Lecture 12 Family planning

Question 1

Family planning

Answer 1

The conscious decision on when to conceive or to avoid pregnancy throughout the reproductive years.

Question 2

Contraception

Answer 2

The intentional prevention of pregnancy during sexual intercourse.

Question 3

Birth control

Answer 3

The device and/or practice used to decrease the risk of conceiving or bearing offspring.

Question 4

BRAIDED mnemonic - informed consent

Answer 4

B - Benefits (advantages and success rates)
R - Risks (disadvantages and failure rates)
A - Alternatives
I - Inquiries (opportunity to ask questions)
D - Decisions (opportunity to decide or change mind)
E - Explanations
D - Documentation (of the information given and the client’s understanding)

Question 5

The most effective contraceptive methods at preventing pregnancy are the _

Answer 5

Long-acting, reversible contraceptive (LARC) methods - contraceptive implants, intrauterine contraception.

Question 6

Fertile phase of the menstrual cycle

Answer 6

About 5 to 7 days around the middle of the cycle, including several days before and during ovulation and the day afterward.

Question 7

Calendar Rhythm Method

Answer 7

• Requires accurate recording of the dates of menstrual cycles for 6 months.*
  1. Beginning of the fertile period = Length of the shortest cycle – 18 days.
  2. End of the fertile period = Length of the longest cycle – 11 days.
  3. The couple then abstains from intercourse during the fertile period (i.e., no sex from days 6 through 19).

Question 8

Standard Days Method (CycleBeads necklace)

Answer 8

Assumes regular cycles; the woman abstains from unprotected intercourse from days 8 through 19 (as represented by the white beads on the necklace).

Question 9

Basal Body Temperature Method

Answer 9

1. Basal body temperature: The lowest body temperature of a healthy person, taken immediately after waking and before getting out of bed.
2. The BBT drops at the time of ovulation and then increases after ovulation.
3. The fertile period is defined as the day of first temperature drop, through 3 consecutive days of elevated temperature.

Question 10

Cervical mucus changes during the menstrual cycle

Answer 10

Postmenstrual mucus = Scant
Preovulation mucus = Cloudy, yellow or white, sticky
Ovulation mucus = Clear, wet, sticky, slippery
Postovulation fertile mucus = Thick, cloudy, sticky
Postovulation, postfertile mucus = Scant

Question 11

Spinnbarkeit

Answer 11

The cervical mucus right before ovulation, indicating the period of maximum fertility - abundant, thick, feels similar to a lubricant and can be stretched 5+ cm between the thumb and forefinger.

Question 12

Secondary signs and symptoms of the menstrual cycle

Answer 12

Increased libido, midcycle spotting, mittelschmerz (cramplike pain prior to ovulation), pelvic fullness or tenderness, and vulvar fullness.

Question 13

Nonoxynol-9 (N-9)

Answer 13

1. A spermicide that reduces sperm motility, preventing it from reaching the cervical os.
2. The use of N-9 spermicides is not recommended for preventing STIs or HIV, and in some cases may increase transmission.

Question 14

Diaphragm

Answer 14

1. A shallow dome-shaped latex or silicone device with a flexible rim that completely covers the cervix.
2. Should be used in conjunction with a spermicide; spermicide must be reapplied before each act of intercourse; spermicides are contraindicated among women at high risk for HIV.
3. Can be inserted up to 6 hours before intercourse; should be removed 6 to 8 hours after intercourse.

Question 15

Toxic shock syndrome (TSS)

Answer 15

1. Can occur in association with the use of the contraceptive diaphragm and cervical caps; results from bacterial toxins.
2. Symptoms: Sunburn-like rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden high fever, and vomiting.

Question 16

Cervical cap (FemCap)

Answer 16

1. Silicone rubber cap that fits snugly around the base of the cervix; contains spermicide.
2. Should remain in place no less than 6 hours and not more than 48 hours at a time, and at least 6 hours after the last act of intercourse.
3. Spermicide does not need to be reapplied between acts of intercourse.

Question 17

Contraceptive sponge

Answer 17

1. Small round sponge containing N-9 that fits into the vagina and provides protection for up to 24 hours and for repeated instances of sexual intercourse.
2. Should be left in place for at least 6 hours after the last act of intercourse.

Question 18

Combined oral contraceptives (COCs)

Answer 18

1. Estrogen and progestin.
2. MoA: Suppression of the action of the hypothalamus and the anterior pituitary, leading to insufficient secretion of FSH and LH; follicles do not mature, and ovulation is inhibited.
3. The cervical mucus remains thick, in contrast to the thin, watery mucus normally present at ovulation.
4. Side effects: Nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, chloasma; stroke, myocardial infarction, hypertension, gallbladder disease, liver tumors.

Question 19

Dyspareunia

Answer 19

Painful/difficult intercourse.

Question 20

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse’s best response?

Answer 20

“Your current medications will reduce the effectiveness of the pill.” [Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. The anticonvulsant reduces the effectiveness of the pill, not the other way around.]

Question 21

Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice?

Answer 21

The ideal candidate has difficulty remembering to take oral contraceptives daily. [Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.]

Question 22

Emergency contraception should be taken _

Answer 22

As soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation.

Question 23

Which nonpharmacologic contraceptive method has a failure rate of less than 25%?

Answer 23

Standard days’ variation. [The standard days’ variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.]

Question 24

Importantly, the nurse must be aware of which information related to the use of IUDs?

Answer 24

IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. [The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.]

Question 25

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, “My period is due in a few days, and my temperature has not gone up.” What is the nurse’s most appropriate response?

Answer 25

“You probably didn’t ovulate during this cycle.” [The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method.]

Question 26

ACHES mnemonic - complications of oral contraceptives

Answer 26

A - Abdominal pain (problem with liver or gallbladder)
C - Chest pain, dyspnea (possible clot problem within lungs or heart)
H - Headaches (sudden or persistent - CVA or hypertension)
E - Eye problems (may indicate vascular accident or hypertension)
S - Severe leg pain (may indicate thromboembolus)