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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
What is the "Coitus Interrupts Method"?
The male withdraws before ejaculating. * least effective (r/t preejaculation being present during sex even before true ejaculation) * provides no protection from infections
26
What is the male barrier method?
a silicone or latex condom - some are tx with spermicide - require space at end to collect semen
27
What kind of lubricant can be used with male condoms?
water soluble or silicone
28
True or False: It is safe to use petroleum-based lube with male condoms.
FALSE Petroleum-based lubes can breakdown the material of the condom. Only water soluble or silicone lubes should be used.
29
What is the female barrier method?
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
30
Vaginal diaphragm
A flexible silicone or latex dome w/ flexible wire rim that covers the cervix and under symphysis pubis.
31
How long can a vaginal diaphragm be used?
up to 2 years
32
True or False: A vaginal diaphragm can be bought OTC.
FALSE. Rationale: A vaginal diaphragm requires a prescription and must be fitted by a physician.
33
Is spermicide needed when using a vaginal diaphragm?
Yes.
34
True or False: A woman should wear her vaginal diaphragm for at least 6hrs after sex.
TRUE. Rationale: She should not leave it in for longer than 24hrs after sex.
35
True or False: A woman should have annual GYN exams done if using a diaphragm.
TRUE.
36
When does a diaphragm require refitting?
After > 20% weight gain or loss, pregnancy
37
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 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
How should a woman clean her diaphragm?
With soap and water
39
What two conditions is a woman using a diaphragm at higher risk for?
Urethritis and cystitis. Rationale: The ring can rub against a full bladder and cause irritation.
40
When should a woman void when using a diaphragm to reduce risk of developing urethritis or cystitis?
Before insertion and after sex.
41
When should a diaphragm not be used?
Hx of TSS, during menses, presence of abnormal discharge
42
Cervical Cap: "Lea's Shield/FemCap"
Reusable, silicone vaginal barrier that covers the cervix and held in place by vaginal walls
43
What does a cervical cap have that a vaginal diaphragm does not?
A one-way valve that allows for cervical mucus/air to flow through.
44
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?
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
Should a woman use spermicide with a FemCap?
Yes.
46
When can a cervical cap/Lea's Shield/FemCap be removed after sex?
No sooner than 6 hrs after sex and 48 hrs before (prevention of TSS)
47
Can a vaginal sponge be used more than once?
No.
48
Is a vaginal sponge available OTC?
Yes.
49
True or False: A vaginal sponge is one size fits all and does not require a fitting with a physician.
TRUE.
50
How is the spermicide in a vaginal sponge activated?
When wet.
51
How long should a vaginal sponge stay in place after sex?
Minimum of 6hrs and maximum of 24hrs.
52
True or False: Allergic reactions are extremely rare with vaginal sponges.
FALSE. Rationale: allergic reactions are more common with a vaginal sponge
53
Which group are vaginal sponges most effective for: nulliparous or multiparous women?
Nulliparous
54
What is an IUD?
a medicated device inserted into the uterus by medical professional
55
How does an IUD work as a form of BC?
- thickens cervical mucus - impair sperm motility - decrease lining of the uterus
56
When should a woman check the strings on her IUD?
After menses and sex
57
How long can a ParaGard (copper) IUD be worn?
up to 10 years
58
True or False: A copper IUD is naturally spermicidic.
TRUE.
59
True or False: A copper IUD is hormone free.
TRUE.
60
True or False: A copper IUD also uses estrogen.
FALSE. Rationale: ParaGard IUD is hormone-free.
61
How long can a Mirena IUD be worn?
up to 5 years
62
Does the Mirena IUD used hormones?
Yes.
63
How many years are the Liletta/Skyla/Kyleena IUDs effective for?
up to 3 years
64
Which IUD is flexible?
Liletta/Skyla/Kyleena
65
Do Liletta/Skyla/Kyleena IUDs use hormones?
Yes.
66
Which IUD causes an immune response to create a toxic environment for sperm?
ParaGard - Copper
67
What are the major side effects associated with IUDs?
- initial increased bleeding with menses - uterine perforation - P.A.I.N.
68
How does menses change after placement of non-copper IUD?
- becomes lighter - fewer cramps - irregular spotting
69
What condition is the acronym "P.A.I.N." associated with and what does it stand for?
associated with IUD complications Period late (or abnormal bleeding). Abdominal pain. Infection. No string.
70
How do combination OCPs work?
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
When do women on OCPs get their withdrawal bleeding (periods)?
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
Are OCPs effective?
Yes!! 99%, but only if taken on schedule.
73
What are four benefits to taking birth control pills?
- reduction in menstrual sx: - migraines - endometriosis pain - anemia - regulation of periods
74
Complications of OCPs (acronym)
``` Abdominal pain (r/t liver and gallbladder issues) Chest pain (SOA) Headaches Eye problems Severe leg pain (blood clot) ```
75
True or False: If you miss >1 OCP, you can take the next and be fine.
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
True or False: Anticoagulants and oral hypoglycemic medications remain unaffected by OCPs.
FALSE. Rationale: OCPs decrease the effectiveness of these two drugs.
77
What medications decrease the effectiveness of OCPs?
- anticonvulsants - antifungals (think STIs) - antibiotics!!!! - TB meds - antiretrovirals (STIs again)
78
What is Seasonale/ Seasonique? Which pill is taken which days?
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
True or False: Seasonale/ Seasonique is an estrogen-only OCP.
FALSE. Rationale: Seasonale/ Seasonique includes estrogen AND levonorgesterol (progesterone)
80
How many periods will a woman on Seasonale/Seasonique have every year?
4 periods/ year on every 13th week | when the placebo is taken for days 85-91, menses begins
81
Which OCP is ideal for women with anemia?
Seasonale/Seasonique
82
What are the absolute contraindications for OCPs?
- 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
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?
"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
If a pt on a progestin-only OCP forgets a pill, does their risk for ovulation increase or decrease?
Increase.
85
True or False: The transdermal form of birth control "Ortho Evra" contains both estrogen and progesterone.
TRUE
86
How long do you wear an Ortho Evra patch?
For 3 weeks, no patch on week 4 = menses
87
What is the maximum weight for a transdermal birth control patch?
198 lbs
88
Pt teaching r/t Ortho Evra
- 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
True or False: Transdermals provided better prolonged absorption compare to OCPs.
TRUE.
90
A candidate for Ortho Evra should be at low risk for what condition?
DVT *the estrogen causes an increased risk for blood clots

Maternal Newborn (6 decks)

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