Unit 2: Antepartum Nursing Care Flashcards
Abstinence is
abstaining from having sexual intercourse eliminating the possibility of sperm entering a woman’s vagina. (Though other “sexual acts” may be practiced)
Advantages of abstinence are
- 100% effective
- Can eliminate the risk of STIs if there is no genitalia contact
- Abstinence during fertile periods (rhythm method) can be used, but it requires an understanding of the menstrual cycle and fertility awareness.
Disadvantages of Abstinence
Requires self-control
Risks / complications / contraindication of Abstinence
None if complete abstinence is maintained
Define Coitus Interuptus
Man withdraws penis from vagina prior to ejaculation
Advantages of Coitus Interuptus
Possible choice for monogamous couples with no other option for birth control (i.g. religious restrictions)
Disadvantages of Coitus Interuptus
- Most ineffective method of contraception
- No protection against STIs
Risks /complications / contraindications
of Coitus Interuptus
- Male partner’s control can make this an effective method
- Leakage of fluid that contains spermatozoa prior to ejaculation can be deposited in the vagina
- Risk of pregnancy
Define the calendar method
- A woman records her menstrual cycle and calculates her fertile period based on the assumption that ovulation occurs 14-day prior to menstruation.
- Viability of sperm (48-120hr) and ovum (24hr) must also be accounted.
Advantages of the Calendar Method
- Most useful when combined with basal body temperature or cervical mucus method
- Inexpensive
Disadvantages of the Calendar Method
- Not a very reliable technique
- Requires accurate record keeping
- Requires compliance with abstinence during fertile window
Risks / complications / contraindications of the Calendar Method
- Various factors can affect and change the time of ovulation and cause unpredictable menstrual cycle.
- Risk of pregnancy
Define the Basal body temperature method
Temperature can drop slightly at the time of ovulation This can be used to facilitate contraception, or be used as a natural contraceptive
Advantages of the basal body temperature method
- Inexpensive
- convenient
- no side effects
Disadvantages of the basal body temperature
- BBT reliability can be influenced by many variables that can cause inaccurate interpretation of temperature changes
- stress
- fatigue
- illness
- alcohol
- warmth/coolness of sleeping environment
Risks/ Complications / Complications of the Basal body temperature method
- Risk of pregnancy
Define the symptom based method (cervical mucus)
Fertility awareness method based on ovulation.
Ovulation occurs about 14 days prior to the next ovulation cycle. Following ovulation, the cervical mucus becomes thin and flexible under the influence of estrogen and progesterone to allow for sperm motility and viability.
The ability of the cervical mucus to stretch between the fingers is greatest during ovulation. (~1” spinnbarkeit sign)
Advantages of the cervical mucus method
- A woman can become knowledgeable in recognizing her own mucus characteristics at ovuation, and self-evaluation can be very accurate
- Self-evaluation of cervical mucus can also be diagnostically helpful in determining the start of ovulation while breastfeeding, in noting the commencement of menopause, and in planning a desired pregnancy
Disadvantages of the cervical mucus method
- Some women may be uncomfortable with thouching their genitals and mucus and therefore, will find this method objectionable.
Risks / Complications / Contraindications of the cervical mucus method
- Assessment of cervical mucus characteristics may be inaccurate if mucus is mixed with other fluids
- Risk of pregnancy
Define condoms as a contraceptive method
A thin flexible sheath worn on the penis during intercourse to prevent semen from entering the uterus
Advantages of the condom
Protects against STIs and involves the male in the birth control method
Disadvantages of the condom method
- High rate of noncompliance
- May reduce spontaneity of intercourse
- The penis must be erect to apply a condom
- If the penis is withdrawn while still erect, this can interfere with sexual intercourse
Risks / Complications / Contraindications of condoms
- Condoms can rupture or leak
- condoms have a one-time usage
- Condoms made of latex should nt be worn by those who are sensitive or allergic to latex
- Only water-soluble lubricants should be used with latex condoms to avoid condom breakage
Teaching for condoms
- A man places the condom on the erect penis, leaving an empty space at the tip for a sperm reservoir
- Following ejaculation, a man withdraws his penis from the woman’s vagina while holding the rim of the condom to prevent any semen spillage to the woman’s vulva or vaginal area
- May be used in conjunction with spermicidal gel or cream to increase effectiveness.
Define diaphram as a contraceptive
- A dome-shaped cup with a flexible rim made of latex or silicone that fits snugly over the cervix with spermicidal cream or gel place into the dome and around the rim
Teaching for diaphragm
- A female client must be fitted with a diaphragm
- A client must be refitted by the provider every 2 years, if there is a 15lb(7kg) weight change, full-term pregnancy or second-term abortion
- Requires proper insertion and removal.
- prior to coitus - inserted vaginally with spermicide on the cervical side and rim
- post coitus - the diaphragm must stay in place at least 6 hours
- Spermicide must be reapplied with each act of coitus
- A client should emply her bladder prior to insertion of the diaphragm
Advantages of the diaphragm
This barrier bethod eliminates surgery and gives a woman more control over contraception
Disadvantages of the diaphragm
- Diaphragms are inconvenient, interfere with spontaneity, and require reapplication with spermicidal gel, cream, or foam with each coitus act
- Requires a prescriiption and a visit to a provider
- Must be inserted correctly to be effective
Risks / complications / contraindications of the diaphragm
- Diaphragms not reccommended for pts who have a hx of toxic shock syndrome, or frequent, recurrent UTIs
- Increased risk of Toxic shock ( caused by bacterial infection)
- Proper hand hygiene aids in prevention of TSS, as well as removing diaphragm promptly at 6 hr folllowing coitus
- Diaphragms made of latex should not be worn by those with sensitivity or allergy to latex
Definition of combined oral contraceptive methods
Hormonal contraception containing estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation.
Advantages of combined oral contraceptive methods
- Highly effective if taken correctly and consistently
- Medication can alleviate dysmenorrhea by decreasing menstrual flow and menstrual cramps
- Reduces acne
Disadvantages of combined oral contraceptives method
- Oral contraceptives do not protect against STIs
- Birth control pills can increase the risk of thromboses, breast tenderness, scant or missed menstruation, stroke, nausea, headaches, and hormone-dependent cancers
- Exacerbates conditions affected by fluid retention such as migraine, epilepsy, asthma, kidney, or heart disease
Risks/ Complications / Contraindications of Combined oral contraceptives
- Woman with a hx of blood clots, stroke, cardiac problems, breast or estrogen-related cancers, pregnancy, or smoking (if over 35 yro), are advised not to take oral contraceptive medications
- Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes, such as anticonvulsants and some antibiotics
Teaching for combined oral contraceptives
- Meication that requires a prescription and follow-up appointments
- Medication requires consistent and proper use to be effective
- Instruct client on S/S of adverse effects
- chest pain, shortness of breath, leg pain, headache, or eye problems from stroke, or hypertension
- In the event of missed doses
- one dose missed - take one as soon as possible
- more than one dose missed - follow manufacturers instruction and use alternative contraceptives
Define the minipill contraceptive
Oral progestins that provide the same action as combined oral contraceptives
Advantages of the minipill
- Fewer side effects than the combined oral contraceptives
- Considered safe to take while breastfeeding
Disadvantages of the minipill
- Less effective in ovulation suppression than the combined oral pill
- Pill increases occurance of ovarian cysts
- Pill does not decrease risk of STIs
- Users frequently report breakthrough, irregular, vaginal bleeding, and decreased libido
- Increases appetite
Risks/ complications/ contraindications of the minipill
- Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes, such as anticonvulsants and some antibiotics.
Teaching related to the minipill
- Take the pill at teh same time daily
- Do not miss a pill
- Use a second form of birth control during the first month
Definition of the emergency oral contraceptive
Morning after pill that prevents fertilization from taking place
Teaching r/t emergency oral contraceptives
- Pill must be taken within 72 hours after unprotected coitus
- Take an OTC antiemetic 1 hr prior to the emergency oral contraceptive for nausea (due to high doses of estrogen and progetin)
- See a HCP if menstruation does not occur withing 21 days
- Counsel the pt regarding contraception and behavior modification r/t at risk sexual practices
- Is considered a form of “emergency” birth control (debated)
Advantages of the emergency oral contraceptive
- Pill is not taken on a regular basis
- Can be obtained w/o a prescription by women 17 years or older
Disadvantages of the emergency oral contraceptive
- Side effects of nausea, heavy mentruation, lower abdominal pain, fatigue, and headache
- Does not provide long-term contraception
- Does not terminate an established pregnancy
- Does not protect against STIs
Risks / complications/ contraindications of the emergency oral contraceptive
- Contraindicated if the pt is pregnant or has undiagnosed vaginal bleeding
- Pt may be pregnant if menstruation does not begin w/in one week of expected start date.
Define the transdermal contraceptive patch
Contains norelgestromin (progesterone) and ethinyl estradiol, which is delivered at continuous levels through the skin into subcutaneous tissue.
Teaching r/t the transdermal contraceptive patch
- Apply to dry skin of the buttock, abdomen, upper arm, or torso.
- Requires patch replacement once a week
- Patch is applied the same day of the week for 3 weeks with no application of the patch on the fourth week
Advantages of the transdermal contraceptive patch
- Maintains consistent blood levels of hormones
- Avoids liver metabolism of medication because it is not absorbed in the GI tract
- Decreases risk of forgetting a daily pill
Disadvantages of the transdermal contraceptive patch
- Patch does not protect against STIs
- Poses same side effects as oral contraceptives
- Skin reaction may occur from patch application
Risks/ complications/ contraindications
- Same as those of oral contraceptives
- Avoid applying of patch to skin rashes or lesions
Define injectable progestin (Depo-Provera)
An intramuscular injection given to a female client every 11 to 13 weeks
Teaching r/t injectable progestins (Depo-Provera)
- Start of injections should be during the first 5 days of the client’s cycle and every 11 to 13 weeks thereafter
- Injections of postpartum nonbreastfeeding women should begin within 5 days after delivery.
- Breastfeeding women should start injections in the sixth week postpartum
- Pt should keep follow-up appointments
- Pt should maintain an adequate intake of Ca and vitamin D
Advantages of the injectable progestins (Depo-Provera)
- Very effective and requires only four injections per year
- Does not impair lactation
Disadvantages of the injectable Progestins (Depo-Provera)
- Can prolong amenorrhea
- Irregular or unpredictable bleeding or spotting
- Increases the risk of thromboembolism
- Decreases bone mineral density
- Does not protect against STIs
- Should only be used as a long-term method of birth control (>2 yrs) if other methods are not effective
Risks/ complications/ contraindications of the injectable progestins (Depo-Provera)
- Avoid messaging the injection site to avoid accelerating the medication absorption
- this shortens the effectiveness duration
Define contraceptive vaginal rings (Nuvaring)
Containes etonogestrel and ethinyl estradiol that is delivered at continuous levels vaginally
Teaching related to contraceptive vaginal rings (Nuvaring)
- Insert the ring vaginally
- Replace the ring after 3 weeks, and the new ring within 7 days of removal.
- Insertion should not occur on the same day of the week monthly
Advantages of the contraceptive vaginal ring (Nuvaring)
- Vaginal ring does not have to be fitted
- Decreases the risk of forgetting to take the pil;
Disadvantages of the contraceptive vaginal ring (Nuvaring)
- Vaginal ring does not protect against STIs
- Poses the same side effects as oral contraceptives
- Some pts report discomfort during intercourse
Risks/ complications/ contraindications of the contraceptive vaginal ring
- Adverse effects include: Blood clots, hypertension, stoke and heart attack
- Side Effects include: Vaginal irritation, increased vaginal secretions, headache, weight gain, and nausea
Define implantable progestin etonogestril (Implanon)
- Requires a minor surgical procedure to subdermally implant and remove a single rod containing etonogestrel on the inner side of the upper aspect of the arm
Teaching r/t implantable progestin etonogestrel (Implanon)
- Avoid trauma to the area of implantation
Advantages of the implantable progestin etonogestrel (Implanon)
- Effective continuous contraception for 3 years
- Reversible
- Can be used by mothers who are breastfeeding after 4 weeks postpartum
Disadvantages of implantable progestin etonogestrel (Implanon)
- Etonogestrel does not protect against STIs
- Most common side effect is irregular and unpredictable menstruation
- Headache
Risks/ complications/ contraindications of implantable progestin etonogestrel (Implanon)
- Increased risk of ectopic pregnancy if pregnancy occurs
Define intrauterine device (IUD)
- A chemically active T-shaped device inserted through the women’s cervix, into the uterus by a provider.
- Releases a chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization
Teaching r/t intrauterine device (IUD)
- Monitor the device monthly after menstruation to ensure the presence of the small string that hangs from the device into the upper part of the vagina
Advantages of the intrauterine device (IUD)
- An IUD can maintain effectiveness for 1 to 10 years
- Contraception can be reversed
- Does not interfere with spontineity
- Safe for breastfeeding mothers
- It is 99% effective in preventing pregnancy
Disadvantages of the intrauterine device (IUD)
- An IUD can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy
- Pt should report late or abnormal spotting or bleeding, abdominal pain, pain with intercourse, abnormal or foul-smelling vaginal discharge, fever, chills, a change in string length, or it IUD cannot be located.
- An IUD does not protect against STIs
Risks/ Complications/ Contraindications of intrauterine device (IUD)
- Best used by women in monogomous relationship
- May cause irregular bleeding
- Risk of bacterial vaginosis, uterine perforation, or uterine expulsion
- Must be removed in the event of pregnancy
Define Essure
The insertion of small flexible agents through the vagina and cervix into the uterine tubes. This results in the development of scar tissue blocking the tubes.
Teaching r/t Essure
- Normal activities may be resumed by most within 1 day of the procedure
Advantages of Essure
- Quick procedure that requires no general anesthesia
- Nonhormonal means of birth control
- Essure is 99% effective
- Rapid return to normal ADLs
Disadvantages of Essure
- Not reversible
- Not intended for postpartum pt
- Delay in effectiveness of 3 months
- Changes in menstrual patterns
Risks/ Complications/ Contraindications of Essure
- Perforation can occur
- Unwanted pregnancy can occur if pt has unprotected intercourse during the first 3 months
- Increased of ectopic pregnancy
Define female sterilization
Bilateral tubal ligation is a surgical procedure consisting of severance and/or burning/blocking of the fallopian tubes
Advantages of female sterilization
- Permanent contraception
- Sexual function is unaffected
Disadvantages of female sterilization
- A surgical procedure with normal risks r/t anesthesia, complications, infection, hemorrhage, or trauma
- Considered irreversible in the event that a client desires contraception
Risks/ Complications/ Contraindications of female sterilization
- Risk of ectopic pregnancy
Define male sterilization
A vasectomy is a surgical procedure consisting of ligation and severance of the vas deferens
Teaching r/t male sterilization
- Use alternative contraceptives for the first approx. 20 ejaculations to allow all sperm to clear the vas deferens.
Advantages of male sterilization
- A vasectomy is a permanent contraceptive method
- Procedure is short, safe and simple
- Sexual function is not impaired
Disadvantages of male sterilization
- Requires surgery
- Considered irreversible in the event that a client desires contraception
Risks/ Complications/ Contraindications of male sterilization
- Complications are rare , but may include bleeding, infection, and anesthesia reactions.
