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Women's Health Test II > Chapter 31: Family Planning > Flashcards

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
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2
Q

what are the most popular contraceptive methods in the US?

A
  • oral contraception
  • tubal sterilization
  • male condoms
  • vasectomy
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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
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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
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5
Q

what is the best protection from STDs?

A

male condom

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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
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7
Q

what are the most effective long acting reversible contraceptives?

A

IUDs and contraceptive implants

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8
Q

what types of contraceptives may lead to amenorrhea in some women?

A
  • hormone implants or injections
  • IUDs
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9
Q

what are some benefits to oral contraceptives besides prevention of pregnancy?

A
  • reduction of acne
  • decreased bleeding during periods
  • prolonged amenorrhea
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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
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11
Q

which types of contraceptives are available OTC without prescription?

A
  • condoms
  • spermicides
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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
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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
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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
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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
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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
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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

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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
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19
Q

complications of sterilization

A
  • hemorrhage
  • infection
  • anesthesia complications
  • pregnancy: more likely to be ectopic after sterilization
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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
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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
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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
  • 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
Q

which women should not use IUDs?

A
  • recurrent pelvic infections
  • hx of ectopic pregnancy
  • bleeding disorders
  • abnormalities of the uterus
26
Q

IUDs: teaching

A
  • 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
Q

hormone implant

A
  • 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
Q

hormone injections

A
  • 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
Q

oral contraceptives (OCs)

A
  • work by inhibiting ovulation
  • available as combination OC (w/ progestin and estrogen) and as “minipills” (w/ progestin only)
30
Q

Combination OCs

A
  • 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
Q

Progestin Only Pills

A
  • 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
Q

which women should not sure OCs?

A
  • 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
Q

benefits of OCs

A
  • 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
Q

risks of OCs

A
  • 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
Q

SEs of OCs

A
  • 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
Q

teaching with OCs

A
  • 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
Q

blood hormone levels w/ OCs

A
  • 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
Q

missed doses of OCs

A
  • 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
Q

OCs: postpartum and lactation

A
  • 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
Q

what are the warning signs of OC complications?

A
  • 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
Q

emergency contraception

A
  • 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
Q

transdermal contraceptive patch

A
  • 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
Q

vaginal contraceptive ring

A
  • 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
Q

barrier methods

A
  • 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
Q

chemical barriers

A
  • 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
Q

male condom

A
  • 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
Q

female condom

A
  • 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
Q

contraceptive sponge

A
  • 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
Q

diaphragm

A
  • 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
Q

cervical cap

A
  • 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
Q

Natural Family Planning (NFP)

A
  • 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
Q

abstinence

A
  • 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
Q

least reliable methods of contraception

A
  • 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

Women's Health Test II (8 decks)

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