Reproductive Health Concerns Flashcards
STI’s - Reportable
Concern: using contraception to prevent pregnancy but not to prevent STI’s (OCP)
Transmission: blood and body fluids (oral, vaginal, anal, BF)
- Many STIs are incurable including: hep B, genital herpes, HPV & HIV
- Reportable (Gonorrhea, Syphilis, Chlamydia, HIV AIDS, Hep A, Hep B, Hep C
Prevention is Key
- include a risk-assessment as part of general health assessments
- when high-risk behaviours are identified, provide counseling on safer sex options
- Behaviour is driven by perceived risk
- If she/he doesnt believe there are serious consequences, she/he won’t change behaviour
Nursing Care STI:
- provide specific, unbiased information
- may be providing care to clients whose lifestyle behaviours do not match your own values; non-judgemental care
- Provide care in a private setting with open-ended discussion
- consider who else is in the room
- Need to “match client” in terms of level of language
- avoid “overly professional terms” & confirm patient’s understanding of what is sex
Assessing STI Risk Behaviour
How do you define “sexually active”?
Are you currently sexually active now?
No -> Have you had sex in the past?
With how many different people?
Have your partners been men, women or both?
Have you ever thought that a sex partner put you at risk for STI/HIV?
(e.g. IV drug user, bisexual)
Have you ever had a STI?
What do you do to protect yourself from HIV/STIs
Do you have any health problems you believe are affecting your sexual expression?
Have you ever had testing for a STI?
Do you have any worries or concerns about sex now?
Contraception
A contraceptive that is 100% safe, 100% effective, inexpensive, simple to use, readily available, totally reversible, not directly connected to the act of intercourse does not exist
Facts from SOGC
- nearly 1/3 of all Canadian sexually active women aged 15-44 yrs use the OCP
- condoms are used by only 21% of females
- 6% rely on the withdrawal method
- 21% have chosen sterilization
- 50% of all pregnancies in Canada every year are unintended % 75% of sexually active teens do not use protection regularly
Barriers to Access
Embarrassment
- doctor/public health nurse as “gatekeeper”
- having the cashier ring it through
Access issues
- rural communities where maybe 1 or 2 places to get it
Cost
- not covered by MSP
Privacy
- small town- “everyone know’s everyone”
- being seen going into Dr’s office
Barriers for Use
Not comfortable discussing it
- not a long-term relationship; “in the moment”
May not have it with you
- diaphragm; situation wasn’t planned
Consumption of alcohol, cannabis
Contraception Options
Hormonal Methods
Barrier Methods (putting up a wall)
Fertility Awareness Methods (understanding menstrual and ovulatory part of the cycle)
Sterilization
Implications of Use (Female Condom)
- Require high motivation
- Noisy
- May interfere with the maintenance of an erection
- May interfere with or interrupt foreplay
- May interfere with either partner’s enjoyment of intercourse
- May break or slip
- May have an unpleasant taste if used during oral sex
Spermicide
Nonoxynol-9
- discipline for foams, sponges, films. Need 15 min or > before ejaculation to work as directed
- not 100% effective against certain STIs
Diaphragm & Cervical Cap
Teaching for all women who rely upon either of these methods:
- potential risk of toxic shock syndrome - never use either during menstrual bleeding & up to 6 weeks postpartum
- women using these methods must remove 6-8 hrs post insertion
- Must be refitted after any gyne surgery, birth or major weight losses or gains
Hormonal Methods: oral contraceptive pills
One of the world’s most prescribed medications - approx 100 million women
different combinations of estrogen & progesterone available
- “the pill” is suitable for most healthy women and can be used long-term. Estrogen-based: CAUTION in women who smoke and are > 35 years
With proper use, the Pill is 99.9% effective, making it the most reliable contraception. Reality: 3% user failure rate
Benefits of Hormonal Birth Control
- in addition to being the most effective form of contraception, the Pill:
- regulates the menstrual cycle
- reduces menstrual flow
- can reduce the number of periods per year
- reduces acne
- protects against certain cancers
- is completely reversible
Must take OCP at the same time every day
if 1 is missed, take asap and continue, even if you end up taking two at the same time.
If 2 are missed, take both and use a supplementary form of contraception
If 3 or more are missed, follow algorish on next page.
Contraindications of OCP
those with personal hx of breast cancer, migraine with aura and seizure disorders, pregnancy and lactation, hypertension and DM Type 1 and 2
Depo-Provera: Ideal Candidates
have side effects with, or a recognized contraindication to, combined OCP or estrogen
have trouble remembering contraceptive methods that require daily use
over the age of 35 who smoke
have discontinued oral contraceptives while awaiting major surgery
have migraine headaches, including focal varieties
sickle cell disease
on anti-convulsants that interfere with the combined OCP
developmental challenges
heavy or irregular menstruation (Depo-Provera may cause amenorrhea)
Natural Birth Control Methods
- Fertility rhythm method
- Basal body temperature method
- Cervical mucus method
- Breastfeeding
- Withdrawal
Key Points: need to know the fertility cycle and your particular cycle. Need to know signs of pre-ovulation, ovulation, and post-ovulation. Cervical mucus changes to help keep sperm alive and moving during highest fertility (ovulatory mucus is thinner, milky white, and know as leukorrhea) - BF is not reliable as contraception due to cycles without menses but where ovulation still occurs, and because of variations in hormone between day and night and week to week depending on BF habits of the infant
Fertility Awareness Methods
Most effective for:
- educated highly motivated couples
- woman has stable periods - limited stress
- personal discipline - daily monitoring, choices, r/t sexual spontaneity
- able to “bear risk” of unplanned pregnancy esp. during “training period”
Excellent option for couple education & awareness of fertility for when wanting to conceive
Good choice for women who cannot use hormonal methods
Emergency Contraceptive Pill: Plan B
- requires a prescription
- use within 120 hours or 5 days of unprotected intercourse
- can cause nausea, consider an anti-nausea 1-2 hours before administration
- decreases chances of pregnancy by 60-85%
- Does not end an implanted pregnancy
A hormone that stops trophoblasts from developing. Egg comes out of ovary, travels through fallopian, sperm meets it, trophoblasts are cellular division that happens prior to implantation. Prevents trophoblastic meiosis. If fertilized egg burrows into the uterine wall and develops then the plan B will have zero impact. Not an abortion.
Key Points of Sexual Health Education
- The transmission of STIs is a significant, ongoing epidemic
- professional, non-judgemental, unbiased manner
- provide safe, open discussion where our patients feel comfortable
- truthfully inquiring about their needs/concerns
- understand the patient’s lived reality
- assist clients to find a method that meets their needs and matches their values
Infertility
- Sperm issues: combination of low sperm count and motility issues
- Ovarian factors: quality or number
- Male anatomy: sperm can’t get out
- BMI: impactful and combined with other issues
- Uterine: cystic issues, fibroids
- Age
- endometriosis
- endocrine isues
Nursing Role in Fertility
- Sensitive
- assess knowledge & lifestyle issues
- assess needs & support
- Refer to reproductive specialists/counselling
Infertility can be perceived as loss
Loss cycle
- shock
- denial
- anger
- bargain
- depression
- guilt or unworthiness
- acceptance
In-Vitro Fertilization
Indications vary
medication to prepare ovulation egg retrieved
Partner provides semen sample, lab combines the sperm and egg
Embryos are incubated when implanted directly into women’s uterus
Cost -10000-15000
Reasons for Termination of Pregnancy: Therapeutic
performed when the mother’s health/life is in danger if pregnancy continued
Reasons for Termination of Pregnancy: Eugenic
when the child is thought to be unable to live or to suffer severe disability
Reasons for Termination of Pregnancy: Psychiatric
when the mental health of the mother is threatened by the pregnancy
Reasons for Termination of Pregnancy: Ethical
pregnancy is result of incest or rape
Reasons for Termination of Pregnancy: On Demand
abortion at request of mother for any reason
Accessibility in BC
Designated hospitals
Teenagers do not require parental consent; clinics must keep their names confidential
- no referral needed
- up to 20 weeks. most occur before 13 weeks
- < 1:100 will have complications: infection, hemorrhage, cervical tear
Methods: 1st Trimester
Medication: Misprostol: causes uterine contractions. Methotrexate: destroys rapidly dividing cells, blocks folic acid for cell division process
Surgical: vacuum-aspiration: suction applied to evacuate contents of the uterus. with or without cervical dilation. clinic or hospital. Canada does not use mifepristone
Methods: 2nd Trimester
D & E: dilation and evacuation - aspirotomy. also known as dilation and curettage
- sonar, sedative, local, general, or spinal anesthetic
- dilate cervix, bigger cannula for vacuum
- forceps to remove pieces of tissue
- curette to scrape uterus lining
Induction (2nd and 3rd trimester)
- dilation of cervix, and labour, and birth)
- Medicatios: salt water, digoxin, potassium chloride into amniotic sac.
- prostaglandins, such as misprostol vaginally,
- oxytocin IV
Risks of Pregnancy Termination
- Medical 95% successful
- surgical - most often used
- most common risks:
Bleeding-retained products
Infection
Cervical damage or uterine damage
Emotional damage - usually no effect on future fertility
Role as a nurse
professional boundaries
ethical standards of practice
duty to provide care
