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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
Q

Describe the two day method

What if you have no secretions and are dry for 2 whole days?

A

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.

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26
Q

What is Coitus Interruptus?

Failure rate?

Does this protect against infections?

A

Oldest method where male withdrawals before ejaculation.

Failure rate is 22% due to pre-ejaculate containing sperm.

No protection

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27
Q

Barrier method

A

Barrier method is a method where there is some sort of condom involved.

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28
Q

What are condoms made out of?

A

Latex
Silicone
Polyurethane (sti infection protection)

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29
Q

If a condom has nonoxynol-9 what does that mean?

What should the wearer leave at the end of a condom?

A

It means there is a spermicide - which kills sperm to increase prevention from pregnancy

Leave space at the end so semen can accumulate.

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30
Q

What type of lubrication should you use with a condom?

Can you use condoms more than once?

A

Water or silicone based.
NOT petroleum - this leaves holes.

Use condoms only once.

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31
Q

What are female condoms? Which method do they go with?

Can you use this with spermicide?

A

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.

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32
Q

Why should you be cautious about removing a female condom?

A

The female condom is more risky to remove and can cause pregnancy if spilled.

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33
Q

How many times can you use a female condom?

A

Once

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34
Q

What is a vaginal diaphragm made out of?

How do you get one?

A

Flexible silicone or latex dome with a wire rim that you have to be prescribed and fitted for to use.

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35
Q

How long can you use a vaginal diaphragm before needing a new one?

What should you reapply to the vaginal diaphragm?

A

Can use the vaginal diaphragm for about 2 years.

You’ll need to reapply spermicides

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36
Q

How long must you wear the vaginal diaphragm before removing?

A

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

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37
Q

Why do you need to see a GYN when using a vaginal diaphragm?

What are reasons you’d have to refit the vaginal dipahragm?

A

Exam makes sure it fits well.

Refit for 20% weight gain or loss && pregnancy

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38
Q

What can a vaginal diaphragm increase risk of?

A

Cystitis or urethritis due to an increase in pressure against bladder and urethra
A main complaint

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39
Q

How to clean a vaginal diaphragm?

A

Clean with soap and water

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40
Q

How to check for holes in the vaginal diaphragm?

A

Hold up to the light & do so periodically

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41
Q

Reasons why someone may not be ok to use a vaginal diaphragm?

A

Toxic shock syndrome history

Abnormal discharge

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42
Q

Cervical cap method?
How to get one?

Other names?

A

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

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43
Q

What does the central valve of a cervical cap allow for?

Is spermicide used?

A

The central valve allows for flow of cervical secretions and mucus

Yes, a cervical cap can use spermicide

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44
Q

How long can a cervical cap be left in place?

How long is too much & why?

A

Need to leave in for 6 hours at least

But don’t wait any longer than 48 hrs bc of Toxic shock syndrome

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45
Q

What is a vaginal sponge?

How can someone get a sponge?

A

Known as “Today’s Sponge”
Single use soft polyurethane device that contains a spermicide (N-9)

They are OTC

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46
Q

How long can you wear a a vaginal sponge for?

A

Leave in for at least 6 hrs but not more than 24 hrs

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47
Q

Your patient is wearing a vaginal sponge & they develop a rash. Why might this be happening?

Can it move tho?

A

This can happen due to allergic rxn

Yes it can move but it is better than nothing

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48
Q

Nulliparous meaning & how it relates to the vaginal sponge

A

Nulliparous means never having a baby before

Sponge method works best for Nulliparous women

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49
Q

What are long acting contraceptives ? (LARC)

A

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

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50
Q

How does an IUD work?

Why is it a good thing this is radiopaque?

A

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

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51
Q

When should you check the IUD strings & why?

A

Check IUD strings after menses and before sex to make sure it is still in place

52
Q

Does the Paragard IUD have hormones? Why or why not?

How long can it be left in to work?

A

It uses copper which makes it hormone free & it lasts up to 10 years

(copper is a natural spermicide)

53
Q

If you use the Mirena IUD will that have hormones?

How long can it be left in to work?

A

Yes Mirena has hormones.

Lasts for 5 years

54
Q

Liletta IUD’s other names?

Do they use hormones?

How long can these 3 be kept in for?

Why might these be preferred?

A

Skyla and Kyleena (levonorgestrel)

They use hormones

Can be used for 3 years.

They are more flexible so less uterus penetration

55
Q

How can an IUD affect your bleeding?

A

IUD can cause bleeding to increase at first. Later on you may only have spotting or amenorrhea

56
Q

Is there any risk to the uterus by using an IUD?

A

Yes, the uterus is at risk for Uterine Perforation if the iud isn’t flexible enough
(L/S/K are better for this)

57
Q

What acronym can be used to describe IUD side effects?

A

PAINS

Period late or unusual bleeding
Abdomen pain
Infection risk signs due to string hanging 
Not feeling well
String missing or shorter
58
Q

An IUD increases what type of pregnancy?

A

Increase risk of ecoptic tubal pregnancy (of the fertilized egg growing outside the uterus in fallopian tubes)

59
Q

Can a nulligravada woman use an IUD?

A

Yes - a woman who has never been pregnant before can use an IUD now.

60
Q

Your patient wearing an IUD become pregnant despite usage. What should the doctor recommend for plan of care concerning the IUD? Why?

A

Best practice is to remove the IUD to prevent any infection, miscarriage, or preterm labor

61
Q

Types of oral contraceptive

A 
Combo (estrogen & progesterin) 
Mini pill (progesterin only)
62
Q

What does the combo pill do?

How does it affect estrogen and progesterone?

A

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
Q

In the combo pill pack what types of pills are there?

Will you bleed at all?

A

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
Q

What is the big issue with the newer brands of combo pills?
Effective rate?
What should you do if you miss a pill?

A

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
Q

Besides contraception, why else would someone take a BC combo pill?

A

Can help with PMS symptoms like pain, migraines
Control of irregular bleeding and anemia
Endometriosis pain
Acne

66
Q

What acronym describes complications with taking the combo pill?

A 
ACHES
abdominal pain (liver or gallbladder issue)
Chest pain or SOA
Headaches
Eye problems
Severe leg pain from clots
67
Q

How does the combo pill affect diabetic patients?

What about for cardiovascular issues?

A

Can decrease effectiveness of hypoglycemic agents

Decrease effectiveness of Oral anticoagulants due to estrogen thickening the blood

68
Q

What meds can make the combo pill less effective?

A

Combo pill can be affected by….

barbiturates
anticonvulsants
antifungals
antibiotics
TB meds
HIV meds
69
Q

How does the seasonal oral contraceptive work?

What hormones are involved?

A

Take pills for 84 days straight
Then take placebo for 7 days
Repeat

Still deals with estrogen and progesterin (levongestrel)

70
Q

How many periods will you have a year with season oral contraceptives?

What type of patient may want to use this?

A

About 4

Anemic patients

71
Q

If your pregnant should you take the combo pill? why or why not?

A

Don’t take it. It can ruin your pregnancy.

72
Q

Why should you not take the combo pill if you have liver or gallbladder diseases?

A

The combo pill can cause pain in those areas (due to increased cholesterol - but you don’t actually need to know that)

73
Q

Why should you not take a combo pill if you have a hx of thrombophlebitis?

A

Due to estrogen thickening the blood

74
Q

Why should you avoid combo pill with uterine bleeding?

A

Well you really shouldn’t take anything until you know what is causing the bleeding

75
Q

Why would an estrogen dependent cancer keep someone from using a combo pill?

A

The combo pill contains estrogen & could cause cancer cells to increase

76
Q

Why should a person with a smoking issue not take a combo pill?

A

Smoking causes all sorts of complications but it can also increase clot formation

77
Q

Three big reasons/health conditions to not take a combo pill?

A

Hypertension
Diabetes
Hyperlipidemia

78
Q

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?

A

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
Q

What is the transdermal patch?

A

“Ortho Evra” prescription patch on skin that delivers hormones.

80
Q

Where can you put the patch?

A

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
Q

How often are you going to change the patch?

A

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
Q

Maximum weight limit for patch?

A

198 ibs

83
Q

Is the patch more or less reliable then oral contraceptives?

A

More reliable due to steady exposure and absorption through skin thus no peak level or a lower peak level

84
Q

If patient is high risk for DVT can they take the patch?

A

NO - due to estrogen thickening the blood.

Med should have a Black box warning

85
Q

Should you go swimming for a couple hours with the patch?

How should you remove the patch if you choose to?

A

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
Q

What is the Nuva Ring?

Does the Nuva Ring have to be over the cervix?

A

Contraceptive ring that has a low dose sustained estrogen and progesterin release.

Ring just has to go into vaginal canal.

87
Q

How many weeks do you wear the Nuva Ring for?

A

3 weeks

Remove the 4th week so withdrawal bleeding can occur

88
Q

Does the Nuva Ring require a fitting? Weight limit?

A

Nope, one size fits all. Also 198 ibs

89
Q

What should you do with replacement Nuva Rings?

A

Refrigerate them

90
Q

Can you take the nuva ring out for sex?

A

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
Q

How to clean off the nuva ring if the ring falls out?

A

Rinse w warm water and reinsert immediately

92
Q

Injectable form of contraceptive?

Where is the usual injection sight? Should you massage?

A

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
Q

Before giving you the injection contraceptive, what will they test you for

A

Pregnancy test

94
Q

Injection black box warning?

Vitamins and supplements to take?

A

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
Q

Can breastfeeding women take an injection ?

A

yes due to progestin only

96
Q

injection side effects

A

irregular bleeding
ovarian cysts
wt gain

97
Q

What is return fertility like with an injection?

A

It can vary or even be delayed

98
Q

Subdermal impant?
Where does it go?
Hormone?

and size?

A

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
Q

How can they see where the subdermal implant is?

How long can you use Nexplanon?

A

Nexplanon has radiopaqueness

Use for 3 years

100
Q

How does subermal implant Nexplanon work?

A

It thickens mucus to prevent ovulation

101
Q

Subdermal implant Nexplanon side effects?

A 
irregular bleeding
wt gain
scarring from keloids
mood changes
head aches
102
Q

Does a subdermal implant protect you from stis?

A

NOOOO. Use condom

103
Q

What is post coital contraception?

A

Emergency contraception or plan B

104
Q

Why would a woman want to use post coital contraception?

A

Rape
Contraception failure

ONLY METHOD that can be used after coitus

105
Q

How soon should Levongestrol emergency contraceptive be taken?

A

No later than 72 hrs

106
Q

What is Ella?

How does it work?
Do you need a rx?

A

Emergency contraceptive that should be taken within 5 days
It is the progesterone receptor modulator

It is from pharmacy but no rx. OTC

107
Q

Can you take oral bc as emergency contraceptive?
Side effects?

What type of IUD can be used?

A

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
Q

Estrogen concern

Progesterone concern

A

clots for estrogen & cell growth

irregular bleeding w progesterone

109
Q

Female sterilization is what type of contraceptive?

A

It is permanent sterilization.

110
Q

What exactly is involved in female sterilization

How old do you have to be?

A

Occlude or block the fallopian tubes. Use clips, plugs. ligation, bands

Need to be 21

111
Q

Will hospitals do female sterilization?

A

After delivery but not all of them.

After delivery is a good time tho bc tubes are prominent here.

112
Q

If a woman is married - what are the legal steps needed to do female sterilization?

A

Needs consent from both partners

113
Q

Female sterilization complications?

A

Bowel trauma
Pain
infection
anesthesia risks

114
Q

Main male contraceptive?

What age?

Who will do this?

A

Vasectomy or permanent ligation of vas deferens

Must be 21 & have informed consent

Outpatient procedure place like urologist or even clinics

115
Q

Post op care for Vasectomy

A

ice
support of the scortum
rest 2 days

116
Q

How is it they determine the vasectomy was successful & is thus an acceptable form of birth control for you from now on?

A

Need to do a semen analysis for 3 different specimens with zero sperm count
4-6 weeks

117
Q

Vasectomy side effects?

Can it be reversed?

A

pain & infection

It can be reversed but not always successful

118
Q

Induced abortion

Made legal by?

A

Choosing to terminate a pregnancy

Roe vs Wade case legalizing abortions less than 20 weeks

119
Q

Alternatives to abortion

A

Adoption

Pregnancy support

120
Q

First trimester abortion

A

Suction of lining or DC

121
Q

Second trimester abortion

A

Dilation of cervix to remove contents of uterus

122
Q

Pills abortions

A

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
Q

Abortion complications

A

infections
bleeding
cervical trauma - can make labor down the road super hard bc of lack of dilation

124
Q

Lactational Amenorrhea for birth control?

A

Meaning breast feeding after delivery can remove period for a while and work as contraception

125
Q

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?

A

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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