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NURS 4500: Final Material > Class 11: Contraception & Reproduction Choices > Flashcards

Class 11: Contraception & Reproduction Choices Flashcards

1
Q

what are categories of contraception (5)

A
  • hormonal
  • non-hormonal
  • natural
  • permanent
  • emergency
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2
Q

what are examples of hormonal types of contraception (2)

A
  • OCP
  • IUD/IUS
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3
Q

what are examples of non-hormonal types of contraception

A
  • condoms (male and female)
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4
Q

what are examples of natural types of contraception (3)

A
  • withdrawal
  • fertility awareness
  • lactational amenorrhea method
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5
Q

what are examples of permanent types of contraception (2)

A
  • vasectomy
  • tubal ligation
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6
Q

what are considered the most (1-2 pregnancies/100 people)effective methods of contraception (5)

A
  • progestin only IUS
  • progestin implant (0.5/1000) (Nexplanon)
  • vasectomy
  • tubal ligation/occlusion
  • non-hormonal IUD - copper
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7
Q

what are considered the mid-range (4-9 pregnancies/100 people) effective methods of contraception (6)

A
  • combined estrogen & progestin oral pills – COC
  • patch
  • vaginal ring
  • lactational amenorrhea
  • progestin only injection
  • progestin only mini - pill
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8
Q

what are the least effective (>13 pregnancies/100 people) methods of contraception (3)

A
  • withdrawal
  • fertility awareness
  • barriers: condoms
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9
Q

there are more contraindications to estrogen or progesterone?? what does this mean?

A
  • more contraindications to estrogen than progesterone = some people may need progesterone only pill
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10
Q

how do hormonal pills vary

A
  • some have steady state of hormones
  • or ones which fluctuate week by week
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11
Q

what type of IUDs are extremely effective?

A
  • hormonal IUDs
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12
Q

what is nexplanon

A
  • progesterone-only implant injected into inner arm
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13
Q

describe the release of hormones via nexplanon, how long does it stay in?

A
  • releases hormones slowly
  • stays in for 3 years
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14
Q

how often and where is a progestin injection given?

A
  • given in muscle once every 12-15 weeks
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15
Q

which is more effective: progestin only pill or combined

A
  • combined
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16
Q

what is imp to note with progestin only pills to prevent decreased effectiveness

A
  • taken at exact same time every day
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17
Q

describe reversal of tubal ligation

A
  • very difficult to reverse
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18
Q

describe the presence of hormones in a copper IUD

A
  • contains no hormones
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19
Q

what is lactational amenorrhea

A
  • protection provided by chest feeding
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20
Q

with lactational amenorrhea, what should still be used?

A
  • condom
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21
Q

ovulation may still occur w lactational amenorrhea if..

A
  • if breastfeeding is infrequent (less than q4h in day or 6 hrs at night)
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22
Q

what should be assessed r/t contraception (10)

A
  • reproductive health history (include STIs)
  • general & current medical history
  • meds
  • current knowledge on reproduction, sexual health, contraception, and STIs
  • ability to access (afford)
  • efficacy
  • adherence
  • protection from STIs
  • comfort
  • contraindications
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23
Q

define efficacy r/t contraception

A
  • how important it is that you do not become pregnancy
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24
Q

what should be recommended if the pt absolutely does not want to become pregnant?

A
  • high effectiveness methods of contraceptions
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25
Q

describe adherence r/t contraceptions

A
  • how well someone will be able to stick to the contraceptive method
    ex. if cant remember to take pill every day, look at other options
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26
Q

what is the only thing that protects against STIs

A
  • condoms
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27
Q

due to the protection condoms provide against STIs, when should condoms for sure be used? (2)

A
  • if you don’t know someone’s STI status
  • or are not monogamous
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28
Q

what should be considered r/t comfort w contraception

A
  • invasive vs noninvasive
    ex. some dont want IUDs
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29
Q

describe the need for parent consent for medical treatment in canada

A
  • in Canada, an adolescent does not require parental consent for medical treatment including contraception
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30
Q

what is included in hormonal contraception (6)

A
  • combined oral contraceptive (COC)
  • progestin-only pill (POP)
  • injectable contraception
  • vaginal ring
  • contraceptive patch
  • intrauterine contraception (IUS/IUD/IUC)
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31
Q

what are side effects to monitor for with hormonal contraception

A

ACHES

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32
Q

what does ACHES stand for

A

Abdominal pain
Chest pain/dyspnea
Headache (severe)
Eye problems
Swelling & leg pain

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33
Q

why is it important to assess for abdominal pain w hormonal contraception

A
  • increased risk for liver or gallbladder problems
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34
Q

why is it important to monitor the “CHES” of ACHES with hormonal contraception

A
  • related to clotting or strokes
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35
Q

what is the MOA of COC (4)

A
  • suppresses ovulation
  • endometrial changes to reduce chance of implantation (decreases proliferation)
  • thickens cervical mucus
  • impairs motility of fallopian tubes
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36
Q

what are benefits of COC (4)

A
  • shorter menses
  • regular cycle
  • reversible
  • reduces risk of endometrial & ovarian cancer
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37
Q

what are risks of COC (2)

A
  • VTE
  • side effects
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38
Q

what are contraindications of COC (10)

A
  • smoking and age >35
  • HTN
  • VTE
  • heart disease
  • CVA
  • breast cancer
  • liver disease
  • migraines w aura
  • diabetes w complications
  • AUB
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39
Q

what is a risk associated w COC

A
  • clotting
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40
Q

define: aura

A
  • visual disturbances prior to migraine
    ex. lights, spots
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41
Q

with diabetes, what should be considered with COC contraception

A
  • weigh risk of pregnancy (very risky) against risk of taking pill
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42
Q

what is AUB? what should be done w this prior to prescribing a hormonal pill to regulate

A
  • abnormal uterine bleeding
  • should investigate why this is happening
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43
Q

what is the MOA of POP (4)

A
  • suppresses ovulation
  • endometrial changes to reduce chance of implantation (decreases proliferation)
  • thickens cervical mucus
  • impairs the motility of fallopian tubes
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44
Q

what are benefits of POP (4)

A
  • can be used when estrogen is contraindicated
  • shorter menses
  • regular cycle
  • reversible
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45
Q

what are risks w POP

A
  • side effects
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46
Q

what are contraindications to POP (3)

A
  • breast cancer
  • AUB
  • liver disease
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47
Q

what is an imp consideration w POP

A
  • take at same time every day
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48
Q

what is imp to note w suppressing of ovulation w COC vs POP

A
  • POP not as consistent in suppressing ovulation
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49
Q

is there any STI protection with oral contraceptive pills?

A
  • no
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50
Q

intrauterine contraception is placed where? by who?

A
  • in the uterus by a provider
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51
Q

what options are available w intrauterine contraception (2)

A
  • hormonal option
  • non hormonal options (copper)
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52
Q

describe the effectiveness and reversibility of intrauterine contraception

A
  • highly effective
  • reseversible
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53
Q

in a hormonal IUD, what hormones are present

A
  • no estrogen, just progestin
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54
Q

describe menses w hormonal IUDs

A
  • menses may stop completely
  • or reduce flow of menses
55
Q

describe menses w non hormonal IUDs

A
  • often heavier menstrual flow & cramping
56
Q

what are risks w IUD (3)

A
  • infection
  • rupture of uterus
  • expulsion
57
Q

what protection against STIs does intrauterine contraception provide?

A
  • no protection
58
Q

what should be checked before inserting intrauterine contraception

A
  • should check for infection within the genital tract before inserting –> may swab
59
Q

describe the return of fertility after removal of an IUD

A
  • fertility returns quickly
60
Q

when does follow up occur w intrauterine contraception

A
  • follow up after 1st menstrual cycle
61
Q

failure of intrauterine contraception is related to..

A
  • it falling out
62
Q

an IUD may fall out with.. (2)

A
  • early PP
  • uterine structure issues
63
Q

what should be felt outside the cervix w an IUD? what should happen if they are not felt?

A
  • strings
  • if not in place, get an ultrasound
64
Q

what are 2 types of condoms

A
  • male
  • female
65
Q

what is the MOA of condoms

A
  • barrier method
66
Q

what are benefits of condoms (2)

A
  • protection from STIs
  • protection from pregnancy
67
Q

what are risks of condoms (2)

A
  • improper use
  • breaks
68
Q

what are contraindications to condoms

A
  • latex allergies
69
Q

see box 8-9 p.159 in txtbook on info to teach pts on the proper use of condoms

A

know, will likely test on

70
Q

what is the failure rate of condoms

A
  • with correct & consistent use 2%
  • with typical use 15%
71
Q

what are types of natural contraceptives (4)

A
  • withdrawal
  • fertility awareness
  • lactational amenorrhea method
  • abstinence
72
Q

what are the least effective contraceptive methods

A
  • fertility awareness
73
Q

how many become pregnant w withdrawal

A

22/100 / year

74
Q

how many become pregnant w fertility awareness

A

24/100 /year

75
Q

how many become pregnant w lactational amenorrhea method

A

2/100 /year in first 6 months PP

76
Q

what are benefits of natural contraceptives (2)

A
  • no hormones
  • no devices
77
Q

what are risks of natural contraceptives

A
  • higher risk of failure w most (except abstinence) compared w other methods
78
Q

describe the protection against STIs natural contraceptives provide

A
  • no protection from STIs except abstinence
79
Q

what is fertility awareness

A
  • tracking cycle and most fertile periods & avoiding sex during those time frames
80
Q

what are types of permanent contraceptives (3)

A
  • vasectomy
  • tubal ligations
  • tubal occlusion
81
Q

what is the MOA of permanent contraceptives

A
  • surgical interventions to prevent pregnancy
82
Q

what is a benefit of permanent contraceptives

A
  • very effective
83
Q

describe the reversibility of permanent contraceptives

A
  • not easily reversible
84
Q

what is a risk associated w permanent contraceptives

A
  • complications from the procedure are possible
85
Q

what is a contraindication for permanent contraceptives

A
  • not for those who desire pregnancy in the feture
86
Q

describe protection against STIs permanent contraceptives provide

A
  • without condoms, no protection from STIs
87
Q

describe the invasiveness of vasectomies

A
  • much less invasive than tubal ligation & occlusion
  • done in 15 min, outpt procedure
88
Q

what is included in emergency contraception (2)

A
  • oral medication
  • or copper IUD
89
Q

what is the MOA of oral EC pills

A
  • prevent ovulation
90
Q

when should plan B be taken

A
  • take asap (best within 24 hrs, most effective early on) or up to 5 days after intercourse
91
Q

the oral EC pill ella requires?

A
  • prescription
92
Q

when should ella be taken

A
  • more effective than Plan B over the 5 days after intercourse
93
Q

what is the MOA of copper IUD

A
  • inhibits fertilization and implantation
94
Q

when can a copper IUD be inserted as EC

A
  • can be inserted within 7 days of unprotected intercourse
95
Q

what is the most effective EC

A
  • copper IUD
96
Q

what are contraindications for oral EC

97
Q

when should menses return after use of a copper IUD for EC? what if it doesnt return by then

A
  • should occur in 3-4 weeks after insertion
  • if not by then, pregnancy test
98
Q

when should menses return after use of oral EC? what if it doesnt return by then?

A
  • 21 days
  • if no menses after 21 days, test for pregnancy
99
Q

what should be considered w use of EC

A
  • need to test and treat STIs
  • review reproductive plan & offer reliable contraceptive methods
100
Q

semen can live for up to..

101
Q

describe how BMI impacts the effectiveness of plan B

A
  • people with high BMI will have lower effectiveness on plan B
102
Q

oral EC only works if…

A
  • if there has not been ovulation (early in cycle)
103
Q

a medical abortion in MB can be provided for __ weeks gestation

104
Q

what can be used for medical abortion (2)

A
  • mifepristone
  • misoprostol
105
Q

surgical abortion can be provided in clinic for up to __ weeks gestation

106
Q

surgical abortion can be provided in hospital for up to __ weeks gestation

A

19+6 weeks

107
Q

with a medical abortion, they may require ____ if not sure about last menses

A
  • ultrasound
108
Q

describe the cost for abortion services in MB

A
  • no cost at women’s health clinic, HSC, or brandon hospital if you have a MB healthcare card or provincial coverage
109
Q

to receive a medical abortion, access to ___ is required

A

ultrasound

110
Q

what is important consider w abortion services

A
  • accessibility –> everything in winnipeg or brandon, not easily accessible up north
111
Q

what is imp to note in women who get an abortion and are Rh-

A
  • Rh- women with a negative coomb’s test will require Rh immune globulin
112
Q

all people seeking care for abortion services should have..

A
  • access to informed and trained providers to counsel on their options, procedures, risks, follow-up care, and post-abortion contraception
113
Q

what should all people have before receiving an abortion (5)

A

physical exam including:
- height
- weight
- pelvic exam
- VS
- Rh bloodwork

114
Q

what is included in nursing care for abortion (3)

A
  • preop
  • op
  • and postop care
115
Q

what is given w surgical abortion services

A
  • IV meds to provide analgesia & reduce anxiety
116
Q

what type of surgical abortion is provided?

A
  • aspiration
117
Q

describe aspiration

A
  • freezing injected into cervix
  • cervix is dilated
  • suction tube inserted into uterus
118
Q

who must complete a sugrical abortion

A
  • a licensed provider (physician)
119
Q

describe the time requirement of a surgical abortion

A
  • relatively quick & completed in 1 appt
120
Q

what is included in the nursing role for surgical abortions (9)

A
  • history
  • pre-op
  • VS
  • lab tests
  • education
  • review record for signed consent
  • IV
  • op and postop care
  • discharge teaching
121
Q

what is important discharge teaching for a surgical abortion

A
  • cant drive themselves home afterwards
122
Q

describe partner support during a surgical abortion

A
  • no partner support during procedure
123
Q

describe the dosage of mifepristone & misoprostol for a medical abortion

A
  • mifepristone po x 1, then misoprostol 4 tabs po x1 24-48 hrs later
124
Q

what are side effects of misoprostol

A
  • NV
  • fever
  • chills
  • diarrhea
125
Q

what is expected w a medical abortion? when should this reduce?

A
  • heavy bleeding
  • should reduce on 2nd day
126
Q

describe success on medical abortion

127
Q

what is required after a medical abortion

A

follow up appointment

128
Q

what occurs in the follow up appt after a medical abortion

A
  • bloodwork (HCG)
  • appt w provider
129
Q

how long after taking misoprostol will bleeding & cramping occur?

A
  • start 30 min - 4h after
130
Q

what is a benefit of medical abortion (3)

A
  • can control time & place
  • can take meds home
  • can control who they are with
131
Q

what is included in discharge teaching after abortion (6)

A
  • tampons should be avoided
  • normal personal hygeine
  • intercourse
  • waste for S&S of infection
  • watch for abnormally heavy bleeding/clots larger than a lemon
  • contraception –> you can get pregnant at any time
132
Q

menses should return how long after abortion?

A

in 4-6 weeks

133
Q

what is a sign of heavy bleeding after abortion

A
  • more than 4 pads soaked in 2 hrs
134
Q

what are S&S of infection after abortion (3)

A
  • fever greater than 38
  • purulent vaginal discharge
  • uterine tenderness

NURS 4500: Final Material (16 decks)

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