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Maternal Exam 1 > Family Planning > Flashcards

Family Planning Flashcards

1
Q

Family planning definition

A

Conscious decision of when to conceive or avoid pregnancy

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2
Q

Contraception

A

intentional prevention of pregnancy

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3
Q

Birth Control

A

Device or method used to decrease risk of pregnancy

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4
Q

Effectiveness and safety considerations of contraception

Cost?

Religion?

A

You want the most effective method possible but you also want it to be safe.

Want it to be easily available and affordable to make sure will they use it.

Does BC/contraception go against one’s religion? Catholicism for instance

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5
Q

Age considerations of contraception

A

Is the age they are appropriate for complications?

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6
Q

Parity

Can you use an IUD if your parity is none (or you’re nulliparious)?

A

Is the amount of times pregnant.

Yes, now you can.

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7
Q

Why do you need to ask about how many partners someone has?

A

Some contraception works better than others

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8
Q

T/F

Diabetics can use whichever contraception they want

A

False.

Diabetes can limit your options of contraception

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9
Q

Can motivation affect contraception effectiveness?

Cooperation too?

A

Yes. If someone doesn’t comply, then it won’t work as well.

Sometimes you may even have to abstain from intercourse.

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10
Q

BRAIDED acronym of informed consent

A 
Benefits
risks
alternatives
inquiries
decision
explanation/education ; make sure they know how to use it
document
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11
Q

What do fertility awareness methods do?

When does it require abstinence?

A

They’re a method of contraception which focuses on knowing the fertile periods during the menstrual cycle.

Abstinence is needed during fertile days of the cycle.
This is also the method with the least amount of side effects.

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12
Q

What is the calendar method?

How long do you have to record for the calendar rhythm method of contraception?

How many days do you need to count back to know ovulation?

A

The calendar method uses the dates of your menstrual flow to calculate when you are fertile (so no checking mucus or anything. Just math).

Method that requires recorded cycles for 6+ months

Know when you started your menses & count back 14 days to know how far back you were ovulating.

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13
Q

How many days for the calendar method do you need to count back to know when you should practice abstinence?

What is the risk in using the calendar method?

A

Subtract 18 days from shortest cycle
Subtract 11 days from longest cycle
The days in between are when you should abstain.

You’re relying on old data to calculate the future events. Lots of things can throw you off.

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14
Q

What does the Basal Body Temp method detect?
Drop hormone?
Rise hormone?

A

It detects ovulation based off temp changes in your cycle.
The drop is from estrogen around start of ovulation.
The progesterone causes the rise (only tenth of degree)
But this only happens in regular cycle so if yours is irregular, this method is not for you.

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15
Q

How long do you need to record temp before BBT is effective?

A

3-4 months to learn your body

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16
Q

What type of things can affect your temp? (4)

A

Illness
Stress or anxiety
Lack of sleep
Alcohol

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17
Q

What does the Billings method measure and look at?

What does fertile mucus look like?

pH level of mucus?

Pattern in mucus?

A

It looks for physical changes in the mucus.

Fertile:
thin, watery
spinnbarkheit (clear and stretchy)

high pH making it more sperm friendly

ferning

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18
Q

Using the Billing method, you notice your mucus looks fertile. How long should you abstain from sex?

A

Abstain from sex until 4 days after the last day you detect fertile “wet” mucus.

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19
Q

You use the Billing method and your mucus looks infertile (key word here). What does it look like? What hormone is involved in this?

A

Thick
Sticky
Less of it

Progesterone

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20
Q

What do antihistamines do to your mucus levels?

Other factors that can affect your mucus?

A

Will dry you up

Presence of semen
Infections that can affect discharge
Douching

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21
Q

What does the sympothothermal method combine?

Is this more accurate?

A

Combines Basal temp with the observation of mucus (billilngs)
Yes, it is more accurate than them being seperate

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22
Q

Fertile indicators that you should look for with the Sympothermal method.

Libido?
Any spotting?
Mittelschmerz present?
How does the cervix feel?
What mucus changes?
Pelvic and vulvar feeling?
BBT?

Effective or not?
Main uses?

A

Increased libido
Mid cycle spotting can be present.
Mittelschmerz = mid cycle pain associated w ovulation due to free blood & yes.
Cervix feels soft
Mucus becomes much thinner & watery. Also stretchy.
Pelvic and vulvar fullness
BBT drops then rises (bc you combine mucus & temp fo this method).

Again, it is more effective than the two seperate methods.
Can be used to achieve or avoid pregnancy

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23
Q

What do Ovulation predictors do?

How reliable is this?

How many hours is the ovum able to be fertilized?
How long is sperm capable of fertilization?

A

Method that predicts ovulation by checking the LH levels related to ovulation 24 hrs beforehand. After this, fertility is greatest the next 3 days.
Pretty reliable.

24 hrs
48 hrs for sperm to penetrate the ovum

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24
Q

Marquette Model does what?

accuracy?

A

Combines cervical mucus with urinary metabolites of estrogen & LH using test strips to test for fertility periods.
88-90% accurate

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25
Describe the two day method What if you have no secretions and are dry for 2 whole days?
Highly recommended method by ascension where you check mucus every-time you go to the bathroom. The presence of fertile like mucus yesterday or today means you are currently fertile If you're completely dry than you're not fertile So, if you want to avoid getting pregnant, make sure to abstain from sex until mucus is dry for at least 2 days. And the next time you check your mucus and it is fertile, do it again.
26
What is Coitus Interruptus? Failure rate? Does this protect against infections?
Oldest method where male withdrawals before ejaculation. Failure rate is 22% due to pre-ejaculate containing sperm. No protection
27
Barrier method
Barrier method is a method where there is some sort of condom involved.
28
What are condoms made out of?
Latex Silicone Polyurethane (sti infection protection)
29
If a condom has nonoxynol-9 what does that mean? What should the wearer leave at the end of a condom?
It means there is a spermicide - which kills sperm to increase prevention from pregnancy Leave space at the end so semen can accumulate.
30
What type of lubrication should you use with a condom? Can you use condoms more than once?
Water or silicone based. NOT petroleum - this leaves holes. Use condoms only once.
31
What are female condoms? Which method do they go with? | Can you use this with spermicide?
Female condoms are like a reverse condom with a more flexible ring that is considered a barrier method. Yes the female condom can be used with a spermicide.
32
Why should you be cautious about removing a female condom?
The female condom is more risky to remove and can cause pregnancy if spilled.
33
How many times can you use a female condom?
Once
34
What is a vaginal diaphragm made out of? How do you get one?
Flexible silicone or latex dome with a wire rim that you have to be prescribed and fitted for to use.
35
How long can you use a vaginal diaphragm before needing a new one? What should you reapply to the vaginal diaphragm?
Can use the vaginal diaphragm for about 2 years. You'll need to reapply spermicides
36
How long must you wear the vaginal diaphragm before removing?
Need to wear for at least 6 hrs after last act so it can kill all the sperm before removal but don't wear longer than 24 hrs
37
Why do you need to see a GYN when using a vaginal diaphragm? What are reasons you'd have to refit the vaginal dipahragm?
Exam makes sure it fits well. Refit for 20% weight gain or loss && pregnancy
38
What can a vaginal diaphragm increase risk of?
Cystitis or urethritis due to an increase in pressure against bladder and urethra A main complaint
39
How to clean a vaginal diaphragm?
Clean with soap and water
40
How to check for holes in the vaginal diaphragm?
Hold up to the light & do so periodically
41
Reasons why someone may not be ok to use a vaginal diaphragm?
Toxic shock syndrome history | Abnormal discharge
42
Cervical cap method? How to get one? Other names?
Reusable silicone barrier that works by covering the cervix and is held by walls of the vagina but also requires a prescription Other names are Lea's shield or FernCap
43
What does the central valve of a cervical cap allow for? Is spermicide used?
The central valve allows for flow of cervical secretions and mucus Yes, a cervical cap can use spermicide
44
How long can a cervical cap be left in place? | How long is too much & why?
Need to leave in for 6 hours at least | But don't wait any longer than 48 hrs bc of Toxic shock syndrome
45
What is a vaginal sponge? How can someone get a sponge?
Known as "Today's Sponge" Single use soft polyurethane device that contains a spermicide (N-9) They are OTC
46
How long can you wear a a vaginal sponge for?
Leave in for at least 6 hrs but not more than 24 hrs
47
Your patient is wearing a vaginal sponge & they develop a rash. Why might this be happening? Can it move tho?
This can happen due to allergic rxn Yes it can move but it is better than nothing
48
Nulliparous meaning & how it relates to the vaginal sponge
Nulliparous means never having a baby before | Sponge method works best for Nulliparous women
49
What are long acting contraceptives ? (LARC)
Used for an extended period of time but they are reversible - meaning you will ovulate again if you stop.. Could be an IUD or IUC
50
How does an IUD work? Why is it a good thing this is radiopaque?
Device inserted into uterus to cause inflammatory response that inhibits ability to conceive Bc if you're afraid it fell out you can find it with an xray
51
When should you check the IUD strings & why?
Check IUD strings after menses and before sex to make sure it is still in place
52
Does the Paragard IUD have hormones? Why or why not? | How long can it be left in to work?
It uses copper which makes it hormone free & it lasts up to 10 years (copper is a natural spermicide)
53
If you use the Mirena IUD will that have hormones? | How long can it be left in to work?
Yes Mirena has hormones. | Lasts for 5 years
54
Liletta IUD's other names? Do they use hormones? How long can these 3 be kept in for? Why might these be preferred?
Skyla and Kyleena (levonorgestrel) They use hormones Can be used for 3 years. They are more flexible so less uterus penetration
55
How can an IUD affect your bleeding?
IUD can cause bleeding to increase at first. Later on you may only have spotting or amenorrhea
56
Is there any risk to the uterus by using an IUD?
Yes, the uterus is at risk for Uterine Perforation if the iud isn't flexible enough (L/S/K are better for this)
57
What acronym can be used to describe IUD side effects?
PAINS ``` Period late or unusual bleeding Abdomen pain Infection risk signs due to string hanging Not feeling well String missing or shorter ```
58
An IUD increases what type of pregnancy?
Increase risk of ecoptic tubal pregnancy (of the fertilized egg growing outside the uterus in fallopian tubes)
59
Can a nulligravada woman use an IUD?
Yes - a woman who has never been pregnant before can use an IUD now.
60
Your patient wearing an IUD become pregnant despite usage. What should the doctor recommend for plan of care concerning the IUD? Why?
Best practice is to remove the IUD to prevent any infection, miscarriage, or preterm labor
61
Types of oral contraceptive
``` Combo (estrogen & progesterin) Mini pill (progesterin only) ```
62
What does the combo pill do? | How does it affect estrogen and progesterone?
Suppresses feedback of pituitary for FSH & LH. Meaning - no estrogen so no follicle maturation. And no progesterone meaning no release of a follicle. Which overall means NO OVULATION
63
In the combo pill pack what types of pills are there? Will you bleed at all?
In total you'll take 28 pills. The first 21 are the hormone pills. The last 7 are usually the placebo or sugar pills. Will have withdrawal bleeding for 1-4 days
64
What is the big issue with the newer brands of combo pills? Effective rate? What should you do if you miss a pill?
Newer brands have less hormones in them which means you need to take them on schedule. Erratic usage can lead to pregnancy. About 99% effective If yo miss one pill take asap. If you miss more than one use another contraceptive method
65
Besides contraception, why else would someone take a BC combo pill?
Can help with PMS symptoms like pain, migraines Control of irregular bleeding and anemia Endometriosis pain Acne
66
What acronym describes complications with taking the combo pill?
``` ACHES abdominal pain (liver or gallbladder issue) Chest pain or SOA Headaches Eye problems Severe leg pain from clots ```
67
How does the combo pill affect diabetic patients? | What about for cardiovascular issues?
Can decrease effectiveness of hypoglycemic agents Decrease effectiveness of Oral anticoagulants due to estrogen thickening the blood
68
What meds can make the combo pill less effective?
Combo pill can be affected by.... ``` barbiturates anticonvulsants antifungals antibiotics TB meds HIV meds ```
69
How does the seasonal oral contraceptive work? What hormones are involved?
Take pills for 84 days straight Then take placebo for 7 days Repeat Still deals with estrogen and progesterin (levongestrel)
70
How many periods will you have a year with season oral contraceptives? What type of patient may want to use this?
About 4 Anemic patients
71
If your pregnant should you take the combo pill? why or why not?
Don't take it. It can ruin your pregnancy.
72
Why should you not take the combo pill if you have liver or gallbladder diseases?
The combo pill can cause pain in those areas (due to increased cholesterol - but you don't actually need to know that)
73
Why should you not take a combo pill if you have a hx of thrombophlebitis?
Due to estrogen thickening the blood
74
Why should you avoid combo pill with uterine bleeding?
Well you really shouldn't take anything until you know what is causing the bleeding
75
Why would an estrogen dependent cancer keep someone from using a combo pill?
The combo pill contains estrogen & could cause cancer cells to increase
76
Why should a person with a smoking issue not take a combo pill?
Smoking causes all sorts of complications but it can also increase clot formation
77
Three big reasons/health conditions to not take a combo pill?
Hypertension Diabetes Hyperlipidemia
78
What is the mini pill? What type of woman would want to take this? Is there any room for missed pills with the mini pill?
Progesterin only pill (it is synthetic). The type who'd have to avoid estrogen such as breastfeeding or other risk factors . No room - you need to take this pill on time due to one hormone in small amounts. .
79
What is the transdermal patch?
"Ortho Evra" prescription patch on skin that delivers hormones.
80
Where can you put the patch?
You can put the patch on the abdomen, butt, arms, and trunk. Do not put it on the breast. Rotate every time you put a new one on
81
How often are you going to change the patch?
Change every week. You will put a new one on every week for 3 weeks straight and then the 4th week you will leave the patch off so you can have your period.
82
Maximum weight limit for patch?
198 ibs
83
Is the patch more or less reliable then oral contraceptives?
More reliable due to steady exposure and absorption through skin thus no peak level or a lower peak level
84
If patient is high risk for DVT can they take the patch?
NO - due to estrogen thickening the blood. | Med should have a Black box warning
85
Should you go swimming for a couple hours with the patch? How should you remove the patch if you choose to?
Probably not. Water can ruin the adhesive. You can still shower and everything. Just be mindful of how long you're in water. Remove with adhesive remover or else you'll have a gummy residue left behind.
86
What is the Nuva Ring? Does the Nuva Ring have to be over the cervix?
Contraceptive ring that has a low dose sustained estrogen and progesterin release. Ring just has to go into vaginal canal.
87
How many weeks do you wear the Nuva Ring for?
3 weeks | Remove the 4th week so withdrawal bleeding can occur
88
Does the Nuva Ring require a fitting? Weight limit?
Nope, one size fits all. Also 198 ibs
89
What should you do with replacement Nuva Rings?
Refrigerate them
90
Can you take the nuva ring out for sex?
Yes, you can take it out for up to 3 hrs | So you wear the nova ring when you're not having sex but for sex you cant take it out if you prefer
91
How to clean off the nuva ring if the ring falls out?
Rinse w warm water and reinsert immediately
92
Injectable form of contraceptive? Where is the usual injection sight? Should you massage?
Depro Provera injection of to block LH (DMPA) Injected in the arm/deltoid usually due to less pressure than other places . Don't massage
93
Before giving you the injection contraceptive, what will they test you for
Pregnancy test
94
Injection black box warning? Vitamins and supplements to take?
Use for 2 years or less due to bone density loss Vit D, calcium, and do exercise ! Bone loss is reversible but dont like people taking this for long periods of time
95
Can breastfeeding women take an injection ?
yes due to progestin only
96
injection side effects
irregular bleeding ovarian cysts wt gain
97
What is return fertility like with an injection?
It can vary or even be delayed
98
Subdermal impant? Where does it go? Hormone? and size?
Nexplanon which is a single rod w progesterin only. Goes in upper arm subdermal tissue w local anesthesia size is about 2mm x 4cm
99
How can they see where the subdermal implant is? How long can you use Nexplanon?
Nexplanon has radiopaqueness Use for 3 years
100
How does subermal implant Nexplanon work?
It thickens mucus to prevent ovulation
101
Subdermal implant Nexplanon side effects?
``` irregular bleeding wt gain scarring from keloids mood changes head aches ```
102
Does a subdermal implant protect you from stis?
NOOOO. Use condom
103
What is post coital contraception?
Emergency contraception or plan B
104
Why would a woman want to use post coital contraception?
Rape Contraception failure ONLY METHOD that can be used after coitus
105
How soon should Levongestrol emergency contraceptive be taken?
No later than 72 hrs
106
What is Ella? How does it work? Do you need a rx?
Emergency contraceptive that should be taken within 5 days It is the progesterone receptor modulator It is from pharmacy but no rx. OTC
107
Can you take oral bc as emergency contraceptive? Side effects? What type of IUD can be used?
You can take this at a high dosage as recommended by your provider. Side effects include n/v so take an antiemetic Copper IUD can be used as a plan B method
108
Estrogen concern Progesterone concern
clots for estrogen & cell growth irregular bleeding w progesterone
109
Female sterilization is what type of contraceptive?
It is permanent sterilization.
110
What exactly is involved in female sterilization How old do you have to be?
Occlude or block the fallopian tubes. Use clips, plugs. ligation, bands Need to be 21
111
Will hospitals do female sterilization?
After delivery but not all of them. | After delivery is a good time tho bc tubes are prominent here.
112
If a woman is married - what are the legal steps needed to do female sterilization?
Needs consent from both partners
113
Female sterilization complications?
Bowel trauma Pain infection anesthesia risks
114
Main male contraceptive? What age? Who will do this?
Vasectomy or permanent ligation of vas deferens Must be 21 & have informed consent Outpatient procedure place like urologist or even clinics
115
Post op care for Vasectomy
ice support of the scortum rest 2 days
116
How is it they determine the vasectomy was successful & is thus an acceptable form of birth control for you from now on?
Need to do a semen analysis for 3 different specimens with zero sperm count 4-6 weeks
117
Vasectomy side effects? Can it be reversed?
pain & infection It can be reversed but not always successful
118
Induced abortion Made legal by?
Choosing to terminate a pregnancy Roe vs Wade case legalizing abortions less than 20 weeks
119
Alternatives to abortion
Adoption | Pregnancy support
120
First trimester abortion
Suction of lining or DC
121
Second trimester abortion
Dilation of cervix to remove contents of uterus
122
Pills abortions
Mifespristone up to 9 weeks with or without Misorprostil which causes uterus contractions Methotrexaxate with misoprostil which interacts w rna synthesis Prostaglinds for uterine contractility
123
Abortion complications
infections bleeding cervical trauma - can make labor down the road super hard bc of lack of dilation
124
Lactational Amenorrhea for birth control?
Meaning breast feeding after delivery can remove period for a while and work as contraception
125
Lactational amenorrhea ideal practices Can you breastfeed & bottle feed? Can you have one or two menses after giving birth How old can infant be ? How often should infant be fed? Can giving an infant a tiny bit of formula instead of breast milk ruin method?
Must be breastfeeding only No menses since birth Infant must be younger than 6 months Fed routinely around the clock Yes - you need to do it.

Maternal Exam 1 (9 decks)

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