Exam 2 Flashcards
Nearly have of pregnancies in the U.S. are what?
Not planned
Among 75% of adolescents that become pregnant did not _____ ______.
Plan it.
The U.S. has the highest rate of what?
Teen pregnancy
What is contraception?
- It is keeping the egg and the sperm apart.
* The intentional prevention of pregnancy during sexual intercourse
What is birth control?
A device or a practice that decreases the risk for conceiving
What is family planning?
The conscious decision on when to conceive throughout the reproductive years
The decision to practice conception should be a decision made by who?
- A woman
* A woman and her significant other
What is part of initiating conception?
Informed consent
What is informed consent?
BRAIDED •Benefits: birth control •Risk: Always •Alternatives: may not a med •Inquiries: chance to ask questions •Decisions: who decides w/ HCP •Explanations •Documentation
What is the cornerstone of the nursing care plan and planned Interventions?
Education
What are methods of contraception?
- Fertility Awareness Based Methods (FABs)
* Consider cultural and religious beliefs
What is the only form of birth control that is recognized by the roman catholic church?
Natural Family Planning
•Avoid intercourse during fertility periods
What does a woman know when she is fertile?
- Ovulation test strips
* Basal temperature
What are calendar based methods?
- Track when cycles are
- Lasting of menstrual cycle
- Symptoms
- Ovulating or not (increase in cervical mucous)
What are methods of contraception?
- Spermicides
* Barrier Methods
What are spermicides?
- Nonoxynol-9 (N-9) which reduces sperm motility
* Typical failure rate in first year of spermicidal use alone is 29%
Are spermicides effective?
No
What barrier methods are used?
- Condoms: M&F (vaginal sheath)
- Diaphram: 4 types
- Cervical caps:FemCap available in U.S.
- Contraceptive sponge: Today Sponge
- Toxic shock syndrome: risks are present w/ diaphragms, cervical caps, and sponges
What do condoms also protect against?
STDs
Do spermicides, intrauterine devices, and oral contraceptives protect against STDs?
No
What does a woman have to do for a diaphram?
- Get fitted for it.
* Needs to be refitted if she’s had any significant changes in weight or if she was pregnant
How are hormonal methods available?
- In varying formulations and administration; >100 different formulations available
- Combined estrogen-progestin oral contraceptives (COCs)
What is the point of oral contraceptives?
- To inhibit ovulation by preventing the formulation of a follicle.
- We are suppressing the surge of the leutinizing hormone.
How are combined estrogen-progestin oral contraceptives administered?
- Injection
- Transdermal (patch placed on weekly for 3 weeks and on the 4th week no patch)
* Rotate sites
What is a vaginal ring?
- Combo contraceptives
* Nuva ring
What is a Nuva ring?
- Inserted into the vagina in the first 5 days of the cycle
- Important that women have backup contraceptives for 7 days after insertion
- Removed every 3 weeks so they are ring free for one week
What are warning signs to teach patients starting or taking COCs?
ACHES
•Abdominal pain may Indicate a problem with the liver of gallbladder
•Chest pain or SOB may Indicate possible clot problem within the lungs or heart
•Headaches (sudden or persistent) may be caused by cardiovascular
•Eye problems may indicate vascular accident or hypertension
•Severe leg pain may Indicate a thromboembolic
What is not ideal for patients with underlying cardiac issues?
Oral contraceptives because of the risk
What is very common with the Nuva ring?
•Severe leg pain (DVT) blood clots
What are some other adverse effects that we need to educate our patient on with methods of contraception?
- MI
- Stroke
- Suedomenstruation
- Birth control won’t work while on antibiotics
- Related to increase in estrogen:
- N/V
- Dizziness
- Fluid retention
- Leg cramps
- BP unexpectedly high
What is pseudomenstruation?
- Happens on off week of cycle
- Occurs monthly
- Occurs during the 7 day of hormone free period
- Mimics the 28th day menstrual cycle
What is Progestin-only contraception?
- Contains no estrogen
- Safer
- Decreases the risk of cardiovascular side effects
What are some common side effects of Progestin-only contraception?
- Irregular bleeding and spotting
- Depression
- Mood changes
- Decreased libido
- Weight gain
- Recurrent yeast infections
- Acne
What kind of Progestins are there?
- Oral (Mini pill)
- Injectable
- Implantable
What is the failure rate for users that use Progestins (Mini pill)?
•9%
What is Progestin?
- Has to be taken at the same time every day
- Good option for breast feeding mom’s because progesterone won’t effect milk supply
- Inhibits conception by increasing viscosity of survical mucous
- Inhibits the surge of Lh
What is the injectable Progestin called?
- Depot vera
- Highly effective due to its action
- Lasts 11-13 weeks
- Thickens cervical mucosa
- Decreases motility of fallopian tubes
- Fertility may be delayed after taking (3 months)
What are implantable Progestins?
- Rods that are implanted
* Last up to 3 years
What is a Intrauterine device (IUD)?
- Device planted into uterus
- Small T shaped
- Lasts 3-10 years depending on brand
What are the 4 IUDs?
- ParaGard Copper T
- Mirena
- Liletta
- Skyla
How long is the ParaGard Copper T 380A effective for?
Up to 10 years
What does the Mirena release and how long is it effective for?
- Levonorgestrel
* Effective up to 5 years
What does Liletta release and how long is it effective for?
- Releases levonorgestrel
* Up to 3 years
What does Skyla release and how long is it effective for?
- Releases levonorgestrel
* Up to 3 years
What is the typical failure rate of IUDs in the first year?
0.2%
Do IUDs offer protection against STIs or HIV?
No
What is it important that we educate our patients on?
ACHES (signs of potential complications)
What are other methods of contraception?
- Permanent sterilization
* Female sterilization: Tubule occlusion
* Male (Vasectomy): interruption of bad deferens
When is the best day to start a contraceptive?
The first day a woman experiences menstrual flow
What is a quick start with contraceptives?
Can start at anytime but would need backup for 7 days and pregnancy HAS to be ruled out
What happens if someone has a missed dose of contraceptive and they are taking the combo (estrogen-progestin)?
- Take the next tablet and next scheduled tablet
- If more than 3 doses or 3 doses is missed she needs to discontinue the pack and allow for withdrawal bleeding and start a new pack
What happens if someone has a missed dose of contraceptive and they are taking Progestin only contraceptives?
•Take that pill as soon as we realize it’s missed and backup contraceptives is needed for 48 hours
What is the breast feeding method of contraceptive?
- Lactational Amenorrhea (LAM)
- Temporary
- For breast feeding mom exclusively breast feeding around the clock
- Not effective if mom is pumping
What is conception?
Ovum is released during ovulation then the sperm enters the female reproductive system and the egg and sperm join
Where do the sperm and egg join?
Outer 1/3th of the fullopian tube
How long is sperm fertile for?
48 hours
How long are ovum fertile?
24 hours
When and where does implantation occur?
- The endometrium
- Occurs 6-10 days after fertilization
- Bleeding or spotting may occur
What is the first layer that is made?
Fetal membranes •Chorion •Amnion Chromosomes •XX- Female •XY- Male
How is sex determined?
By the father of the baby
What does amniotic fluid do for the fetus?
- Space for movement and protection
- Thermoregulation
- Nutrients and fluid
- Protection
- Prevents umbilical cord suppression
- Prevents amnion adhering to the fetus
What can the amniotic fluid be tested for?
•Genetic studies
How much amniotic fluid should be present at birth?
800-1200mL
What is polyhydromnios?
Too much amniotic fluid >2000mL
What can too much amniotic fluid indicate?
GI malformations
What is Oligohydramnios?
Not enough amniotic fluid (<300 mL)
What can Oligohydramnios indicate?
•Renal malformations
What is the umbilical cord?
- Lifeline between mom and baby
- Protected by Wharton’s Jelly
- No pain receptors
- Has 3 vessels:
- 2 arteries: carries deoxygenated blood and waste away from baby
- 1 vein: carries oxygenated and nutrient rich blood to fetus
What is the placenta considered?
An endocrine gland because it secretes: HPL hCG Estrogen Progesterone
What is detected in maternal serum 10 days after conception?
hCG
What is needed for fetal growth and development?
HPL
What is secreted by the placenta?
Estrogen
Progesterone
When does the placenta develop and fully function?
- 3 weeks
* 12 weeks
What does the placenta regulate?
Regulates transport of gases, nutrients, and waste
Towards the end of pregnancy the placenta begins to what?
Age
Less effective of transportation of gas and nutrients
What is the maternal side of the placenta called?
The dirty dunkin
What is the fetal side of the placenta called?
The shiny shultz
What is the pre-embryonic stage?
- Conception to day 14
- Rapid cell division
- All tissues and organs will develop from
- Primary germ layer and the embryonic membranes form
What is the embryonic period?
- Period where defect most likely occurs week 3-5
- Day 15 to week 8
- Structures of major organs are complete
- Organ systems are functioning
- Teratogens!!! (Harmful to fetus and can cause defects) are greatest threat during this period
What are examples of teratogens?
- Radiation
- Lead
- Chemotherapy
- CMV (A virus)
- MMR vaccine: rule out pregnancy first and ensure she avoids pregnancy 28 days after vaccine; is safe for breastfeeding mother’s
What is the period of time for the fetus?
Week 8 to birth
What months are the 1st trimester?
Months 1,2,3
What happens to the fetus during the 1st trimester?
- Limb buds
- Hematopoiesis (blood cell formationweek 3)
- Day 25 the heart is beating
- The 4th week the GI system is functioning
- Formation of liver, thyroid, bones, muscles, epidermis
- Neutral tube: start of CNS
- Folic acid is important for women of child bearing to take
- Fetus is 1/2 inch <1 oz
What are good sources of folic acid?
- Green leafy vegetables
- Orange juice
- Fortified cereals
What is the first functioning system?
Cardiac system
What happens in the 2nd month of the 1st trimester?
- Ears, ankles, wrists
- Eyelids-SHUT
- Hematopiesis continues
- 5th week swallowing and voiding
- Brain has 5 lobes
- Rh FACTOR>6 weeks
- Fetus is 1 in <1 oz
What is the second most important factor when looking at blood type?
Rh factor
ABO
A+
Rh are what?
•found as proteins on red blood cells
What happens during month 3 of the 1st trimester?
•Fingers and toes •Soft nails •Baby teeth •Doppler •Renal function •Moving •Adrenal cortex producing hormones •Sex characteristics •Lanugo covers the body of the baby (Fine hairs) Vernix casiosa (cheese like coating) •2.5 inches >1 oz
What hapoens during the 4th month of the 2nd trimester?
- Moves, kicks, swallows
- Handprints 16 weeks
- Forming meconium
- Placenta is fully formed
- 6-7 inch 5 oz
What hapoens during the 4th month of the 2nd trimester?
- Moves, kicks, swallows
- Handprints 16 weeks
- Forming meconium
- Placenta is fully formed
- 6-7 inch 5 oz
What hapoens during the 5th month of the 2nd trimester?
- Sleep/ wake intervals
- Week 20: insulin
- 8-12 inches 1/2 lb
- Actively felt by mom
What hapoens during the 6th month of the 2nd trimester?
- Lanugo all over
- Eyes open
- 11-14 inches 1-1.5 inches 1-1.5 lb
- 24 weeks
What trimester is the fetus viable?
The end of the 2nd trimester
What does viable mean?
The baby is more likely to survive outside of mom