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N395 Final > Contraception > Flashcards

Contraception Flashcards

1
Q

Shared decision making

A
  • Decide jointly on a contraceptive method
  • Consider barriers and benefits
  • Individualized
  • Patient should be active participant
  • Consider when she wants to conceive, what is important to her, what concerns her
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2
Q

Considerations impacting choice of contraception

A
  • HER PREFERENCES
  • Motivation
  • Cost
  • Cultural/religious considerations
  • Convenience
  • Effectiveness (most important)
  • Side effects
  • Safety
  • STI protection
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3
Q

Address prior knowledge

A
  • Past contraceptive use

- Myths and misconceptions

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4
Q

Triangle for helping patients decide

A
  • Begin with what is most important to her
  • Explain contraindications
  • Support her choice
  • Offer other choices if necessary
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5
Q

Nurse’s role with contraceptives

A
  • Make sure patients know about available methods
  • Educate them about use
  • Ensure they have follow-up care
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6
Q

Effectiveness of methods

A
  • Most effective = implant, vasectomy, female sterilization, IUD
  • Middle = injectable, pills, patch, ring, diaphragm
  • Least = male condoms, female condoms, sponge, withdrawal, spermicides, fertility awareness
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7
Q

Failure rate

A
  • Number out of every 100 women who experienced an unintended pregnancy within the first year of typical use
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8
Q

Two types of BC

A

Hormonal and non-hormonal

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9
Q

Hormonal BC

A
  • Pills
  • Injection
  • Patch
  • Ring
  • IUD: mirena, skyla
  • Implant
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10
Q

Non-Hormonal BC

A
  • Paragard IUD
  • Condoms
  • Diaphragm/sponge
  • Natural family planning
  • Withdrawal
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11
Q

Birth control pills

A
  • Long lasting but not permanent
  • Alter hormones: estrogen and progestin or progestin only used to inhibit ovulation
  • Also alter cervical mucus to inhibit sperm penetration
  • No STI protection
  • 9% failure with typical use and 0.3% with perfect use
  • Antibiotics can render ineffective
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12
Q

Contraindications for combined BC pills

A
  • Over 35 and smoker
  • HTN
  • DVT
  • Migraines with aura
  • Breast cancer
  • Complicated diabetes
  • Certain anticonvulsants
  • Lupus
  • Cardiac risk factors
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13
Q

Progestin only pills

A

Use for:

  • Breastfeeding moms
  • Women over 35 who smoke
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14
Q

Depo-Provera Injection

A
  • Progesterone-only contraceptive
  • Q12 weeks
  • Potential for bone loss
  • May give in mother baby
  • Can cause problems with breastfeeding
  • 6% failure with typical use and 0.3% failure wtih perfect use
  • MOA: suppress ovulation and production of hormones, thickens cervical mucus, causes endometrial atrophy
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15
Q

Ring

A
  • Flexible, soft ring inserted into vagina for 3 weeks then take out for one week (period)
  • Insert as far back as possible
  • Estrogen and progestin
  • Reduced side effects because absorbed directly into blood stream
  • 9% failure with typical use and 0.3% failure with perfect
  • MOA: Inhibit ovulation, change cervical mucus and endometrium
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16
Q

Patch

A
  • Matchbox size placed anywhere but breasts
  • 3 weeks on then patch-free week (period)
  • Side effects reduced because absorbed directly into bloodstream
  • Risk of DVT and PE
  • Hormones: estrogen and progestin
  • 9% failure with typical and 0.3% failure with perfect
  • MOA: prevent ovulation, also change cervical mucus
17
Q

Implant

A
  • Steady dose of progestin: prevents ovulation and thickens mucus
  • 3 years of protection
  • Rod: Minor surgery to insert and remove
  • Side effects: irregular bleeding, headache, weight gain, breast tenderness, depression
  • 0.05% failure with typical use
18
Q

Contraindications for nexplanon implant

A
  • Pregnancy
  • Active DVT
  • Severe hepatic disease
  • Personal hx of breast cancer
  • Undiagnosed vag bleeding
  • Inability to tolerate irregular period
19
Q

Long acting reversible contraceptives

A

IUD: mirena, skyla, paragard
Impants: nexplanon

20
Q

ParaGard

A
  • Copper IUD
  • Use up to 10 years or as emergency contraception
  • No hormones
  • MOA: impairs viability of sperm and interferes with sperm movement
21
Q

Skyla

A
  • Hormonal IUD
  • Smaller than Mierna
  • Approved for up to 3 years
  • Good for nulliparas
22
Q

Mirena

A
  • Hormonal IUD
  • Approved for up to 5 years
  • Amenorrhea in 20% of users by 1 year
23
Q

MOA of hormonal IUD

A
  • Progestin only
  • Creates inflammatory response = fatal to sperm
  • Thicken cervical mucus
  • Ovulation NOT INHIBITED
  • Thin endometrial lining
24
Q

IUD contraindications

A
  • Pregnancy
  • Cervical malignancy
  • Breast/endometrial cancer
  • Distorted uterine cavity
  • Current PID
  • Current purulent discharge
  • Wilson’s disease (just for copper IUD)
25
Q

Barrier method

A
  • Physically prevent sperm from reaching ovum
  • Many contain latex
  • Diaphragm, cervical cap, condom, sponge
26
Q

Diaphragm

A
  • Soft latex dome surrounded by metal ring
  • Use with spermacide jelly
  • Insert up to 4 hours before sex and leave in 6 hours after
  • Rx and professionally fitted
  • 12% failure with typical and 6% with perfect
27
Q

Spermacide

A
  • Substance that is toxic to sperm
  • Frequent use can breakdown vag tissue and increase HIV susceptibility
  • Most effective when used with barrier method
  • 28% failure with typical and 18% perfect
28
Q

Sterilization

A
  • Popular in developed nations
  • More women than men have it (18% women and 7% men)
  • Permanent but reversal is possible
29
Q

Tubal ligation

A
  • Can happen during c/s, PP, after abortion or procedure unrelated to pregnancy
  • Laparoscope near umbilicus
  • Seal, cut, tie fallopian tubes
  • 0.5% failure with typical and 0.1% perfect
30
Q

Essure

A
  • Transcervical sterilization
  • Visualize fallopian tubes through cervix so don’t need anesthesia or surgery
  • Introduce coil into tube which blocks tube within 3 months
31
Q

Vasectomy

A
  • Outpatient w local anethesia
  • Cut vas deferens
  • Still have semen but no sperm (have semen specimen)
  • 0.15% failure with typical and 0.1% with perfect
32
Q

Fertility awareness methods

A
  • Cervical mucus ovulation method: clear, slippery, smooth, stretchy = fertile
  • Basal body temp: temp rises postovulation and stay until menses
  • Symptothermal method: identify s/s and monitor temp
  • Standard days and 2 days: avoid intercourse on days 8-19 of cycle
  • 24% failure with typical
33
Q

Important tips with fertility awareness

A
  • Women must know their bodies and be comfortable touching themselves
  • Less convenient and spontaneous
  • Must communicate openly with partner
34
Q

Lactational amenorrhea method

A
  • Continuous breastfeeding can postpone ovulation because stimulated prolactin and inhibits gonadotropin (needed for ovulation)
  • Good for 6 months PP but only with no period, BF 6x/day, on demand, no supplements, nighttime feeds Q6 hours
  • 1-2% failure
35
Q

Withdrawal

A
  • Pull and pray
  • Least effective
  • Pre-ejaculate may contain sperm, requires lots of control and trust
  • 22% failure with typical and 4% with perfect
36
Q

Emergency Contraception

A
  • Use within 72 hours unprotected sex
  • The sooner the better
  • Reduces pregnancy risk by 80%
  • Plan B, copper IUD
  • Side effects: N/V
  • Do not use as regular contraception
  • MOA: delays ovulation, thickens mucus

N395 Final (8 decks)

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