Toni - Week 8 - Final Flashcards
what are the 11 contraception decision factors??
- Effectiveness
- Safety
- Age
- Childbearing plans
- Contraindications
- Religious/moral beliefs
- Preference
- Lifestyle
- Partner cooperation
- Motivation
- Finances
what is the longest possible fertile period?
8 days
sperm survive _______ and ovum survive ______
7 days; 24 hrs
In order to avoid pregnancy, when should women should abstain or use barrier method?
- 7 days before ovulation
- 3 days after ovulation
what are the 5 different barrier contraceptives?
- male condom
- female condom
- spermicide
- diaphragm
- cervical cap
a male condom is ____ effective, while a female condom is ____ effective
85%; 79%
spermicide _____ condom effectiveness
increases
diaphragm and cervical cap are both _____ effective.
84%
diaphragms should be replaced every ____.
1 - 2 years
when should a diaphragm be inserted? taken out?
inserted 4 hrs before intercourse; take out 6 hours after.
what are hormonal contraceptives? what are the 2 different types?
ingested hormones
- estrogen and progestin
- progestin alone
how do hormonal contraceptives work?
- inhibits ovum release
- thickens cervical mucus
T/F: hormonal contraceptives are available in 21, 28, 91, and 365 day regimens
TRUE
what is the effectiveness of hormonal contraceptives? the benefits?
92% effective; reduced PMS, cramps, and menstrual flow
hormonal contraceptives protect against ____ _____.
bone loss
what are the disadvantages of hormonal contraceptives?
- no STI protection
- ↑ risk of thromboembolism
what are the 2 hormonal contraceptives that avoid first pass? what is their effectiveness?
- transdermal patch
- vaginal ring
**effectiveness: 92%
what are characteristics of the hormonal patch?
a new patch once a week; patch free week’ not as effective in above 200 lb
what are the characteristics of the ring?
releases estrogen and progestin; in for 3 weeks and then removed
what are the 3 methods of sterilization?
vasectomy, tubal ligation, transcervical sterilization
what is the effectiveness of sterilization?
> 99%
what is depo-provera?
- progestin IM injection q 12 weeks
how does depo-provera work?
inhibits ovulation and stimulates thick cervical mucus
what is the effectiveness of depo-provera?
97%
what are 4 other characteristics of depo provera?
- safe for lactation
- risk of bone loss with prolonged use
- may be used for 2 years
- fertility delayed up to 18 months when d/c
what is a IUD?
plastic device placed in uterus that can remain 5-10 years
how does IUD work?
- some release progestin
- triggers inflammation of endometrium preventing fertilization and implantation
how effective is UTI? what is important to teach?
99% effective; teach to check for string ends between periods; test for STI before insertion
what is emergency contraception?
high dose OCs given within 72 hrs of unprotected intercourse; Two doses 12hrs apart
how does EC work?
may prevent ovulation, fertilization, and implantation
EC is ____ effective
80%
what are the disadvantages of EC?
nausea; advise to take antiemetics
what is also important when someone requests EC?
counseling and discuss risky sexual behaviors
T/F Paragard IUD can also be used within 5 days of unprotected sex
T
what is a therapeutic abortion?
intentional pregnancy interruption before 20 weeks
- elective: woman’s request
- therapeutic: maternal or fetal health
what are the 5 characteristics of TAB?
– Legalized 1970 – 1st trimester abortions legal – Late abortion legality left to individual states – Catholic-run hospitals forbid – RN may refuse abortion care assignment
what is a surgical abortion?
• Vacuum aspiration up to 16
weeks after LMP
• Dilation & evacuation used
after 16 weeks
what are complications of a surgical abortion?
Complications: perforation,
hemorrhage, cervical
lacerations, infection ***prophylactic antibiotics are used
what is the cost of a surgical abortion?
$1,500 aspiration; more for D&E
what is a medical abortion?
PO within 7 weeks of LMP
- Mifepristone (RU-486)
- Misoprostol 2 days later
what are 2 characteristics of medical abortion?
- most woman terminate pregnancy in 5 hrs
- return to MD to confirm
what are the complications of a medical abortion?
- cramping, fatigue, nausea, heavy bleeding
what is the cost of a medical abortion?
up to $800
Highest STI rates are in ____ _____ _____
sexually active adolescents
T/F STIs can bring significant complications
T
how can STIs be prevented?
- abstinence
- monogamy
- latex condoms
- prompt diagnosis and tx
- educate regarding risky behaviors
what are the 5 bacterial STIs
chlamydia gonorrhea syphilis pelvic inflammatory disease bacterial vaginosis
what are the 4 required reportable diseases?
chlamydia
gonorrhea
syphilis
PID
what are the 2 viral STIs
genital herpes and genital warts
what is the parasite STI?
trichomoniasis
what is the fungal STI?
candidiasis
what is the most common bacterial STI?
chlamydia
how is chlamydia transmitted?
• Transmitted via vaginal, anal, oral sex (to neonate during birth)
what are the s/sx of chlamydia?
• S/Sx: often asymptomatic
– Women: mucopurulent discharge, cervicitis, urethritis, vaginal
bleeding
– Men: urethritis with clear or mucoid urethral discharge
what can happen if chlamydia isn’t treated?
• If untreated
– Mom: PID, ectopic pregnancy, infertility
– Newborn: opthalmia neonatorum/blindness; pneumonia
what is the tx for chlamydia?
• Treatment – Azithromicin PO x 1 – Ceftriaxone IM x 1 (empiric treatment of gonorrhea) – Treat partners/abstain until cured – Prevention counseling/education – Reportable STI
what is the nd most common bacterial STI?
gonorrhea
how is gonorrhea transmitted?
Transmitted via vaginal, anal, oral sex (neonate during birth)
what are the s/sx of gonorrhea?
– Women often asymptomatic; may have cervicitis/urethritis
– Men typically present dysuria & purulent penile discharge
what occurs when gonorrhea is untreated?
If untreated
– Mom: PID, ectopic, infertility, preterm labor
– Newborn: opthalmia neonatorum/blindness
what is the tx for gonorrhea?
– Ceftriaxone IM x 1 – Azithromicin PO x 1 (empiric treatment of chlamydia) – Treat partners/abstain until cured – Prevention counseling/education – Reportable STI
how is syphilis transmitted?
Transmitted sexual contact; crosses placenta
what are the s/sx of syphilis?
S/Sx vary depending on infection stage:
– Primary: painless chancre
– Secondary: fever, lymphadenopathy, HA, anorexia, rash
– Latent: asymptomatic
– Tertiary: irreversible multi organ damage & death
what are the screening tests for syphilis?
VDRL and RPR
what happens if syphilis is untreated?
Mom: SAB, stillbirth
Newborn: congenital syphilis (deformities; mental delay)
what is the tx for syphilis?
– Penicillin 2.4 million units IM x 1
– Treat partners/abstain until cured
– Prevention counseling/education
– Reportable STI
what is HPV do?
causes venereal warts; Incurable; vaccine available for common CA-causing types
how is HPV transmitted?
Transmitted via sexual contact or during delivery
what are the s/sx of HPV?
S/sx: fleshy painless growths on vagina, labia, cervix, or anus
how is HPV diagnosed?
Diagnosis via Pap smear, visual exam
what happens if HPV is untreated?
If untreated in pregnancy may obstruct birth canal &
newborn may develop laryngeal papillomas
how can HPV be managed?
– May disappear without treatment
– Removal via cryotherapy, surgery, podophyllin, or acid
– Prevention counseling/education
– Sexual partner examination is not necessary
what is bacterial vaginosis?
- Sexually associated infection - not true STI
* Bacteria outnumber vaginal lactobacilli; alters vaginal pH
what are risk factors for bacterial vaginosis?
multiple partners, douching, smoking
what are the s/sx of BV?
thin, gray-white vaginal discharge; fishy odor
how is BV diagnosed?
microscopic identification of clue cells; whiff test; vaginal
pH 4.5 or above
what happens when BV is untreated?
If untreated in pregnancy: PROM, chorioamnionitis, PTL, PID
what is the tx for BV?
– Metronidazole (Flagyl) PO bid x 7 days
– Abstain or use condom until antibiotics completed
– Treating partner not beneficial
what is PID?
Acute infection of uterus & fallopian tubes (from STIs)
what are the s/sx of PID?
dysuria, pelvic pain, fever, chills, nausea, anorexia,
abnormal vaginal discharge or bleeding
how is PID diagnosed?
– STI +(chlamydia/gonorrhea), elevated WBC, CRP & ESR
– Pain in uterus & cervix when moved during exam
what are the risk factors for PID?
hx STIs, young, low income, multiple
partners, recent IUD insertion, douching
**↑ risk ectopic pregnancy and infertility
what is the tx for PID?
– Ceftriaxone IM, doxycycline PO, metronidazole PO
– Treat partners/abstain until cured
– Prevention counseling/education
– Reportable STI
how is HSV transmitted?
• Transmitted: skin or sexual contact, & to neonate in vaginal
birth (viral shedding can occur in absence of visible sores)
• Highly contagious; incurable
what are the s/sx of HSV?
S/sx: painful blisters vulva, perineum, & anus
how is HSV diagnosed?
visual exam confirmed by viral culture
what can HSV be associated with in pregnancy?
– Mom: SAB, stillbirth
– Neonatal herpes: CNS infection 50% mortality (risk greatest if mom gets virus 1st time in late pregnancy)
what is the tx for HSV?
– Acyclovir & healthy lifestyle reduces symptoms
– C/S if active genital infection at time of birth
what is trichamoiasis? transmission? s/sx? diagnosis? tx?
• Causative agent: anaerobic, flagellated protozoan parasite
• Transmitted via sexual contact
• S/sx: may be asymptomatic
– Women: profuse yellow-green or frothy gray vaginal
discharge with foul odor. Vulvar pruritis/edema, dysuria,
cervicitis (strawberry cervix)
– Men: dysuria, thin, white penile discharge
• Diagnosis protozoa ID microscopically via “wet mount”
• If untreated in pregnancy: PPROM, PTL, stillbirth
• Treatment
– Metronidazole (Flagyl) po x 1 (avoid alcohol)
– Treat partners/abstain until cured
– Prevention counseling/education
what is genital candidiasis? transmission? s/sx? diagnosis? tx?
• Not true STI; overgrowth of vaginal yeast
• Curable with antifungal PO or vaginal suppository
• S/Sx vaginal/vulval itching, burning, vulva/vagina very red &
swollen; cottage cheese-like discharge
• If untreated: can infect newborn at birth: thrush, diaper rash,
meningitis, endocarditis, UTI, sepsis
• Oral yogurt common remedy (vaginal yoghurt also effective)
• Teach preventive measures: reduce dietary sugars, cotton
underwear, showers (no tubs), and avoid bubble bath,
douching, spandex, & super absorbent tampons/pads
