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Maternal Newborn > Family Planning > Flashcards

Family Planning Flashcards

1
Q

If wanting to use the “Calendar Method,” how long does the woman have to track her period?

A

6 months

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2
Q

How should a woman using the “Calendar Method” calculate her period of abstinence?

A

Subtract 18 days from shortest cycle
Subtract 11 days from longest cycle

These together give the window for abstinence.

Example: If woman has very regular cycle of 28 days,

shortest: 28-18 = 10th day
longest: 28-11 = 17th day

so the 10th-17th day would be her period of abstinence.

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3
Q

What makes the “Calendar Method” the least reliable type of BC?

A

have to predict future events based on past data

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4
Q

How does the BC method “Basal Body Temp” work?

A

uses basal body thermometer to detect ovulation by monitoring temperature changes during ovarian cycle

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5
Q

When should a woman take her temp. when using the “Basal Body Temp” method? How long?

A

every morning before getting out of bed and record on graph for 3-4 months

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6
Q

How is body temperature affected by hormones?

A

Temperature drops 0.5 C before ovulation (r/t estrogen) and then rises 0.4-0.8 C for 2-4 days after ovulation (r/t progesterone)

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7
Q

What are some variables that affect temperature monitoring?

A
  • infection
  • fatigue
  • lack of sleep
  • awakening late
  • anxiety
  • ETOH consumption
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8
Q

What is the main idea of the “Ovulation or Billings Method”?

A

interpreting cervical mucus

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9
Q

What are the characteristics of fertile cervical mucus?

A
  • abundant
  • watery
  • Spinbarrkeit (stretchy)
  • thin
  • alkaline (sperm-friendly)
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10
Q

How long should a woman abstain if fertile mucus is present?

A

from first day of fertile mucus until 4 days after last “wet” day

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11
Q

Characteristics of infertile mucus

A
  • thick
  • sticky
  • less abundant
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12
Q

Factors that can affect cervical mucus

A
  • sperm
  • antihistamines
  • contraceptive gels or foams
  • infections (discharge)
  • douches
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13
Q

How do antihistamines affect fertile mucus?

A

Antihistamines dry up secretions, so the characteristics of fertile/infertile mucus can change.

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14
Q

Symptothermal Method

A

Combines “Basal Body Temp” and “Cervical Mucus” info into one method

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15
Q

What is considered the most reliable and effective fertility awareness method?

A

the Symptothermal Method

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16
Q

Indicators of fertility

A
  • female libido
  • midcycle spotting (during ovulation)
  • Mittelschmerz
  • cervical mucus changes
  • pelvic or vulvar fullness
  • basal body temp drop followed by rise
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17
Q

What is Mittelschmerz?

A

mid-cycle abdominal pain associated with the release of the ovum from the graafian follicale

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18
Q

What do ovulation predictor kits (OPKs) detect?

A

LH surge that occurs up to 24hrs < ovulation

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19
Q

When is fertility greatest?

A

up to 3 days after ovulation

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20
Q

Are ovulation predictor kits reliable? Why?

A

Yes. Results are not affected by illness, emotional upset, or physical activity.

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21
Q

How long is an ovum capable of fertilization?

A

24hrs

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22
Q

How long are sperm capable of fertilization?

A

48hrs

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23
Q

What is the “Marquette Model” and why is it not widely used?

A

Utilizes cervical mucus monitoring with urinary metabolites of estrogen and LH

It is very expensive.

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24
Q

Explain the “Two Day Method”

A
  • check mucus before voiding
  • presence of cervical mucus today or yesterday = fertile today
  • no secretions for 2 consecutive days = not fertile
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25
Q

What is the “Coitus Interrupts Method”?

A

The male withdraws before ejaculating.

  • least effective (r/t preejaculation being present during sex even before true ejaculation)
  • provides no protection from infections
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26
Q

What is the male barrier method?

A

a silicone or latex condom

  • some are tx with spermicide
  • require space at end to collect semen
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27
Q

What kind of lubricant can be used with male condoms?

A

water soluble or silicone

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28
Q

True or False:

It is safe to use petroleum-based lube with male condoms.

A

FALSE

Petroleum-based lubes can breakdown the material of the condom. Only water soluble or silicone lubes should be used.

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29
Q

What is the female barrier method?

A

a polyurethane or synthetic latex condom

  • flexible ring at both ends (one open end, one closed end)
  • SHOULD BE USED WITH SPERMICIDE
  • remove with caution to not spill sperm
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30
Q

Vaginal diaphragm

A

A flexible silicone or latex dome w/ flexible wire rim that covers the cervix and under symphysis pubis.

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31
Q

How long can a vaginal diaphragm be used?

A

up to 2 years

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32
Q

True or False:

A vaginal diaphragm can be bought OTC.

A

FALSE.

Rationale: A vaginal diaphragm requires a prescription and must be fitted by a physician.

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33
Q

Is spermicide needed when using a vaginal diaphragm?

A

Yes.

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34
Q

True or False:

A woman should wear her vaginal diaphragm for at least 6hrs after sex.

A

TRUE.

Rationale: She should not leave it in for longer than 24hrs after sex.

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35
Q

True or False:

A woman should have annual GYN exams done if using a diaphragm.

A

TRUE.

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36
Q

When does a diaphragm require refitting?

A

After > 20% weight gain or loss, pregnancy

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37
Q

Case Study:

A young women c/o getting pregnant when using diaphragm with spermicide. The diaphragm she has been using is 1.5 years old. She says it’s within the 2 years and doesn’t know why it failed.

A

A vaginal diaphragm can develop pinpoint holes that sperm can fit through. It should be routinely checked (held up to a light source) in order to be most effective.

38
Q

How should a woman clean her diaphragm?

A

With soap and water

39
Q

What two conditions is a woman using a diaphragm at higher risk for?

A

Urethritis and cystitis.

Rationale: The ring can rub against a full bladder and cause irritation.

40
Q

When should a woman void when using a diaphragm to reduce risk of developing urethritis or cystitis?

A

Before insertion and after sex.

41
Q

When should a diaphragm not be used?

A

Hx of TSS, during menses, presence of abnormal discharge

42
Q

Cervical Cap: “Lea’s Shield/FemCap”

A

Reusable, silicone vaginal barrier that covers the cervix and held in place by vaginal walls

43
Q

What does a cervical cap have that a vaginal diaphragm does not?

A

A one-way valve that allows for cervical mucus/air to flow through.

44
Q

Case Study:

A 14yr old girl asks after her women’s exam if she can buy a “Lea’s Shield” at Walgreens. What do you, the nurse, respond with?

A

No. “Lea’s Shield” or cervical caps are only available by prescription and must be fitted by a physician. Also, address the practices of safe sex to prevent teenage pregnancy.

45
Q

Should a woman use spermicide with a FemCap?

A

Yes.

46
Q

When can a cervical cap/Lea’s Shield/FemCap be removed after sex?

A

No sooner than 6 hrs after sex and 48 hrs before (prevention of TSS)

47
Q

Can a vaginal sponge be used more than once?

A

No.

48
Q

Is a vaginal sponge available OTC?

A

Yes.

49
Q

True or False:

A vaginal sponge is one size fits all and does not require a fitting with a physician.

A

TRUE.

50
Q

How is the spermicide in a vaginal sponge activated?

A

When wet.

51
Q

How long should a vaginal sponge stay in place after sex?

A

Minimum of 6hrs and maximum of 24hrs.

52
Q

True or False:

Allergic reactions are extremely rare with vaginal sponges.

A

FALSE.

Rationale: allergic reactions are more common with a vaginal sponge

53
Q

Which group are vaginal sponges most effective for: nulliparous or multiparous women?

A

Nulliparous

54
Q

What is an IUD?

A

a medicated device inserted into the uterus by medical professional

55
Q

How does an IUD work as a form of BC?

A
  • thickens cervical mucus
  • impair sperm motility
  • decrease lining of the uterus
56
Q

When should a woman check the strings on her IUD?

A

After menses and sex

57
Q

How long can a ParaGard (copper) IUD be worn?

A

up to 10 years

58
Q

True or False:

A copper IUD is naturally spermicidic.

A

TRUE.

59
Q

True or False:

A copper IUD is hormone free.

A

TRUE.

60
Q

True or False:

A copper IUD also uses estrogen.

A

FALSE.

Rationale: ParaGard IUD is hormone-free.

61
Q

How long can a Mirena IUD be worn?

A

up to 5 years

62
Q

Does the Mirena IUD used hormones?

A

Yes.

63
Q

How many years are the Liletta/Skyla/Kyleena IUDs effective for?

A

up to 3 years

64
Q

Which IUD is flexible?

A

Liletta/Skyla/Kyleena

65
Q

Do Liletta/Skyla/Kyleena IUDs use hormones?

A

Yes.

66
Q

Which IUD causes an immune response to create a toxic environment for sperm?

A

ParaGard - Copper

67
Q

What are the major side effects associated with IUDs?

A
  • initial increased bleeding with menses
  • uterine perforation
  • P.A.I.N.
68
Q

How does menses change after placement of non-copper IUD?

A
  • becomes lighter
  • fewer cramps
  • irregular spotting
69
Q

What condition is the acronym “P.A.I.N.” associated with and what does it stand for?

A

associated with IUD complications

Period late (or abnormal bleeding).
Abdominal pain.
Infection.
No string.

70
Q

How do combination OCPs work?

A

suppress feedback mechanism so pituitary gland is not stimulated
- FSH and LH are never released so follicle can’t mature and ovulation won’t occur

71
Q

When do women on OCPs get their withdrawal bleeding (periods)?

A

within 1 to 4 days of last pill

  • if on 28 days, will have period day 21-28
  • if on 21 days, will have period after last pill
72
Q

Are OCPs effective?

A

Yes!! 99%, but only if taken on schedule.

73
Q

What are four benefits to taking birth control pills?

A
  • reduction in menstrual sx:
    - migraines
    - endometriosis pain
    - anemia
  • regulation of periods
74
Q

Complications of OCPs (acronym)

A 
Abdominal pain (r/t liver and gallbladder issues)
Chest pain (SOA)
Headaches
Eye problems
Severe leg pain (blood clot)
75
Q

True or False:

If you miss >1 OCP, you can take the next and be fine.

A

FALSE.

Rationale: boom now you’re pregnant. If you miss more than one birth control pill, you need to use a different kind of contraceptive for the remainder of that cycle (21/28 days).

76
Q

True or False:

Anticoagulants and oral hypoglycemic medications remain unaffected by OCPs.

A

FALSE.

Rationale: OCPs decrease the effectiveness of these two drugs.

77
Q

What medications decrease the effectiveness of OCPs?

A
  • anticonvulsants
  • antifungals (think STIs)
  • antibiotics!!!!
  • TB meds
  • antiretrovirals (STIs again)
78
Q

What is Seasonale/ Seasonique? Which pill is taken which days?

A

A long-term OCP that is taken for 91 days (3 months).

The pill is taken day 1-84. The placebo is taken day 85-91.

79
Q

True or False:

Seasonale/ Seasonique is an estrogen-only OCP.

A

FALSE.

Rationale: Seasonale/ Seasonique includes estrogen AND levonorgesterol (progesterone)

80
Q

How many periods will a woman on Seasonale/Seasonique have every year?

A

4 periods/ year on every 13th week

when the placebo is taken for days 85-91, menses begins

81
Q

Which OCP is ideal for women with anemia?

A

Seasonale/Seasonique

82
Q

What are the absolute contraindications for OCPs?

A
  • pregnancy
  • hx of estrogen dependent cancer
  • hx of thrombolytic disease
  • hx of liver/ gallbladder disease
  • undiagnosed uterine bleeding
  • 35+yrs and smoking
  • HTN
  • DM
  • hyperlipidemia
83
Q

Case study:

A 26yr new mom comes into the clinic and asks you about changing to the “minipill” because she has decided to breastfeed her infant. What is your response, as the nurse?

A

“Minipill” or progestin-only pill is made only with progesterone and designed for women who cannot take estrogen (ie. BF moms or women with risk factors).

84
Q

If a pt on a progestin-only OCP forgets a pill, does their risk for ovulation increase or decrease?

A

Increase.

85
Q

True or False:

The transdermal form of birth control “Ortho Evra” contains both estrogen and progesterone.

A

TRUE

86
Q

How long do you wear an Ortho Evra patch?

A

For 3 weeks, no patch on week 4 = menses

87
Q

What is the maximum weight for a transdermal birth control patch?

A

198 lbs

88
Q

Pt teaching r/t Ortho Evra

A
  • rotate site from back, butt, abdomen, arms, trunk
  • NEVER place patch on breast tissue
  • avoid prolonged contact with water
  • can cause skin irritation if site not rotated
89
Q

True or False:

Transdermals provided better prolonged absorption compare to OCPs.

A

TRUE.

90
Q

A candidate for Ortho Evra should be at low risk for what condition?

A

DVT

*the estrogen causes an increased risk for blood clots

Maternal Newborn (6 decks)

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