Reproduction/Contraceptives/Infertility Flashcards
1
Q
How does puberty occur?
A
Hypothalamic Pituitary cycle
2
Q
Hypothalamic Pituitary cycle
A
Hypothalamus - gonadotropin-releasing hormone
Anterior pituitary = FSH and LH
Ovary and testes produce sex hormones = secondary sex hormones
3
Q
The more sex hormones then the more
A
prominent secondary sex characteristics
4
Q
The hypothalamus secretes what during puberty?
A
gonadotropin-releasing hormones
5
Q
The anterior pituitary secretes what during puberty?
A
FSH
LH
6
Q
FSH
A
follicle-stimulating hormone
7
Q
LH
A
luteinizing hormones
8
Q
Sex hormones aka
A
gametes
9
Q
the genetic sex is determined at
A
conception
10
Q
The reproductive system is similar for the first
A
6 weeks
11
Q
The differentiation of external genitalia is complete at
A
12 weeks
12
Q
Ovaries and testes secrete the
A
primary sex hormones
13
Q
What weeks are you about to check the gender?
A
12-16 weeks
14
Q
Boys would have male sex organs from an _____________ testosterone.
A
increase
15
Q
Girls would develop female organs from an ________ testosterone.
A
no
16
Q
During childhood, the sex glands are
A
inactive
17
Q
Sexual maturation starts at
A
puberty (capable OF REPRODUCTION)
- reproductive organs functional
- primary/secondary sex characteristics
18
Q
Male puberty starts at
A
13.5 y/o age
19
Q
Male puberty is triggered by the production of
A
testosterone
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
21
Q
Female puberty starts at
A
8-13 y/o
22
Q
Female puberty is triggered by the production of
A
estrogen
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
24
Q
Menarche
A
1st menstrual period
2-2.5 years after puberty
25
Who is the quickest to mature puberty?
females
26
Can females get pregnant before their
1st period
27
What are the structures of the female reproductive system?
Ovaries
Fallopian tubes
Uterus
Cervix - Internal & External os
Vagina
28
Corpus luteum-
fluid fill mass on the ovary that makes your uterus a healthy place for the fetus to grow
29
What produces the hormones for the fetus before the placenta matures and makes the hormones?
corpus luteum
30
Anterior Pituitary glands produce what hormones
FSH
LH
31
The ovaries produce what hormones?
estrogen
progesterone
32
FSH function
helps control menstrual cycle and **production eggs by ovaries**
33
LH function
surge causes ovulation and results in **formation of corpus luteum**
34
Estrogen function
**thickens** uterine lining and regulates growth, development, and physiology of reproductive systems
35
Progesterone function
prepares the lining of the uterus to** implant and grow a fertilized egg
inhibits FSH and LH**
36
Menstrual cycle
Menstrual phase
Proliferative phase
Ovulatory phase
Luteal phase
37
Endometrial cycle
Menstrual phase
Proliferative phase
Secretory phase
Ischemic phase
38
Menstrual phase
change in mood swings
breast tenderness
cavings
irritable
anxious (emotionally high alert)
- period starts
**vasoconstriction and sloughing off**
39
Proliferative Phase
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( _
40
Ovulatory Phase
hormone when LH increase
- one egg is taken and transported to the uterus whether impalantation or not
41
Secretory Phase
endometrial lining thickens
- implant then get thicker
- if no implantation start to shed again
42
Ischemic Phase
- vasoconstriction
43
What are the conditions of fertilization?
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
44
What measures the sperm count and how healthy the sperm is?
postcoital test
45
Patent fallopian tubes prevent
ectopic pregnancy
46
Endometrial biopsy measures
adequate progesterone and thickening endometrium of the uterus
47
What percentage of sperm indicates health and fertility?
60% move forward and are healthy
48
Indications of Ovulation
**Notable drop in temperature
Spinnbarket mucus
cervical os
mittelschmerz**
saliva ferning
increased libido
49
what does the temperature do at ovulation?
notable drop occurs 1 day before ovulation and remains elevated 10-12 days
50
Spinnbarkeit mucus in ovulation
abundant, watery thin, clear, stretchy (egg white)
51
Cervical os for ovulation
dilates lightly
softens and rises in the vagina
52
Mittelschmerz occurs
localized abd pain (usually right-sided)
53
What does a fertile saliva ferning look like?
no space
54
What does the serum LH look like during ovulation?
too high
55
Infertility
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)
56
Infertility after ____ months if > 35 y/o
6
57
Primary infertility
no children
58
Secondary infertility
have had 1 living child
59
Infertility can cause stress
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
60
___/____ couples will have trouble getting pregnant or sustaining a pregnancy
1/8
61
Causes of Infertility in Men
abnormal erections, ejaculation
abnormalities of seminal fluid (inflammation)
- obstructions/infections in the genital tract
Abnormalities of the sperm
62
Retrograde ejaculation
goes into the bladder not the penis
63
Retrograde ejaculation causes
diabetes
neurologic disorders
antihypertensives and psychotropics
64
Azoospermia
absent sperm in semen
65
Oligospermia
decrease sperm in semen
66
Impairing sperm factors
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
67
Monchidism
1 testicle
68
Causes of infertility in women
- disorders in ovulation
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)
69
Causes of women's infertility due to abnormalities of the fallopian tubes
endometriosis - tissue lining going outward
70
Causes of women's infertility due to abnormal cervix
**Estrogen levels decreased** preventing development of spinnbarkeit
71
Causes of infertility in women
- recurrent pregnancy loss
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)
72
Evaulation of Infertility from a H&P
- REPRODUCTIVE MEDICAL HX
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
73
Who is usually tested first due to cheap and quick?
men
74
Men Dx Test for fertility
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
75
Women Dx Tests
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
76
Nonmedical Therapy for facilitating pregnancy
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**
77
A loss of ____% body weight if obese can restore ovulation
5
78
Medication Therapy for Fertility
Clomiphene citrate and Letrozole
79
Clomiphene citrate and Letrozole purpose is to
stimulates pituitary gland to increase secretion of luteinizing hormone (LH) & follicle-stimulating hormone (FSH), can cause ovarian hyperstimulation syndrome
80
Clomiphene citrate and Letrozole have a risk of
Risk of multiple gestations (use responsibly)
81
Clomiphene citrate and Letrozole side effects
include hot flashes, blurred vision, nausea, vomiting, pain in pelvis, bloating, and headache
82
Clomiphene citrate and Letrozole contraindications
bleeding disorders or liver disease
83
What medication is also given along with Clomiphene citrate and Letrozole for PCOS patients?
Metformin
84
Clomiphene citrate and Letrozole can cause
ovarian hyperstimulation syndrome
85
In-vitro fertilization (IVF)
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
86
Intrauterine insemination (IUI)
Places prepared sperm in the uterus at the time of ovulation
**Makes the journey to fallopian tubes much shorter**
87
Gestational surrogacy
couple goes through **IVF and the embryo is placed in another woman with no genetic** ties to the embryo
88
Traditional surrogacy
woman inseminated with semen; carries fetus to birth
89
IUI is used for
cervical scarring
male partner not long-distance swimmers
premature ejaculation
90
What fertilization is done outside of the body?
Intracytoplasmic sperm injection
Zygote Intrafallopian transfer (ZIFT)
In vitro fertilization-embryo transfer (IVF-ET)
91
Intracytoplasmic sperm injection
Single sperm selected and injected directly into mature oocyte in laboratory
92
What fertilization is done inside of the body?
Gamete intrafallopian transfer (GIFT)
Intrauterine insemination (IUI)
93
Gamete intrafallopian transfer (GIFT)-
Oocytes retrieved; placed with prepared motile sperm; then placed in fallopian tubes
Religions-
94
Zygote Intrafallopian transfer (ZIFT)-
Zygote is placed in fallopian tube instead of uterus
95
Intrauterine insemination (IUI)
Places prepared sperm in uterus at time of ovulation
96
In vitro fertilization-embryo transfer (IVF-ET)
Eggs are collected from ovaries, fertilized in laboratory with sperm; embryo then transferred to uterus
97
Fertility Nursing Interventions
**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**
98
Placenta if formed by
fetal and maternal tissue
99
The placenta exchanges
substances between the mother an fetus occurring in the intervillous spaces
100
The placental membrane prevents
maternal and fetal blood mixing; gasses, nutrients, and electrolytes are exchanged via the umbilical cord
101
What can cross the placental membrane and enter the fetal circulation?
viruses and drugs
rubella and cytomegalovirus
102
Degenerative placenta
: Infarcts & calcifications that interfere with uterine-placental-fetal oxygen exchange
103
Degenerative placenta is more likely in
severe preeclampsia, smokers, drug abuse and post dates
104
What are the two membranes forming the amniotic sac?
Amnion = next to fluid for baby (urine)
Chorion = next to placenta
105
Membranes stretch to accommodate
growth of developing fetus and increasing amount of amniotic fluid
106
Amniotic fluid is made from
from fetal urine and fluid transported from maternal blood
107
Amniotic fluid purpose
**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
108
Oligohydramnios
Abnormally small quantity of fluid **(< 50% of amount expected for gestation or < 400 ml at term)**
109
Oligohydramnios causes
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
110
Polyhydramnios
Quantity of fluid may exceed 2000 mL
111
Polyhydramnios causes
**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
112
Umbilical Cord is the ____________ between fetus and placenta.
lifeline
113
The umbilical cord consists of
2 arteries
1 vein
vessels around Wharton's jelly(collagenous)
- protects from compression
114
Marginal cord
umbilical cord not in the center of the placenta
115
If there is not good fetal circulation, the baby is at risk of
IUGR
116
Umbilical cord abnormalities
Congenital absence of umbilical artery
Cord Insertion Variation
Cord Length Variations
117
Average length of an umbilical cord
55 cm
118
Short umbilical cord
with umbilical hernias, abruptio placentae, cord rupture
119
Long umbilical cord
twist, tangle around fetus
120
Monochorionic
one chorion (placenta)
121
Monoamniotic
share the same amniotic sac
122
Dichorionic
two chorions(placentas)
123
Monochorionic increase of
twin-to-twin transfusions(imbalance of blood flow in vasculature) – one over and one under perfused
124
Monoamniotic increase risk for
- same sac
- increase of mortality due to entangling of the umbilical cords
125
Monozygotic twins-
One zygote; genetically identical
126
Dizygotic twins
fraternal twins (do not look the same)
127
Multiple gestations have a greater risk for
Risks increase with an increased number of fetuses
Risks for women
Risks for fetus and newborns
Conjoined twins
128
Management for Multifetal pregnancies
Ultrasounds for discordant growth (proportional)
Genetic testing
129
The nurse should monitor what in multifetal pregnancies?
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
The fundal height on a multifetal pregnancy is going to be
higher
131
Role of a Nurse during Contraception
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
Five P’s of Taking A Sexual Health History
Partners – the number in last 12 months (men, women, or both)
Pregnancy - planning or preventing
Protection from STI’s - always, sometimes, never
Practices - vaginal, anal, oral
Past history of STI’s - No, Yes, - if yes, which STI
**Tell me about your sexual Hx and activities (open ended)**
133
How should a nurse counsel adolescents about contraception? **SPRREE**
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 1st pelvic exam
Encourage condom use for STI prevention
Encourage discussion with parents
134
What should be considered when choosing a method of contraception?
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
Contraceptive
Strategy or device used to reduce the risk of fertilization or implantation to prevent a pregnancy
136
What are the different options of contraceptives?
Contraceptive methods
Natural family planning
Barrier
Hormonal
Intrauterine devices
Surgical procedures
137
What outweighs absolute reality?
consistency
138
What is the most reliable method of contraceptions?
Abstinence
139
Abstinence
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
What is the least reliable methods of contraception?
lactational amenorrhea
pull-out method
141
lactational amenorrhea
Exclusive breastfeeding - for 6 months- avoid ovulation & menses
142
Pt education on lactational amenorrhea
Disruption of breastfeeding or supplementation ↑ risk of pregnancy
Effectiveness enhance by frequent feedings or use of barrier method
Alternate method once menses returns
143
Advantage and Disadvantage of lactational amenorrhea
Advantages - inexpensive
Disadvantages - failure rate - 1st ovulation unpredictable
Risks - unplanned pregnancy
144
What is not an option if the patient has irregular menses?
lactational amenorrhea
145
What are the different names for pull-out method?
WITHDRAWAL/ COITUS INTERRUPTS
146
WITHDRAWAL/ COITUS INTERRUPTS
Removal of the penis prior to ejaculation
147
WITHDRAWAL/ COITUS INTERRUPTS pt education
Pre-ejaculate fluid may contain sperm & can leak prior to ejaculation
148
WITHDRAWAL/ COITUS INTERRUPTS
risks and benefits
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
Natural Family Planning Methods
Fertility awareness/Periodic Abstinence Method
Calendar
SYMPTOTHERMAL METHOD
CERVICAL MUCUS
150
Fertility Awareness requires
awareness of the menstrual cycle
Fertile days - Sperm is 4-5 days & Ovum is 24-48 hrs.
Mittelschmerz
151
Fertile days of sperm
4-5 days
152
Fertile days of ovum
24-48 hours
153
Mittelschmerz
Right-sided pain in the ovary region, mid-cycle during ovulation)
154
Fertility Awareness advantage and disadvantages
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
What is the least reliable family planning method?
calendar
156
Calendar Method
based on ovulation occurs approximately 14 days prior to menses
157
Standard days method -
used to determine fertile day with varied cycles
158
Pt education on calendar method
Determine fertile period – over 6 cycles - number of days/cycle
Start of fertile time - (shortest cycle - 18 days) - 26 -18 = 8th day
End of fertile time - (longest cycle - 11 days) - 30 -11 = 19th day
Avoid intercourse during fertile days – Days 8-19
On calendar (11th-22nd)
159
Determine the fertile period over how many Cycles
– over 6 cycles - number of days/cycle
160
Start of fertile time is determined by
(shortest cycle - 18 days) - 26 -18 = 8th day
161
End of fertile time is determined by
(longest cycle - 11 days) - 30 -11 = 19th day
162
Avoid intercourse during fertile days on what days
Days 8-19
On calendar (11th-22nd)
163
Calendar Method advantages or disadvantages
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
What can stress do to the calendar method?
chnage the cycles and get inaccurate reading of the ovulation
165
SYMPTOTHERMAL METHOD
Assessment of basal body temperature, cervical mucus, mittelschmerz & other symptoms near ovulation
BBT
166
SYMPTOTHERMAL METHOD pt education
**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 3rd night after ↑ BBT
167
BBT will then ↓
2-4 days before menses or remain ↑ if pregnant
168
Avoid intercourse until ____ night after ↑ BBT
3rd
169
SYMPTOTHERMAL METHOD advantages and disadvantages
Advantages
Inexpensive
Acceptable by most religions
Disadvantages - failure rate - 24 %
Stress, fatigue, illness, or environmental temperature can affect
No protection against STI’s
170
Cervical Mucus
cervical mucus becomes thin, flexible, slippery & stretches between fingers at ovulation
171
Cervical Mucus is also known as
Spinnbarkeit or Billings sign
172
Cervical Mucus pt education
Good hand hygiene
Obtain mucus from entrance of vagina
Examine for consistency starting on last day of the cycle
Observing for thinning characteristic
173
Your mucus should look like what when ovulating/abstaining
thin mucus and note when the peak was and fertile 4 days after
174
What hormone causes the mucus
estrogen
175
Cervical Mucus advantages and disadvantages
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 with blood, semen, contraceptive foam, or discharge**
Unplanned pregnancy
176
Spermicides
chemical gel, foam, cream, or suppository inserted deep into the vagina 15 minutes prior to intercourse to destroy sperm
177
Spermicides pt education
Inserted into the vagina **15 minutes before** intercourse
Must be **reapplied for multiple** acts
178
Spermicides advantages and disadvantages
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
Male condom
thin rubber sheath worn over the penis during intercourse, prevents sperms from entering the uterus
180
Male condom pt education
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
Male condom advantages and disadvantages
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
What condom can be used for males with a latex allergy?
lamb skin
- not protected from STIs
183
Female condom
synthetic rubber sheath inserted into the vagina prior to intercourse which prevents sperms from entering the uterus
184
Female condom pt education
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
Female condom advantages and disadvantages
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
On a female condom, oil-based products can cause
the latex protection to be negated
- possible for STIs
187
Female condoms need to be placed how long before intercourse?
8 hours
188
Sponge for mechanical barriers
pillow-soft, cup-shaped, absorbent sponge which fits over the cervix containing spermicide
189
Sponge for mechanical barriers
pt education
One size fit all
Remain in place for 6 hrs. - up to 48 hrs. after intercourse
190
Sponge for mechanical barriers
insertion instructions
Empty bladder
Hand hygiene
Moistened with water prior to inserting vaginally
191
Sponge for mechanical barriers Advantages and disadvantages
Advantages - available over the counter
One-time use - but may **use for multiple acts in 24 hours**
Can be inserted just before or hours ahead 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
Toxic Shock Syndrome
life-threatening bacteria infection released into the bloodstream
193
Warning signs of toxic shock syndrome
high fever
low BP
V/D
sunburn rash on palms and soles
confusion
muscle aches
seizures
194
The sponge might not fit on a multigravida pt because
the cervical os increases and might need to go up a size or refit
195
Diaphragm
dome-shaped latex or silicone cup which fits over the cervix
196
Diaphragm pt education
**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
Cervical Cap
soft, cup which fits over cervix to prevent sperm from entering
198
Cervical cap should be smaller than
diaphragm
199
Cervical cap pt education
No pressure placed on bladder
Can stay in place for 48hrs
Keep in place for 6-8 hours after intercourse
200
A papsmear is needs after how long of using the cervical cap?
3 years
201
Diaphragm and Cap pt eduction
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
Diaphragm and cap should be fit and refitted
Every 2 yrs., after childbirth, or a 20% weight gain or loss
203
Diaphragm and Cap
good and bad
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
What devices should not be used for a history of UTIs
sponge
diaphragm
cap
- toxic shock syndrome
205
Combination ORAL CONTRACEPTIVES have
estrogen and progesterone
206
Combination ORAL CONTRACEPTIVES do what
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
The mini pill has
progestin-only
208
The mini pill causes
thickening of cervical mucus
209
Oral Contraceptives are often used for
Regulate menstrual cycles
Reducing dysmenorrhea
Blood loss for excessive menstrual cycles, and anemia
210
With oral contraceptives, when should fertility return
within 3 months
211
Planning pregnancy after fertility returns off the oral contraceptive needs to
alternate method for 2-3 month
212
Combo oral contraceptives pt education
Consistent and proper use to be effective
Miss 1 pill - take asap
Miss 2-3 pills must use backup method
213
Combo oral contraceptives risks**
Postpartum & lactation - ↑ risk for DVT & ↓ milk production
Don’t use if smoker or over 35 y/o
214
Combo oral contraceptives if they miss 1 pill
take ASAP
215
Combo oral contraceptives MISS 2-3 PILLS
use back up method
216
Mini pill is less effective at
inhibiting ovulation, causes thickening of the cervical mucus prevents sperm penetration and alters uterine lining preventing implantation
217
Mini pill pt education
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
What oral contraceptive is a better choice for breastfeeding women/PP?
mini pill
219
With the mini pill fertility can return
quicker
220
Combo and MINI PILL contraceptives improves
Acne
Benign breast disease
Endometriosis
Fibroid bleeding
Premenstrual symptoms
Hirsutism
221
Combo and MINI PILL contraceptives side effects
Breast tenderness
Excessive cervical mucus
Nausea and vomiting
Headache
Hypertension
Breakthrough bleeding
222
Combo and MINI PILL contraceptive risk factors
Failure 3%
No protection for STI’s
Increased - migraines, hypertension, strokes, & thromboembolic disease
Altered blood glucose levels
223
Combo and MINI PILL contraceptives medication interactions
**Antibiotics decrease effectiveness
Avoid hepatotoxic medication
Interfere with anticoagulants**
Increase toxicity of tricyclic antidepressants
224
Transdermal Contraceptive Patch
releases continuous small amounts of estrogen and progestin that is absorbed by the skin suppressing ovulation, and thickens cervical mucus
225
Transdermal Contraceptive Patch pt education
An alternate method of birth control is needed for 1st week following initial application
Apply patch to buttocks, abdomen, upper arm **same day of the week for 3 weeks**
Remove patch for **4th week (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
A patinet with a Transdermal Contraceptive Patch should use an alternative form for how long
1st week
227
Transdermal Contraceptive Patch
improves and side effects
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
When does fertility return after the trandermal contraceptive?
1 month
229
If the transdermal patch fall off in 24 hours, the nurse should
put it back on
230
Vaginal Ring
soft, flexible, vinyl ring which releases small amounts of estrogen and progestin continuously to prevent ovulation
231
Vaginal Ring pt education
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
On the 1st insertion of the Nuvaring use the back up method unless placed the
1st 5 days of menses
233
The NuvaRing can be inserted as quickly as
placenta delivery
234
If the patient is 48 hours without the Nuvaring
1st two weeks requires a backup method for 7 days
235
NuvaRing advantages and disadvantages
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
You can remove the nuvaring for how long until the effectiveness is gone?
3 hours
237
IUDs (Mirena)
Chemical or hormone active device which is inserted into the uterus, damages sperm, & prevents fertilization
238
IUDs (Mirena) pt education
Inserted by a provider in the office
Check for string monthly to confirm placement
239
IUDs (Mirena) contraindication
diabetes, anemia, abnormal pap, history of pelvic infections
240
IUDs (Mirena) fertility returns
when removed fertility returns
241
IUDs (Mirena) advantages
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
IUDs (Mirena) disadvantages
No protection against STI’s
Increased cramping & bleeding 1st few cycles which resolves
243
IUDs (Mirena) potential side effects/complications
Menorrhagia – endometrial irritation
Pelvic Inflammatory Disease (PID) – endometrial irritation progresses
Ectopic pregnancy or Spontaneous abortions if pregnancy occurs
Perforation of the uterus
244
How long can a copper IUD stay
10 years due to chemical damaging the sperm
245
How long can the IUDs (Mirena) stay in
5 years damage the sperm
246
Contraceptive Implant
a progestin-filled rod that is placed in the upper inner arm under a local anesthetic.
247
Contraceptive Implant pt education
Requires a minor surgical office procedure
**Effective within 24 hours of insertion**
**Increased risk of ectopic pregnancy**
Fertility
248
Contraceptive Implant progestin inhibits
ovulation, thickens the cervical mucus & thins the endometrium
249
Contraceptive Implant advantages
Continuous long-acting contraception (3 yrs.)
Reversible
**Lactating - once Breastfeeding is established for 4 weeks**
250
Contraceptive Implant disadvantages
No protection against STI’s
Side effects same as oral contraceptives
Irregular and/or unpredictable menstrual bleeding
Acne, minimal weight gain or skin irritation at site
Removal required
251
Depo-Provera
IM hormone injection of Progestin which prevents pregnancy for 15 weeks, repeat injection should be given every 3 months
Patient Education
252
Depo-Provera pt education
1st dose 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
The Depo-Provera can only be used for
USE LESS THAN 2 YEARS due to decreased bone density
254
Depo-Provera fertility return
after 1 year
255
Depo-Provera advantages
Long-term birth control - injections every 3 months
Does not impair lactation once breastfeeding is established
Decrease bleeding or absence of period
256
Depo-Provera disadvantages
No protection against STI’s
Amenorrhea, spotting, irregular bleeding
Nervousness, dizziness, GI disturbances, headaches, fatigue, **weight gain**
257
Depo-Provera contraindicated for
history of breast cancer, stroke, blood clots, liver disease
258
Morning After Pills
PLan B
Ella
259
Plan B/Next Choice
progestin levonorgestrel or Progestin-only
-Inhibit ovulation, thicken mucus & interferes with corpus luteum function (house egg)
NO prescription needed for all ages
260
Ella/ulipristal acetate
Delays surge of LH, ovulation, and implantation
Requires pregnancy test as it can disrupt an early pregnancy
Prescription REQUIRED for all ages
261
Which morning after pill does not need a Rx?
Plan B
262
The plan B pill needs to be taken within
72 hours after intercourse
263
Ella needs to be taken within
5 days of sex
264
Both prevent pregnancy after unprotected intercourse however mechanism of actions are
different
265
Morning After Pill pt edu
Taken within 72 hrs. of unprotected intercourse
**Not to be used as a regular form of birth control!**
266
Morning After Pill advantages
Reduces risk of pregnancy for one-time unprotected sex
Over-the-counter (Plan B)
267
Morning After Pill disadvantages
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
Female Sterilization
Bilateral Tubal Ligation Salpingectomy - fallopian tubes are surgically cut, tied, burned, and/or blocked to prevent conception
269
PPBTLS PT EDUCATION
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
After a BTLS, NO
sex or lifting heavy objects for 1 week post-op*
271
BLTS advantages
Permanent contraception
Sexual function is unaffected
272
BLTS disadvantages
No protection against STI’s
Surgical procedure that requires anesthesia
Should be considered irreversible if future pregnancies are desired
273
BLTS risks and complications
Surgical complications - pain, infection & bleeding
Risk for ectopic pregnancy if pregnancy occurs
274
Male Sterilization
Vasectomy - vas deferens is surgically severed so sperm can no longer pass into the semen
275
Vasectomy pt edu
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
Vasectomy risks
Bleeding, infection, and anesthesia reactions
Permanent sterilization may not occur for 3 months so risk of getting pregnant
277
Permanent sterilization after a vasectomy
starts after 3 months
278
Vasectomy advantages
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
Vasectomy disadvantages
No protection from STI’s
Discomfort for 2-3 days
Considered irreversible - future pregnancies are desired
**Alternate contraception until 2 negative sperm counts**
280
After a vasectomy, an alternate contraceptive until
2 negative sperm counts due to the 3 months left inside
