estrogen in BCP’s
18
Q
sterilization
A
- most widely used method of contracetion
- permanent end to fertility
- greatest risk for regret if woman is under 30, pressure from spouse, medical indication, not enough information
19
Q
complications of sterilization
A
- hemorrhage
- infection
- anesthesia complications
- pregnancy: more likely to be ectopic after sterilization
20
Q
tubal sterilization
A
- involves cutting the fallopian tubes to prevent fertilization
- can be performed at any time but easiest during abdominal surgery/C section or w/in 48 hours of vaginal birth
- after procedure, avoid intervourse, strenuous exercise, and heavy lifting for 1 week
- can use mild analgesics for pain
- call HCP if: temp over 100.4 deg F, fainting, severe pain, bleeding
21
Q
vasectomy
A
- involves making a small cut in scrotum to cut a section of vas deferens so sperm can no longer pass into semen
- lower morbidity, lower failure rate, and less expensive than tubal sterilization
- post op: wear scrotal support for 48 hours, apply ice for 4 hours and take analgesics
- avoid strenuous activity for 1 week
- notify HCP if: fever, pain, bleeding, swelling greater than 2x the normal size
- intercourse may be resumed in 1 week BUT complete sterilization may not occur for 3 mos
- must have semen specimen for contraception
22
Q
IUDs
A
- Copper (paragard) or levonorgestrel (Mirena/LNG-IUS)
- Paragard works for 10 yrs
- Mirena works for 5 years
- can be inserted anytime the woman is not pregnant and does not currently have an STD or pelvic infection
- can be inserted as soon as placenta is delivered
- Paragard works immediately
- Mirena if inserted w/in 5 days of start of menses, no backup is needed
- can be inserted as soon as placenta is delivered
- fertility returns prompty when removed
- recommended b/c long term, cost effective
23
Q
IUDs: action
A
- cause a sterile inflammatory response which results in a spermicidal intrauterine environment
- Mirena: progestin thickens cervical mucus and prevents transport of sperm to endometrial cavity
- Paragard: progestin causes dec sperm and ova viability, thickens cervical mucus, inhibits sperm motility
24
Q
IUDs: SEs and complications
A
- cramping
- bleeding
- esp irregular bleeding in early months
- common reasons for Paragard removal: menorrhagia and dysmenorrhea
- complications: perforation of uterus and expulsion
25
which women should not use IUDs?
* recurrent pelvic infections
* hx of ectopic pregnancy
* bleeding disorders
* abnormalities of the uterus
26
IUDs: teaching
* teach woman about SEs and to check for presence of strings
* expulsion most common during menses--\>teach them to check for threads weekly for first 4 weeks, then monthly after menses
* S/S of infection: vaginal pain, discharge, itching, low pelvic pain, fever
* any signs of pregnancy must be reported immediately to rule out ectopic
27
hormone implant
* AKA Inplanon--implanted into upper arm
* provides 3 years of contraception
* action: inhibits ovulation, thickens cervical mucus, makes endometrium an unfavorable env
* can be inserted immediately postpartum if not breastfeeding
* SEs: irregular menstrual bleeding
* fertility returns immediately on removal
28
hormone injections
* AKA Depo Provera--IM or subQ
* prevents ovulation for 15 weeks, but should be injected every 13 weeks
* no backup method of contraception if 1st injection w/in 7 days of beginning of LMP
* reason for discontinuation: menstrual irregularities
* SEs: spotting, weight gain, HA, depression, hair loss, nervousness, dec libido, breast discomfort
* may also cause a dec in bone density, so women should be taught to take calcium and vit D and inc weight bearing exercises
* can be inserted in immediate postpartum period, but there is a delay in return of fertility
29
oral contraceptives (OCs)
* work by inhibiting ovulation
* available as combination OC (w/ progestin and estrogen) and as "minipills" (w/ progestin only)
30
Combination OCs
* action: thickening of cervical mucus, suppress production of LH and FSH (which prevent maturation of follicle and ovulation)
* most available in packs of 21 or 28:
* 21: take for 3 weeks then off 7 days for menses
* 28: take for 3 weeks, then take placebo for 7 days for menses
* may also take more continuously to prevent bleeding, but breakthrough bleeding and spotting are common
31
Progestin Only Pills
* are taken daily with no hormone free days
* less effective at inhibiting ovulation, but cause thickening of the cervical mucus
* good for women who cannot take estrogen
* must take a pill every day and at the same time to effectively prevent pregnancy
* breakthrough bleeding and pregnancy are more common with POPs than COCs
32
which women should not sure OCs?
* hx of:
* thrombophlebitis
* cerebrovascular or CV dz
* any estrogen dependent CA or breast CA
* liver tumors
* HTN
* migraines w/ aura or if over 35 yo
* diabetes longer than 20 yrs
* w/ current:
* any of the above
* impaired liver fcn
* pregnancy
* cigarette smoking in women over 35 yo
33
benefits of OCs
* regular menses
* decreased flow, PMS, dysmenorrhea
* reduced acne
* improved bone density
* reduces ovarian and endometrial CA
* less risk of PID, ectopics, sickle cell crisis, asthma
34
risks of OCs
* no protection against STDs
* may inc susceptibility to Chlamydia
* compliance: must be every day, same time
* missed doses are not an issue
* usually should not BF
35
SEs of OCs
* S/S of pregnancy are common but this may be reduced by decreasing the amount of estrogen in the pill
* including nausea, breast tenderness
* breakthrough bleeding
* weight gain
* fluid retention
* amenorrhea
* melasma
36
teaching with OCs
* teach how to use properly
* 3 methods of how begin OC use:
* quick start: preferred, take first pill on day pills are prescribed, backup for first 7 days unless cycle started less than 5 days ago
* first day start: 1st pill taken on 1st day of next menstrual period
* Sunday start: pills begun on 1st Sunday after menses start, use backup for 1st 7 days of first cycle
* teach about SEs, and that spotting is common
37
blood hormone levels w/ OCs
* maintaining a constant blood hormone level is important for effectiveness
* woman must take pills near same time each day
* illness may affect blood hormone levels
* if experience vomiting/diarrhea, use a backup method of contraception for 7 days
38
missed doses of OCs
* if miss inactive pill, just discard and continue
* 1 missed pill:
* take 1 active pill ASAP, take next dose at usual time
* continue pack as usual, no backup needed
* 2+ missed pills in 1st 2 weeks
* take 2 pills ASAP, then one tab daily
* use backup for 7 days
* 2 missed pills in last week of active pills
* take 1 active pill each day until finished, discard inactive
* start new pack next day
39
OCs: postpartum and lactation
* COCs inc the risk for a thromboembolism and reduce milk production in lactating women
* avoid COCs for 3 weeks after giving birth
* avoid for 4 weeks if lactating
* if hx of thromboembolism, avoid for 6 weeks
40
what are the warning signs of OC complications?
* **ACHES**
* **A**: abdominal pain
* vein thrombosis, , benign liver tumor, gallbladder dz
* **C**: chest pain, dyspnea, hemoptysis
* PE or MI
* **H**: HA, weakness, numbness, HTN
* stroke migraine
* **E**: eye problems
* retinal vein thrombosis, stroke, migraine
* **S**: severe leg pain, swelling, heat, redness
* DVT
41
emergency contraception
* morning after pill
* method to prevent pregnancy after unprotected sex
* available to women of all age w/o a prescription
* works by inhibiting ovulation, thickening cervical mucus, and interfering w/ function of corpus luteum
* but ineffective if implantation already took place
* take ASAP or up to 120 hours after unprotected sex
* may need anti-emetic
42
transdermal contraceptive patch
* AKA Ortho Evra
* action: releases estrogen and progestin which suppress oculation and thicken cervical mucus
* changed once a week
* wear a new patch for 3 weeks, then remove for 1 week for a period
* use non hormonal contraceptive during the first week of use
* fertility returns quickly
* SEs: spotting, breast tenderness, HAs, skin rxns
* risk of VTE higher w/ patch than pill
* less effective if weight more than 198 lb
* never apply to breasts
43
vaginal contraceptive ring
* AKA NuvaRing
* insert into vagina for 3 weeks
* action: releases estrogen and progestin to prevent ovulation
* use can be during first 5 days of menstrual cycle
* backup contraceptive is necessary for fist 7 days of 1st cycle
* SE: HA, vaginitis, expulsion, vaginal discharge/discomfort, breakthrough bleeding
* ring may be removed for up to 3 hours w/o loss of effectiveness
44
barrier methods
* involve chemicals or devices that prevent sperm from entering the cervix
* may kill sperm or place temporary partition b/w penis/cervix
* all are coitus related
* avoid use of systemic hormones
45
chemical barriers
* spermicides: chemicals that kill sperm
* effective for less than 1 hour
* woman should not douche for at least 6 hours after research
* they are inserted deep into vagina about 15 min before sexual interourse so that they are in contact with the cervix
* available w/o prescription, inexpensive
* inc lubrication, but messy
46
male condom
* cover the penis to prevent sperm from entering the vagina
* usually made of latex and may be coated w/ lubricant
* best protection against STDs
* no prescription needed, inexpensive
* water based lubricant helps prevent breakage
47
female condom
* AKA vaginal pouch
* polyurethane sheath inserted into the vagina
* flexible ring inside the end fits into the cervix and another ring extends outside the vagina to cover the perineum
48
contraceptive sponge
* made of polyurethane and acts by trapping and absorbing semen and contains spermicide
* provides contraception for 24 hours
* no prescription, no hormones, easy to use
* should remain in place after the last intercourse for 6 hours
* do not use during menstruation or left in place for more than 24-30 hours, b/c inc risk of TSS
49
diaphragm
* latex dome surrounded by a spring
* place spermicide into dome and around rim and insert over the cervix
* prevents passage of sperm
* must be fitted by HCP
* must recheck each year, after a weight gain/loss of 10 lb, after each pregnancy
* should not be used for first 6 weeks after pregnancy
* inc risk of UTIs
50
cervical cap
* cuplike device placed over the cervix to prevent sperm from entering
* fitted by HCP
* stays in place by suction
* can remain in place for 48 hours
* but do not remove for 8 hours after the last intercourse
* add more spermicide if intercourse is repeated
* do not use if hx of TSS
51
Natural Family Planning (NFP)
* use physiologic cues to predict ovulation so that women can determine when conditions are favorible for ovulation
* acceptable to most religious groups and avoids use of drugs, chemicals, devices
* couples must be highly motivated b/c must abstain from intercourse during as much as half the menstrual cycle
52
abstinence
* avoidance of sexual intercourse and any activity that may allow sperm to enter the vagina
* requires perfect use to be effective
* no cost, avoids hormones, and has no side effects or medical risks
53
least reliable methods of contraception
* breast feeding
* inhibits ovulation b/c suckling and prolactin interfere w/ secretion of gonadotropin releasing hormone and LH
* frequency, intensity, and duration of suckling are important in inhibiting ovulation
* menstrual cycle resumes w/in 6 mos
* coitus interruptus
* removal before ejaculation
* requires great control by the man and may be unsatisfying to both partners
* sperm spilled on the vulva may enter the vagina and cause pregnancy
