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Module 6 (Labor And Delivery) > Reproduction/Contraceptives/Infertility > Flashcards

Reproduction/Contraceptives/Infertility Flashcards

1
Q

How does puberty occur?

A

Hypothalamic Pituitary cycle

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2
Q

Hypothalamic Pituitary cycle

A

Hypothalamus - gonadotropin-releasing hormone
Anterior pituitary = FSH and LH
Ovary and testes produce sex hormones = secondary sex hormones

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3
Q

The more sex hormones then the more

A

prominent secondary sex characteristics

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4
Q

The hypothalamus secretes what during puberty?

A

gonadotropin-releasing hormones

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5
Q

The anterior pituitary secretes what during puberty?

A

FSH
LH

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6
Q

FSH

A

follicle-stimulating hormone

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7
Q

LH

A

luteinizing hormones

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8
Q

Sex hormones aka

A

gametes

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9
Q

the genetic sex is determined at

A

conception

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10
Q

The reproductive system is similar for the first

A

6 weeks

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11
Q

The differentiation of external genitalia is complete at

A

12 weeks

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12
Q

Ovaries and testes secrete the

A

primary sex hormones

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13
Q

What weeks are you about to check the gender?

A

12-16 weeks

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14
Q

Boys would have male sex organs from an _____________ testosterone.

A

increase

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15
Q

Girls would develop female organs from an ________ testosterone.

A

no

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16
Q

During childhood, the sex glands are

A

inactive

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17
Q

Sexual maturation starts at

A

puberty (capable OF REPRODUCTION)
- reproductive organs functional
- primary/secondary sex characteristics

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18
Q

Male puberty starts at

A

13.5 y/o age

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19
Q

Male puberty is triggered by the production of

A

testosterone

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20
Q

What secondary sex characteristics are seen in male puberty?

A

Skeletal growth
Increase in body composition
Develop body hair- facial, axillary and pubic
Voice changes
Enlargement of testes and penis
Nocturnal emissions (wet dreams) – no mature sperm

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21
Q

Female puberty starts at

A

8-13 y/o

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22
Q

Female puberty is triggered by the production of

A

estrogen

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23
Q

Female secondary sex characteristics changes

A

Develop body hair – axillary, legs & pubic area
Body contours - widening of hips
Skeletal growth
Reproductive organs
Breast changes - mammary ducts & nipples erect

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24
Q

Menarche

A

1st menstrual period
2-2.5 years after puberty

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25
Q

Who is the quickest to mature puberty?

A

females

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26
Q

Can females get pregnant before their

A

1st period

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27
Q

What are the structures of the female reproductive system?

A

Ovaries
Fallopian tubes
Uterus
Cervix - Internal & External os
Vagina

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28
Q

Corpus luteum-

A

fluid fill mass on the ovary that makes your uterus a healthy place for the fetus to grow

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29
Q

What produces the hormones for the fetus before the placenta matures and makes the hormones?

A

corpus luteum

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30
Q

Anterior Pituitary glands produce what hormones

A

FSH
LH

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31
Q

The ovaries produce what hormones?

A

estrogen
progesterone

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32
Q

FSH function

A

helps control menstrual cycle and production eggs by ovaries

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33
Q

LH function

A

surge causes ovulation and results in formation of corpus luteum

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34
Q

Estrogen function

A

thickens uterine lining and regulates growth, development, and physiology of reproductive systems

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35
Q

Progesterone function

A

prepares the lining of the uterus to** implant and grow a fertilized egg
inhibits FSH and LH**

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36
Q

Menstrual cycle

A

Menstrual phase
Proliferative phase
Ovulatory phase
Luteal phase

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37
Q

Endometrial cycle

A

Menstrual phase
Proliferative phase
Secretory phase
Ischemic phase

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38
Q

Menstrual phase

A

change in mood swings
breast tenderness
cavings
irritable
anxious (emotionally high alert)
- period starts
vasoconstriction and sloughing off

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39
Q

Proliferative Phase

A

day 5 (after menstruation) to 14
Pituitary FSH makes the egg and LH for he egg
- start progesterone to ready lining
- depends on the estrogen starts the (thinning of the cervical mucus( _

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40
Q

Ovulatory Phase

A

hormone when LH increase
- one egg is taken and transported to the uterus whether impalantation or not

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41
Q

Secretory Phase

A

endometrial lining thickens
- implant then get thicker
- if no implantation start to shed again

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42
Q

Ischemic Phase

A
  • vasoconstriction
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43
Q

What are the conditions of fertilization?

A

Live, motile, normal sperm present (no clumps or abnormal)
patent fallopian tubes
healthy progesterone and thickening endometrium of the uterus
60% of sperm move forward

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44
Q

What measures the sperm count and how healthy the sperm is?

A

postcoital test

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45
Q

Patent fallopian tubes prevent

A

ectopic pregnancy

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46
Q

Endometrial biopsy measures

A

adequate progesterone and thickening endometrium of the uterus

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47
Q

What percentage of sperm indicates health and fertility?

A

60% move forward and are healthy

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48
Q

Indications of Ovulation

A

Notable drop in temperature
Spinnbarket mucus
cervical os
mittelschmerz
saliva ferning
increased libido

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49
Q

what does the temperature do at ovulation?

A

notable drop occurs 1 day before ovulation and remains elevated 10-12 days

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50
Q

Spinnbarkeit mucus in ovulation

A

abundant, watery thin, clear, stretchy (egg white)

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51
Q

Cervical os for ovulation

A

dilates lightly
softens and rises in the vagina

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52
Q

Mittelschmerz occurs

A

localized abd pain (usually right-sided)

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53
Q

What does a fertile saliva ferning look like?

A

no space

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54
Q

What does the serum LH look like during ovulation?

A

too high

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55
Q

Infertility

A

Inability to conceive/maintain a pregnancy after 12 mos. of unprotected intercourse (6 mo. if > 35y/o)
- grouped with miscarriages before 20 weeks (age of viability)

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56
Q

Infertility after ____ months if > 35 y/o

A

6

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57
Q

Primary infertility

A

no children

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58
Q

Secondary infertility

A

have had 1 living child

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59
Q

Infertility can cause stress

A

Mentally- Inability to conceive
Financially- Expenses
Emotionally- Effect on couple’s relationship can be seen as crisis in relationship (each blames each other) – 1/3 woman, 1/3 male, 1/3 both

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60
Q

___/____ couples will have trouble getting pregnant or sustaining a pregnancy

A

1/8

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61
Q

Causes of Infertility in Men

A

abnormal erections, ejaculation
abnormalities of seminal fluid (inflammation)
- obstructions/infections in the genital tract
Abnormalities of the sperm

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62
Q

Retrograde ejaculation

A

goes into the bladder not the penis

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63
Q

Retrograde ejaculation causes

A

diabetes
neurologic disorders
antihypertensives and psychotropics

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64
Q

Azoospermia

A

absent sperm in semen

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65
Q

Oligospermia

A

decrease sperm in semen

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66
Q

Impairing sperm factors

A

Abnormal hormonal stimulation
Acute or chronic illness (mumps, cirrhosis, or renal failure)
Infections of the genital tract (inflammation and clump of the sperm)
Anatomic abnormalities such as varicocele (enlarged vein in the back of the testes)
Exposure to toxins such as lead, pesticides, or other chemicals
Antineoplastic drugs, chemo, or radiation
Excessive alcohol intake; use of illicit drugs
Elevated scrotal temperature (febrile illness, use of saunas or hot tubs, or sitting for prolonged periods)
Immunologic factors produced by man or woman

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67
Q

Monchidism

A

1 testicle

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68
Q

Causes of infertility in women
- disorders in ovulation

A

Hypothalamus or pituitary gland dysfunction
Failure of ovaries to respond to follicle-stimulating hormone (FSH) or luteinizing hormone (LH)
PCOS – most common
Cranial tumors
Stress (same with dad)
Obesity or anorexia
Systemic disease
Abnormalities in ovaries or other endocrine glands (polypos or increase of cervical mucus)

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69
Q

Causes of women’s infertility due to abnormalities of the fallopian tubes

A

endometriosis - tissue lining going outward

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70
Q

Causes of women’s infertility due to abnormal cervix

A

Estrogen levels decreased preventing development of spinnbarkeit

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71
Q

Causes of infertility in women
- recurrent pregnancy loss

A

Abnormalities of fetal chromosomes
Abnormalities of the cervix or uterus
Endocrine abnormalities
Immunologic and thrombotic factors – increase of miscarriage and loss of the baby
Environmental agents
Infections (implantation not able to)

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72
Q

Evaulation of Infertility from a H&P
- REPRODUCTIVE MEDICAL HX

A

Menstrual history
Any pregnancies, complications and outcomes (BMI)
Contraceptive methods-past and present
Fertility with other partners
Pattern of intercourse
Exposure to toxins
Medications- Rx or OTC
Family history of pregnancy loss
Home tests/other methods used

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73
Q

Who is usually tested first due to cheap and quick?

A

men

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74
Q

Men Dx Test for fertility

A

Semen analysis-collection after 2-3 days of abstinence
Ultrasonography
Hormone analysis
FSH, LH, Testosterone, & Prolactin
Testicular Biopsy – environment
Sperm Penetration Assay “hamster test”
Mix to test for penetration

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75
Q

Women Dx Tests

A

Ovulation Prediction
X-ray of uterus & fallopian tubes to determine patency
Hysterosalpenogrpahy – patency of the fallopian
Hysterot
Laparoscopy – observing for
Hormone analysis
Progesterone, FSH, Estrogen, Luteinizing hormone & Prolactin

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76
Q

Nonmedical Therapy for facilitating pregnancy

A

Nutritional and Dietary Changes
Exercise, Yoga, and Stress Management
Lifestyle changes- No smoking/drinking
Ovulation Predictor
Use water-soluble lubricant for intercourse
Do not use spermicides as it can misread the ovulation by thinning the mucus

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77
Q

A loss of ____% body weight if obese can restore ovulation

A

5

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78
Q

Medication Therapy for Fertility

A

Clomiphene citrate and Letrozole

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79
Q

Clomiphene citrate and Letrozole purpose is to

A

stimulates pituitary gland to increase secretion of luteinizing hormone (LH) & follicle-stimulating hormone (FSH), can cause ovarian hyperstimulation syndrome

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80
Q

Clomiphene citrate and Letrozole have a risk of

A

Risk of multiple gestations (use responsibly)

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81
Q

Clomiphene citrate and Letrozole side effects

A

include hot flashes, blurred vision, nausea, vomiting, pain in pelvis, bloating, and headache

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82
Q

Clomiphene citrate and Letrozole contraindications

A

bleeding disorders or liver disease

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83
Q

What medication is also given along with Clomiphene citrate and Letrozole for PCOS patients?

A

Metformin

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84
Q

Clomiphene citrate and Letrozole can cause

A

ovarian hyperstimulation syndrome

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85
Q

In-vitro fertilization (IVF)

A

fertilization-embryo transfer (IVF-ET)-Eggs are collected from ovaries, and fertilized in the laboratory with sperm; the embryo is then transferred to the uterus (fertilized outside the body)
Timing is important to be put in

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86
Q

Intrauterine insemination (IUI)

A

Places prepared sperm in the uterus at the time of ovulation
Makes the journey to fallopian tubes much shorter

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87
Q

Gestational surrogacy

A

couple goes through IVF and the embryo is placed in another woman with no genetic ties to the embryo

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88
Q

Traditional surrogacy

A

woman inseminated with semen; carries fetus to birth

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89
Q

IUI is used for

A

cervical scarring
male partner not long-distance swimmers
premature ejaculation

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90
Q

What fertilization is done outside of the body?

A

Intracytoplasmic sperm injection
Zygote Intrafallopian transfer (ZIFT)
In vitro fertilization-embryo transfer (IVF-ET)

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91
Q

Intracytoplasmic sperm injection

A

Single sperm selected and injected directly into mature oocyte in laboratory

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92
Q

What fertilization is done inside of the body?

A

Gamete intrafallopian transfer (GIFT)
Intrauterine insemination (IUI)

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93
Q

Gamete intrafallopian transfer (GIFT)-

A

Oocytes retrieved; placed with prepared motile sperm; then placed in fallopian tubes
Religions-

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94
Q

Zygote Intrafallopian transfer (ZIFT)-

A

Zygote is placed in fallopian tube instead of uterus

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95
Q

Intrauterine insemination (IUI)

A

Places prepared sperm in uterus at time of ovulation

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96
Q

In vitro fertilization-embryo transfer (IVF-ET)

A

Eggs are collected from ovaries, fertilized in laboratory with sperm; embryo then transferred to uterus

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97
Q

Fertility Nursing Interventions

A

Educate on available options for reproductive assistance and encourage couples to discuss feelings about infertility
Educate the couple on roles of specialists they will see
Monitor for adverse effects associated with infertility treatments
Teach that infertility medications that can increase risk of multiple births
Refer for psychosocial counseling if needed
Educate regarding assisted reproductive therapies and available options such as surrogacy and adoption

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98
Q

Placenta if formed by

A

fetal and maternal tissue

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99
Q

The placenta exchanges

A

substances between the mother an fetus occurring in the intervillous spaces

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100
Q

The placental membrane prevents

A

maternal and fetal blood mixing; gasses, nutrients, and electrolytes are exchanged via the umbilical cord

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101
Q

What can cross the placental membrane and enter the fetal circulation?

A

viruses and drugs
rubella and cytomegalovirus

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102
Q

Degenerative placenta

A

: Infarcts & calcifications that interfere with uterine-placental-fetal oxygen exchange

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103
Q

Degenerative placenta is more likely in

A

severe preeclampsia, smokers, drug abuse and post dates

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104
Q

What are the two membranes forming the amniotic sac?

A

Amnion = next to fluid for baby (urine)
Chorion = next to placenta

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105
Q

Membranes stretch to accommodate

A

growth of developing fetus and increasing amount of amniotic fluid

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106
Q

Amniotic fluid is made from

A

from fetal urine and fluid transported from maternal blood

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107
Q

Amniotic fluid purpose

A

Cushions Impact to maternal abdomen
Prevents adherence of fetus to amniotic membranes
Allows freedom of fetal movement
Provides a consistent thermal environment
Essential for fetal lung development
Allows symmetric development as major body surfaces fold to midline

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108
Q

Oligohydramnios

A

Abnormally small quantity of fluid (< 50% of amount expected for gestation or < 400 ml at term)

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109
Q

Oligohydramnios causes

A

Poor placental blood flow (increased risk of umbilical cord compression
PPROM
Failure of kidney development
Blocked urinary tract
Fetal effects
Poor fetal lung development
Malformations such as skeletal abnormalities

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110
Q

Polyhydramnios

A

Quantity of fluid may exceed 2000 mL

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111
Q

Polyhydramnios causes

A

Poorly controlled maternal diabetes mellitus resulting in large quantities of fetal urine excretion having elevated glucose level
Malformations of the CNS, cardiovascular system, or GI tract
Chromosomal abnormalities
Multifetal gestation
Sometimes no known cause

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112
Q

Umbilical Cord is the ____________ between fetus and placenta.

A

lifeline

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113
Q

The umbilical cord consists of

A

2 arteries
1 vein
vessels around Wharton’s jelly(collagenous)
- protects from compression

114
Q

Marginal cord

A

umbilical cord not in the center of the placenta

115
Q

If there is not good fetal circulation, the baby is at risk of

116
Q

Umbilical cord abnormalities

A

Congenital absence of umbilical artery
Cord Insertion Variation
Cord Length Variations

117
Q

Average length of an umbilical cord

118
Q

Short umbilical cord

A

with umbilical hernias, abruptio placentae, cord rupture

119
Q

Long umbilical cord

A

twist, tangle around fetus

120
Q

Monochorionic

A

one chorion (placenta)

121
Q

Monoamniotic

A

share the same amniotic sac

122
Q

Dichorionic

A

two chorions(placentas)

123
Q

Monochorionic increase of

A

twin-to-twin transfusions(imbalance of blood flow in vasculature) – one over and one under perfused

124
Q

Monoamniotic increase risk for

A
  • same sac
  • increase of mortality due to entangling of the umbilical cords
125
Q

Monozygotic twins-

A

One zygote; genetically identical

126
Q

Dizygotic twins

A

fraternal twins (do not look the same)

127
Q

Multiple gestations have a greater risk for

A

Risks increase with an increased number of fetuses
Risks for women
Risks for fetus and newborns
Conjoined twins

128
Q

Management for Multifetal pregnancies

A

Ultrasounds for discordant growth (proportional)
Genetic testing

129
Q

The nurse should monitor what in multifetal pregnancies?

A

Preterm labor; prevent preterm birth (no stress)
Maternal anemia; gestational diabetes
Hypertension, preeclampsia and hydramnios
Antenatal hemorrhage, intrauterine hemorrhage
Intrauterine fetal demise (kick counts daily)
Increased fetal surveillance including NST, BPP

130
Q

The fundal height on a multifetal pregnancy is going to be

131
Q

Role of a Nurse during Contraception

A

Provide education & counsel regarding​

Types of contraception available​
Risks and benefits of each​
Proper use of each method​
Backup method if needed​
What to do if changing methods​
What to do if an error is made​
Emergency contraception​
Answer questions and concerns​

132
Q

Five P’s of Taking A Sexual Health History​

A

Partners – thenumber in last 12 months​ (men, women, or both)​
Pregnancy - planning or preventing​
Protection from STI’s - always, sometimes, never​
Practices - vaginal, anal, oral​
Past historyof STI’s -No, Yes, - if yes, which STI
Tell me about your sexual Hx and activities (open ended)

133
Q

How should a nurse counsel adolescents about contraception? SPRREE

A

Sensitive to adolescent’s feelings​
Provide education utilizing understandable terminology and audiovisual aids​
Reassure the teen of confidentiality​ (WILL NOT RUN AND TELL HER PARENTS)
Reduce anxiety related to 1stpelvic exam​
Encourage condom use for STI prevention​
Encourage discussion with parents​

134
Q

What should be considered when choosing a method of contraception?

A

Expense/Availability
Effectiveness​
Risk, benefits, and side effects​
Protection against STI’s​
Convenient and readily available​
Interfere with spontaneity​
Acceptable based on religious, cultural, and personal beliefs​
Other considerations - family planning goals​

135
Q

Contraceptive

A

Strategy or device used to reduce the risk of fertilization orimplantation to prevent a pregnancy

136
Q

What are the different options of contraceptives?

A

Contraceptive methods​
Natural family planning​
Barrier​
Hormonal​
Intrauterine devices​
Surgical procedures​

137
Q

What outweighs absolute reality?

A

consistency

138
Q

What is the most reliable method of contraceptions?

A

Abstinence

139
Q

Abstinence

A

Refraining from sexual intercourse​

Patient Education​
Saying “NO” to sexual intercourse​
“YES” - allow other gratifying sexual activities​
Requires self-control​
Advantages -Failure - 0%​
Effective if practiced perfectly​
Risks - none if abstinence is maintained​

140
Q

What is the least reliable methods of contraception?

A

lactational amenorrhea
pull-out method

141
Q

lactational amenorrhea

A

Exclusive breastfeeding- for6 months- avoid ovulation & menses​

142
Q

Pt education on lactational amenorrhea

A

Disruption of breastfeeding or supplementation ↑ risk of pregnancy​
Effectiveness enhance by frequent feedings or use of barrier method​
Alternate method once menses returns​

143
Q

Advantage and Disadvantage of lactational amenorrhea

A

Advantages - inexpensive​
Disadvantages - failure rate - 1stovulation unpredictable​
Risks - unplanned pregnancy

144
Q

What is not an option if the patient has irregular menses?

A

lactational amenorrhea

145
Q

What are the different names for pull-out method?

A

WITHDRAWAL/ COITUS INTERRUPTS

146
Q

WITHDRAWAL/ COITUS INTERRUPTS

A

Removal of the penis prior to ejaculation​

147
Q

WITHDRAWAL/ COITUS INTERRUPTS pt education

A

Pre-ejaculate fluid may contain sperm & can leak prior to ejaculation​

148
Q

WITHDRAWAL/ COITUS INTERRUPTS
risks and benefits

A

Advantages – choice for monogamous couples with religious conviction​
Disadvantages - failure rate - 22 %​
No protection against STI’s​
Require self-control on males’ part​
Risks -unplanned pregnancy​

149
Q

Natural Family Planning Methods

A

Fertility awareness/Periodic Abstinence Method
Calendar
SYMPTOTHERMAL METHOD
CERVICAL MUCUS

150
Q

Fertility Awareness requires

A

awareness of the menstrual cycle​
Fertile days - Sperm is 4-5 days & Ovum is 24-48 hrs.​
Mittelschmerz

151
Q

Fertile days of sperm

152
Q

Fertile days of ovum

A

24-48 hours

153
Q

Mittelschmerz

A

Right-sided pain in the ovary region, mid-cycle during ovulation)

154
Q

Fertility Awareness advantage and disadvantages

A

Advantage​
Works best with regular menstrual cycles​
Acceptable to religions that prohibit birth control​
Disadvantage​
Interfere with sexual spontaneity​
Poor choice for irregular cycles, breastfeeding, perimenopause

155
Q

What is the least reliable family planning method?

156
Q

Calendar Method

A

based on ovulation occurs approximately 14 days prior to menses​

157
Q

Standard days method -

A

used to determine fertile day with varied cycles​

158
Q

Pt education on calendar method

A

Determine fertile period – over 6 cycles - number of days/cycle​
Start of fertile time - (shortest cycle - 18 days) - 26 -18 = 8thday​
End of fertile time - (longest cycle - 11 days) - 30 -11 = 19thday​
Avoid intercourse during fertile days – Days 8-19​
On calendar (11th-22nd)

159
Q

Determine the fertile period over how many Cycles

A

– over 6 cycles - number of days/cycle​

160
Q

Start of fertile time is determined by

A

(shortest cycle - 18 days) - 26 -18 = 8thday​

161
Q

End of fertile time is determined by

A

(longest cycle - 11 days) - 30 -11 = 19thday​

162
Q

Avoid intercourse during fertile days on what days

A

Days 8-19​
On calendar (11th-22nd)

163
Q

Calendar Method advantages or disadvantages

A

Advantages​
Inexpensive​
No drug or hormones​
Combined with barrier method improve the effectiveness​

Disadvantages - failure rate - 24 %​
No protection against STI’s​
Unpredictable menstrual cycles/ovulation​
Compliance with abstinence during the fertile period​

Risks - unplanned pregnancy​

164
Q

What can stress do to the calendar method?

A

chnage the cycles and get inaccurate reading of the ovulation

165
Q

SYMPTOTHERMAL METHOD

A

Assessment of basal body temperature,cervical mucus,​mittelschmerz & other symptoms near ovulation​
BBT

166
Q

SYMPTOTHERMAL METHOD pt education

A

Measure BBT same time each morning before getting out of bed​ - NO DRINKING BEFORE
BBT ↓ before ovulation, and ↑ after ovulation​
BBT will then↓ 2-4 days before menses or remain ↑ if pregnant​
Avoid intercourse until 3rdnight after ↑ BBT​

167
Q

BBT will then ↓

A

2-4 days before menses or remain ↑ if pregnant​

168
Q

Avoid intercourse until ____night after ↑ BBT​

169
Q

SYMPTOTHERMAL METHOD advantages and disadvantages

A

Advantages​
Inexpensive​
Acceptable by most religions​

Disadvantages - failure rate - 24 %​
Stress, fatigue, illness, or environmental temperature can affect​
No protection against STI’s​

170
Q

Cervical Mucus

A

cervical mucus becomes thin, flexible, slippery & stretches ​between fingers at ovulation​

171
Q

Cervical Mucus is also known as

A

Spinnbarkeit or Billingssign​

172
Q

Cervical Mucus pt education

A

Good hand hygiene​
Obtain mucus from entrance of vagina​
Examine for consistency starting on last day of the cycle​
Observing for thinning characteristic​

173
Q

Your mucus should look like what when ovulating/abstaining

A

thin mucus and note when the peak was and fertile 4 days after

174
Q

What hormone causes the mucus

175
Q

Cervical Mucus advantages and disadvantages

A

Advantages​
Women become knowledgeable regarding mucus​
Self-evaluation is diagnostically helpful in recognizing ovulation​
Breastfeeding, menopause, planning pregnancy​

Disadvantages - failure rate - 24 %​
Uncomfortable touching her genitals & mucus​
No protection against STI’s​

Risks​
Inaccurate if mixed withblood, semen, contraceptive foam, or discharge​
Unplanned pregnancy​

176
Q

Spermicides

A

chemicalgel, foam, cream, or suppositoryinserted deep intothe vagina 15 minutes prior to intercourse to destroy sperm​

177
Q

Spermicides pt education

A

Inserted into the vagina 15 minutes before intercourse​
Must be reapplied for multiple acts​

178
Q

Spermicides advantages and disadvantages

A

Advantages - inexpensive, readily available, & easy to use​
Disadvantages - failure rate -28 %​
Irritation, allergic reaction​
Must be reapplied for multiple acts​
No protection for STI’s​
May be seen as messy
can have inaccurate readings due to watery mucus
Risks - unplanned pregnancy

179
Q

Male condom

A

thin rubber sheath worn over the penis during intercourse,prevents sperms from entering the uterus​

180
Q

Male condom pt education

A

Roll condom onto the erect penis, leaving empty space in tip​
Used with spermicide increases the effectiveness​
Following ejaculation – remove from erect penis​
Holding rim of condom to prevent semen spillage​
Discard condom​
Heat accelerates deterioration – avoid storage in a hot place​
Used water-soluble jelly for lubrication; petroleum can cause deterioration​

181
Q

Male condom advantages and disadvantages

A

Advantages​
Protects against STI’s​
Involves male in birth control​
Inexpensive, lightweight and readily available​

Disadvantages - failure 18 %​
Reduces spontaneity and non-compliance
One-time use - do not reuse​

Risks​
Allergic reaction, contraindicated if latex allergy​
Rupture or leak resulting in unwanted pregnancy​

182
Q

What condom can be used for males with a latex allergy?

A

lamb skin
- not protected from STIs

183
Q

Female condom

A

synthetic rubber sheath inserted into the vagina prior tointercourse which prevents sperms from entering the uterus​

184
Q

Female condom pt education

A

Insert closed end of the condom into the vagina​
Push towards the back of the vagina​
Make sure the inner ring fits over the cervix​
Open outer ring covers labia​/perineum
Following intercourse - twist outer ring, remove & discard

185
Q

Female condom advantages and disadvantages

A

Advantages​
Non-latex, protects against STI’s​
79 % effective​
No prescription is needed​

Disadvantages - failure rate 21%​
Reduces spontaneity & non-compliance​
More expensive than the male condom​
Noisy during sex​
Cumbersome feel
One-time use​-

Risks - Allergic reaction
No use of oil-based products - stop latex protection​

186
Q

On a female condom, oil-based products can cause

A

the latex protection to be negated
- possible for STIs

187
Q

Female condoms need to be placed how long before intercourse?

188
Q

Sponge for mechanical barriers

A

pillow-soft, cup-shaped, absorbent sponge which fits over thecervix containing spermicide​

189
Q

Sponge for mechanical barriers
pt education

A

One size fit all​
Remain in place for 6 hrs. - up to 48 hrs. after intercourse​

190
Q

Sponge for mechanical barriers
insertion instructions

A

Empty bladder​
Hand hygiene​
Moistened with water prior to inserting vaginally​

191
Q

Sponge for mechanical barriers Advantages and disadvantages

A

Advantages - available over the counter​
One-time use- but may use for multiple acts in 24 hours
Can be inserted just before orhoursahead of time​

Disadvantages​
Difficult to insert & remove​(short fingers)
Does not protect against STI’s​

Risks​
Failure rate -12 % no prior birth & 24 % prior birth​
Irritation & allergic reaction​
Absorbs vaginal secretions - vaginal dryness​
Toxic shock syndrome​

192
Q

Toxic Shock Syndrome

A

life-threatening bacteria infection released into the bloodstream

193
Q

Warning signs of toxic shock syndrome

A

high fever
low BP
V/D
sunburn rash on palms and soles
confusion
muscle aches
seizures

194
Q

The sponge might not fit on a multigravida pt because

A

the cervical os increases and might need to go up a size or refit

195
Q

Diaphragm

A

dome-shaped latex or silicone cup which fits over the cervix

196
Q

Diaphragm pt education

A

Places pressure on urethra
May cause irritation or UTI’s
Voiding after sex helps prevent infection
Must be left in place for 6 hours after intercourse

197
Q

Cervical Cap

A

soft, cup which fits over cervix to prevent sperm from entering

198
Q

Cervical cap should be smaller than

199
Q

Cervical cap pt education

A

No pressure placed on bladder
Can stay in place for 48hrs
Keep in place for 6-8 hours after intercourse

200
Q

A papsmear is needs after how long of using the cervical cap?

201
Q

Diaphragm and Cap pt eduction

A

Requires fitting & refitting
Requires proper insertion prior to intercourse​
Empty bladder & perform hand hygiene​
Apply spermicide & insert into vagina covering the cervix​
Clean with soap and water after removal

202
Q

Diaphragm and cap should be fit and refitted

A

Every2 yrs., afterchildbirth, or a20%weight gain or loss​

203
Q

Diaphragm and Cap
good and bad

A

Advantages - can remain in place multiple acts
Reduced incidence of cervical gonorrhea/chlamydia​
Disadvantages - requires fitting & prescription
- not for no healthcare​
Inconvenient and inhibits spontaneity​
Spermicidal cream must be applied & reapplied​
Difficult to insert & remove​
Does not protect against STI’s​
Risks - failure rate 12 %​
Irritation, latex allergic reactions​
Cap can be associated with cervical changes​
Toxic Shock Syndrome​

204
Q

What devices should not be used for a history of UTIs

A

sponge
diaphragm
cap
- toxic shock syndrome

205
Q

Combination ORAL CONTRACEPTIVES have

A

estrogen and progesterone

206
Q

Combination ORAL CONTRACEPTIVES do what

A

suppress ovulation and thicken cervical mucus​
- inhibit ovulation
3 weeks of active and 1 of placebo for period
OR
11 weeks of active and 1 week of placebo

207
Q

The mini pill has

A

progestin-only

208
Q

The mini pill causes

A

thickening of cervical mucus

209
Q

Oral Contraceptives are often used for

A

Regulate menstrual cycles​
Reducing dysmenorrhea​
Blood loss for excessive menstrual cycles, and anemia​

210
Q

With oral contraceptives, when should fertility return

A

within 3 months​

211
Q

Planning pregnancy after fertility returns off the oral contraceptive needs to

A

alternate method for 2-3 month

212
Q

Combo oral contraceptives pt education

A

Consistent and proper use to be effective​
Miss 1 pill - take asap​
Miss 2-3 pills must use backup method​

213
Q

Combo oral contraceptives risks**

A

Postpartum & lactation - ↑ risk for DVT & ↓ milk production​
Don’t use if smoker or over 35 y/o

214
Q

Combo oral contraceptives if they miss 1 pill

215
Q

Combo oral contraceptives MISS 2-3 PILLS

A

use back up method

216
Q

Mini pill is less effective at

A

inhibiting ovulation, causesthickening of the cervical mucus prevents sperm penetration andalters uterine lining preventing implantation​

217
Q

Mini pill pt education

A

Consistent & proper use to be effective​
One pill at the same time daily to ensure effectiveness​
Take pill 3 hours late must use back up method​
If diarrhea or vomiting use a backup method- can cause irregular or amenorrhea

218
Q

What oral contraceptive is a better choice for breastfeeding women/PP?

219
Q

With the mini pill fertility can return

220
Q

Combo and MINI PILL contraceptives improves

A

Acne​
Benign breast disease​
Endometriosis​
Fibroid bleeding​
Premenstrual symptoms​
Hirsutism​

221
Q

Combo and MINI PILL contraceptives side effects

A

Breast tenderness​
Excessive cervical mucus​
Nausea and vomiting​
Headache​
Hypertension​
Breakthrough bleeding​

222
Q

Combo and MINI PILL contraceptive risk factors

A

Failure 3%​
No protection for STI’s​
Increased - migraines, hypertension, strokes, &thromboembolic disease​
Altered blood glucose levels​

223
Q

Combo and MINI PILL contraceptives medication interactions

A

Antibiotics decrease effectiveness​
Avoid hepatotoxic medication​
Interfere with anticoagulants​
Increase toxicity of tricyclic antidepressants​​

224
Q

Transdermal Contraceptive Patch

A

releases continuous small amounts of estrogenand progestin that is absorbed by the skin suppressing ovulation, and thickenscervical mucus​

225
Q

Transdermal Contraceptive Patch pt education

A

An alternate method of birth control is needed for 1stweek​ following initial application
Apply patch to buttocks, abdomen, upper arm same day of the week for 3 weeks​
Remove patch for 4thweek (menses occurs)​
No oils/lotions in area of application
Don’t cut or alter shape
Do not use more than 1 patch at a time
If 2 days or more late in changing patch use backup method for 7 days

226
Q

A patinet with a Transdermal Contraceptive Patch should use an alternative form for how long

227
Q

Transdermal Contraceptive Patch
improves and side effects

A

Advantages - apply weekly, as effective as oral contraceptives​
Regulates menstrual cycles
Disadvantages
Skin irritation​
Visible if wanting to keep contraceptive unknown
Risk – failure 9 %​
Less effective for larger women (198 lbs.)​
Higher risk for VTE since exposure to estrogen in greater

228
Q

When does fertility return after the trandermal contraceptive?

229
Q

If the transdermal patch fall off in 24 hours, the nurse should

A

put it back on

230
Q

Vaginal Ring

A

soft, flexible, vinyl ring which releases small amounts of estrogen and progestin continuously to prevent ovulation

231
Q

Vaginal Ring pt education

A

Change monthly
Must be refrigerated
1st insertion use backup method unless placed the 1st 5 days of menses
48 hrs. without a ring, 1st two weeks requires a backup method for 7 days
Breakthrough bleeding is less common
Can be inserted immediately after delivery of placenta

232
Q

On the 1st insertion of the Nuvaring use the back up method unless placed the

A

1st 5 days of menses

233
Q

The NuvaRing can be inserted as quickly as

A

placenta delivery

234
Q

If the patient is 48 hours without the Nuvaring

A

1st two weeks requires a backup method for 7 days

235
Q

NuvaRing advantages and disadvantages

A

Advantages - fitting not required
Can remove for 3 hours without loss of effectiveness
Not visible
Decrease risk of forgetting to take oral pill
Disadvantages - Failure 9 %
Must remember to remove and reinsert
Expulsion resulting in an unplanned pregnancy
No STI protection
Risk
If not able to take oral contraceptives, same risks apply with vaginal ring
Side effects include breast tenderness, nausea, and vaginitis
Vaginal prolapse – feels

236
Q

You can remove the nuvaring for how long until the effectiveness is gone?

237
Q

IUDs (Mirena)

A

Chemical or hormone active device which is inserted into the uterus, damages sperm, & prevents fertilization

238
Q

IUDs (Mirena) pt education

A

Inserted by a provider in the office
Check for string monthly to confirm placement

239
Q

IUDs (Mirena) contraindication

A

diabetes, anemia, abnormal pap, history of pelvic infections

240
Q

IUDs (Mirena) fertility returns

A

when removed fertility returns

241
Q

IUDs (Mirena) advantages

A

Stays in place all the time
Effective for 5-10 years
Safe for breastfeeding mothers
Decreases dysmenorrhea, and menstrual blood loss
Copper IUD - Emergency contraception if placed within 5 days of intercourse

242
Q

IUDs (Mirena) disadvantages

A

No protection against STI’s
Increased cramping & bleeding 1st few cycles which resolves

243
Q

IUDs (Mirena) potential side effects/complications

A

Menorrhagia – endometrial irritation
Pelvic Inflammatory Disease (PID) – endometrial irritation progresses
Ectopic pregnancy or Spontaneous abortions if pregnancy occurs
Perforation of the uterus

244
Q

How long can a copper IUD stay

A

10 years due to chemical damaging the sperm

245
Q

How long can the IUDs (Mirena) stay in

A

5 years damage the sperm

246
Q

Contraceptive Implant

A

a progestin-filled rod that is placed in the upper inner arm​ under a local anesthetic.

247
Q

Contraceptive Implant pt education

A

Requires a minor surgical office procedure​
Effective within 24 hours of insertion
Increased risk of ectopic pregnancy​​
Fertility

248
Q

Contraceptive Implant progestin inhibits

A

ovulation, thickensthe cervical mucus & thins the endometrium​

249
Q

Contraceptive Implant advantages

A

Continuous long-actingcontraception (3 yrs.)​
Reversible
Lactating - once Breastfeeding is established for 4 weeks

250
Q

Contraceptive Implant disadvantages

A

No protection against STI’s​
Side effects same as oral contraceptives​
Irregularand/or unpredictable menstrual bleeding​
Acne, minimal weight gain or skin irritation at site​
Removal required​

251
Q

Depo-Provera

A

IM hormone injection of Progestin which prevents​pregnancy for 15 weeks, repeat injection should be given every 3 months
Patient Education​

252
Q

Depo-Provera pt education

A

1stdose given during first 5 days of a menstrual cycle​
Keep follow-up appointments​
Decreased bone density
Calcium & Vitamin D for bone health​
May take up to 1 yrs. after stopping to become pregnant​
Fertility

253
Q

The Depo-Provera can only be used for

A

USE LESS THAN 2 YEARS due to decreased bone density

254
Q

Depo-Provera fertility return

A

after 1 year

255
Q

Depo-Provera advantages

A

Long-term birth control - injections every 3 months​
Does not impair lactation once breastfeeding is established​​
Decrease bleeding or absence of period​

256
Q

Depo-Provera disadvantages

A

No protection against STI’s​
Amenorrhea, spotting, irregular bleeding​
Nervousness, dizziness, GI disturbances, headaches, fatigue, weight gain​

257
Q

Depo-Provera contraindicated for

A

history of breast cancer, stroke, blood clots, liver disease​

258
Q

Morning After Pills

A

PLan B
Ella

259
Q

Plan B/Next Choice

A

progestin levonorgestrel or Progestin-only​
-Inhibit ovulation, thicken mucus & interferes with corpus luteum function​ (house egg)
NO prescription needed for all ages

260
Q

Ella/ulipristal acetate​

A

Delays surge of LH, ovulation, and implantation​
Requires pregnancy test as it can disrupt an early pregnancy​
Prescription REQUIRED for all ages

261
Q

Which morning after pill does not need a Rx?

262
Q

The plan B pill needs to be taken within

A

72 hours after intercourse

263
Q

Ella needs to be taken within

A

5 days of sex

264
Q

Both prevent pregnancy after unprotected intercourse​ however mechanism of actions are

265
Q

Morning After Pill pt edu

A

Taken within 72 hrs. of unprotected intercourse​
Not to be used as a regular form of birth control​!

266
Q

Morning After Pill advantages

A

Reduces risk of pregnancy for one-time unprotected sex
Over-the-counter (Plan B)

267
Q

Morning After Pill disadvantages

A

failure depends on the time taken after unprotected sex
No protection against STI’s
Does not provide long-term contraception
Nausea, vomiting, headache, fatigue
Abdominal pain or cramping, heavier menstrual bleeding
Possible Pregnancy if the cycle does not occur within 21 days

268
Q

Female Sterilization

A

Bilateral Tubal Ligation Salpingectomy - fallopian tubes are surgically cut,tied, burned, and/or blocked to prevent conception​

269
Q

PPBTLS PT EDUCATION

A

Surgical procedure under anesthesia​
Pre-op & post-op care​
Considered permanent and difficult to reverse​
Slight vaginal bleeding following​
No backup contraceptive method is needed
No sex or lifting heavy objects for 1 week post-op​
Notify of fever or bleeding/drainage at incision site

270
Q

After a BTLS, NO

A

sex or lifting heavy objects for 1 week post-op​*

271
Q

BLTS advantages

A

Permanent contraception​
Sexual function is unaffected​

272
Q

BLTS disadvantages

A

No protection against STI’s​
Surgical procedure that requires anesthesia​
Should be considered irreversible if future pregnancies are desired​

273
Q

BLTS risks and complications

A

Surgical complications - pain, infection & bleeding​
Risk for ectopic pregnancy if pregnancy occurs​

274
Q

Male Sterilization

A

Vasectomy - vas deferens is surgically severed so sperm can no longer pass into the semen

275
Q

Vasectomy pt edu

A

Surgical office procedure
Ligated under local anesthesia​​
Limit activity for a couple of days​
Scrotal support for 48 hours
Take mild analgesics and place ice to area
Notify of severe pain, fever , bleeding or discharge or severe swelling

276
Q

Vasectomy risks

A

Bleeding, infection, and anesthesia reactions
Permanent sterilization may not occur for 3 months so risk of getting pregnant

277
Q

Permanent sterilization after a vasectomy

A

starts after 3 months

278
Q

Vasectomy advantages

A

Permanent contraception; Reversal
Short, safe, simple office procedure requiring local anesthesia only​
Sexual function is not impaired​
Less expensive since can be done in office
Can resume intercourse in 1 week

279
Q

Vasectomy disadvantages

A

No protection from STI’s
Discomfort for 2-3 days​
Considered irreversible - future pregnancies are desired​
Alternate contraception until 2 negative sperm counts​

280
Q

After a vasectomy, an alternate contraceptive until

A

2 negative sperm counts due to the 3 months left inside

Module 6 (Labor And Delivery) (7 decks)

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