Week 5 Contraceptives/STDS

Question 1

What questions are important to ask the patient about birth control? (6)

Answer 1

•Is it important that I don’t get pregnant right now?
•Do I plan to have children in the future?
•Would a pregnancy be a problem now?
•Is this method safe for me? (Health Concerns)
•How does my partner feel about birth control?
•Is this method easy to use?
•How often do I have sex?
•Do I need a method that helps protect me from HIV and other STDs?

Question 2

What are the 4 methods of birth control?

Answer 2

1.Barrier methods: condoms, spermicides (foams and creams), diaphragm, cervical cap

2. Hormonal methods: oral contraceptives, injections, implants, patches, cervical rings, IUD’s
3. Natural family planning: calendar, basal body temperature, cervical mucus, coitus interruptus (withdrawal), breastfeeding
4. Sterilization: tubal ligation, vasectomy

Question 3

Barrier methods

Answer 3

•block sperm
-male condom = 88% effective, w/spermicide 99%
-female condom = 79% effectiveness

Advantages: protects from STD, easy to use/carry.

Question 4

Disadvantages of condoms (4)

Answer 4

-Must be put on during sex every time
-Some men say it reduces sexual feelings
-Condoms with spermicide may irritate vagina or penis
-Some people are allergic to latex

IF* not used every time/correctly or if there are skin breaks where fluid can enter the body stds could still occur.

Question 5

Foams, gels, suppositories, films

Answer 5

•Often combined with condoms
•Made of chemicals that kill sperm, placed into vagina before sex
• Effectiveness: 74-94% (depending on care taken with use).
•When used with condoms-99% effective.

Question 6

Foams, gels, suppositories, films advantages/disadvantages

Answer 6

Advantages:
•Easy to buy and carry
•Used only when needed
•May help protect against some* STDs

Disadvantages:
•Must be put in shortly before sex
•Messy
• May cause irritation of vagina or penis
•not effective against HIV

Question 7

What is a Diaphragm

Answer 7

•Small rubber cup fits inside vagina, over the cervix
•Used with contraceptive cream or jelly that kills sperm
•Must be fitted by a clinician
•Effectiveness: If you are very careful each time, 94%, not very careful each time, 80%
•Few health problems, small risk for toxic shock syndrome
•More bladder infections for some women (pressure placed on bladder)

Question 8

Diaphragm advantages/disadvantages

Answer 8

Advantages:
• Can be put in 2 hours before sex
• May help against some STDs (not HIV)

Disadvantages:
•Must be left in place 6-8 hrs after sex
• Some say it’s hard to put in and take out
•Some women feel the diaphragm(especially when urinating)
•Can be messy (cream or jelly may cause irritation)
•No protection against HIV

Question 9

What is a cervical cap?

Answer 9

Similar to the diaphragm, but smaller (causes less pressure on urethra)

• Comes in 4 sizes (may not fit some women)
•Effectiveness: 82%

•Advantages: can remain in place for 48 hours, no feeling of pressure

Disadvantages:
•insertion is more difficult (due to size)
•effectiveness lower than diaphragm
•no use during menses
•dislodgment
•cervical/vaginal tissue irritation

Question 10

Hormonal contraception action

Answer 10

Alters hormone fluctuations of menstrual cycle (prevents ovulation and good development of endometrium)

Question 11

The pill

Answer 11

•most widely used hormonal contraceptives in US
•inhibits maturation of the follicle and ovulation

Question 12

Combined oral contraception

Answer 12

•Estrogen/ Progestin combination
•Prevents FSH & LH release from the pituitary (preventing maturation of follicle/ovulation)
•Effectiveness: Careful 99%, not careful 95%
•21 or 28 day packets

Question 13

Progestin only Pill

Answer 13

•breastfeeding mom can ONLY use progestin pills. Estrogen drys up milk
•can be used during breastfeeding
•start 4-6 weeks after delivery
•needs to use other barrier methods before starting pill. Can get pregnant again

Question 14

Advantage/ disadvantage of the pill

Answer 14

Advantages:
•Highly effective, simple & easy to use
•Not too expensive
•Doesn’t interfere with sex
•less bleeding/cramping with periods
•less chance of PID, ovarian/endometrial cancer
• Regulates menstrual cycle, improves Endometriosis

Disadvantages:
•Side effects: weight changes, moodiness, spotting, breast tenderness, nausea, headaches.
•Must remember to take every day
•No protection against HIV and STDS
•Risks: Very small chance of blood clots, heart attacks, strokes, may cause HTN

Question 15

Hormone injections

Answer 15

•Depo-Provera (progesterone)-injectable progestin (1 shot x3months)

•Action: Prevents ovulation , thickens mucus in cervix so it is hard for sperm to enter uterus- 99% effective

•might stop period - hard to tell if you’re pregnant or not

Should not be used by women with liver or heart disease, breast cancer or blood clots

•Few serious problems for most women, Can cause bone-density problems in teens (can only be used for up to 4 years)

Question 16

Depo-Provera advantages/disadvantages

Answer 16

Advantages:
•Doesn’t interfere with sex
•Lasts 3 months
•Often decreases bleeding & cramping seen with periods
•Safe to use while breastfeeding
•Less chance of ovarian or endometrial cancer

Disadvantages:
•Must have injection by HCP
•May cause heavy, irregular, light periods, or no period at all
• May not be able to get pregnant several months after shots are discontinued
•May have weight changes (5.4 lbs. 1st year, 8.1 ,2yrs, 13.8, after 4 years)
•moodiness, depression, headaches or dizziness
•No protection against HIV/ STDs

Question 17

IUD Action

Answer 17

•Small device put inside uterus by a clinician copper ParaGard & Mirena

•Action: immobilizes sperm, prevents implantation
• Effectiveness:98-99%
•need to check string 1x month for placement/migration in uterus

Question 18

IUD Advantages/ Disadvantages

Answer 18

Advantages:
• Always in place, doesn’t interfere with sex
•Effective for 5-10 years (check string length monthly)

Disadvantages:
•Side effects: Menorrhagia, dysmenorrhea-more bleeding and cramping, pain during period
•Should not be used by women with multiple partners, no protection against HIV or STDs
•Increases chance of pelvic inflammatory disease
(PID, Ectopic pregnancy, and perforation of the uterus)

Question 19

STD RN Responsibilities for Health Hx of Pt

Answer 19

•Health History, sexual history, age of first intercourse, # of partners, unsafe sex, a partner with an STD, personal hx of STD or Pelvic infection, ectopic pregnancy or loss

•He sleeps with you- you sleep with everyone he’s been with
•Medications and contraceptives
•Physical exam
•Sensitivity
•Confidentiality

Question 20

STD TRANSMISSION

Answer 20

•Mode of Transmission: most commonly by sexual contact, blood, blood products, auto-inoculation

•Highest Risk Age group: 15-24 years old

Question 21

Trichomoniasis

Answer 21

•Organism: A protozoan parasite (Trichomonas vaginalis) thrives in alkaline environment

*Most common STI in the world
7.4 million/year

•Increase risk of HIV(because they’re probably not protecting themselves as they should), cervical neoplasms, PTL, PID & infertility

•S&S- frothy yellow-green vaginal discharge with a strong odor (fishy), discomfort during intercourse and urination, irritation.

Treatment: Flagyl (Metronidazole) most effective treatment for both* partners, at the same time

Question 22

Chlamydia

Answer 22

*Most common STD in US

• Often Asymptomatic (the silent STD), causes serious and irreversible damage to the reproductive tract
• Untreated, it causes sterility in men and infertility in women, PID; can be passed to infant during childbirth
• Resembles Gonorrhea (and often coexist)

Question 23

Chlamydia S/S

Answer 23

Men: watery white drip from penis, swollen or tender testicles (normally men know there is something wrong before women based on S/S)

Women: yellowish vaginal discharge, painful urination, bleeding between periods, pain in abdomen with fever and/or nausea

Question 24

Chlamydia treatment

Answer 24

Treatment:
• Antibiotics: Vibramycin, Zithromax, floxin, erythromycin or amoxicillin for pregnancy
•Use of condoms until partner treatment is completed, or remain abstinent.
•Treatment of all sexual partners is essential!

Question 25

Gonorrhea

Answer 25

Organism: Neisseria gonorrhea
• Can cause eye infection, blindness in newborn (every NB Tx. with Erythromycin eye ointment).

• TX: ANTIBIOTICS; penicillin or erythromycin

•Men get treatment sooner
(45% have Chlamydia or syphilis also)
• All sexual partners should be treated simultaneously

Question 26

Gonorrhea S/S

Answer 26

Asymptomatic in some (normally women)

Thick yellow or white discharge from vagina or penis, burning, frequency or pain on urination or defecation, ectopic pregnancy, pain with intercourse.

Complication: Disseminated gonococcal infection (systemic) 0.6-3.0% of women,
0.4-0.7% of men:
-skin lesions/pustules
-fever
-arthralgia or arthritis
-Meningitis or Endocarditis
-PID, Infertility

Question 27

Syphilis

Answer 27

•Divided into primary, secondary & tertiary stages.

•Primary- a painless chancre that develops on the genitalia,
anus, lips or oral cavity

•Secondary- 2 months post initial infection. Enlarged spleen and liver, headache, anorexia, generalized maculopapular skin rash, skin eruptions on vulva.

•Tertiary (latent)- involves heart, blood vessels and CNS. General paralysis and psychosis may result. May not develop for 3-15 years.

Question 28

Primary Syphilis

Answer 28

Can spear anywhere (lip genitals etc)- highly infectious at this time

Question 29

Secondary syphilis

Answer 29

•condylomata Lata
2months- 1-2 years
•systemic rash genitals/skin

Question 30

Tertiary (late) syphilis

Answer 30

3-20 years after initial infection

Most complications:
•Cardiac (aneurysms, scarring of the aortic valve, heart failure)
• Neuro (degeneration of the brain with mental deterioration)
• Sensory (loss of vision or hearing)
•Musculoskeletal (join instability, bone damage, inability to walk)

Question 31

Congenital syphilis

Answer 31

•Passes through placenta after 10th week of pregnancy.
• High risk of stillbirth
•CNS problems (blind, deaf)
• Pink or copper colored peeling rash
•Enlarged liver & spleen

Question 32

Herpes Genitalis

Answer 32

•Herpes Simplex Virus (HSV)
•HSV-1 (oral) & HSV-2 (genital)
•S/S show 1-30 days or longer after contact
•1.7 million new cases each year, 1 out Of 5 Americans have had a genital HSV infection
•recurrent attacks occur in 50-80% of victims, abstinence should be observed when lesions are present
•Treatment: ANTIVIRALS, acyclovir, valacyclovir and famciclovir, can be used safely up to 5 years

Question 33

Herpes in birth

Answer 33

If mom is having an active outbreak of genital herpes, baby needs to be delivered via C-section. If delivered vaginally, baby will be born with herpes rash too.

If no sores are visible baby can be born vaginally

Question 34

Herpes S/S

Answer 34

•flu-like symptoms (with primary stage)

•small painful blisters on genitals (clusters on vulva, perineum or perianal- can also be on cervix or in the vagina) or mouth, preceded by itching or burning, lasting 1-6 weeks.

•Can progress to aseptic meningitis and/or lower motor neuron damage.

Question 35

Herpes virus groups

Answer 35

•Herpes simplex (HSV I)
mouth, oropharynx, mucosal tissue, “cold sore”

• Herpes simplex (HSV II) cause for 80% of genital lesions, STD

• Varicella Zoster, chicken pox/shingles
• Epstein-Barr virus
•Cytomegalovirus (CMV)
•Human B-lymphotropic virus

Question 36

Treatment for Herpes

Answer 36

•There is no cure for Herpes!
•Lies dormant in nerve ganglion
•Anti-viral* meds reduce outbreaks

Question 37

HPV

Answer 37

Organism: Human Papillomavirus
• 100 strains - 40 affect the genital tract.

•mom may not be able to delivery vaginally (warts cover opening)
• Incubation 3-4 months or longer, immune-suppressed persons, pregnant women, diabetics are most susceptible
• Warts can grow rapidly during pregnancy or with the use of birth control pills (can be passed to fetus)
• Linked with cervical & vulvar cancer in women
•anorectal / squamous cell cancer of penis in men

Question 38

Treatment for HPV

Answer 38

•Remove the warts with trichloroacetic acid, or podophyllin, for small warts.
•Cryotherapy (liquid nitrogen) electrocautery, laser therapy, fluorouracil & surgical excision may be indicated.
• no treatment available for the virus

• Vaccine (Gardasil) protects against HPV 6, 11, 16 and 18. Won’t protect against warts

•Ineffective if HPV infection already present. CDC recommended girls age 11-12

Question 39

Infertility

Answer 39

Definition
• Inability to conceive after one year of unprotected intercourse (6 months if the woman is over 35)

• Or, inability to carry a pregnancy to live birth

• 1of 8 couples have trouble getting pregnant or sustaining a pregnancy.

Question 40

Factors of infertility : male

Answer 40

•Abnormalities of the sperm
•Abnormal erections
• Abnormal ejaculation
•Abnormalities of seminal fluid

Question 41

Factors of infertility : female

Answer 41

•Disorders of ovulation
• Abnormalities of the fallopian tubes
• Abnormalities of the cervix

Question 42

Recurrent pregnancy loss

Answer 42

•Abnormalities of the fetal chromosomes (#1 reason for
Miscarriage. 6-8 weeks)
•Abnormalities of the cervix or uterus
•Endocrine abnormalities
• Immunologic and thrombotic factors
•Environmental agents
•Infections

Question 43

Evaluation of infertility (infertility not really tested on final)

Answer 43

•Preconception counseling
•History & physical examination
•Diagnostic tests
• Therapies to facilitate pregnancy
• Pharmacologic management
•Surgical procedures
•Therapeutic insemination
•IVF
•Egg donation
•Surrogate parenting

Question 44

What is a hysterosalpingogram

Answer 44

Shoot dye up into the uterus/fallopian tubes to see if they’re open/working. Let’s the doctor know if there is scar tissue covering opening where egg can’t get out. This may be causing the infertility. If the tubes are open, something else is wrong & more investigation is needed.

Question 45

In vitro fertilization

Answer 45

Bring together sperm and egg in lab to create an embryo and then place into women’s uterus for hope of implantation/pregnancy

Question 46

Inter uterine insemination

Answer 46

Sperm in cup
Prime uterus
Inject sperm into uterus
(Jane the virgin method 😂)

Question 47

Emotional responses to infertility

Answer 47

•Growing awareness of a problem
•Seeking help for infertility
•Identifying the importance of having a baby
• Sharing intimate information
•Considering financial resources
•Committing to involvement in care (stressful, emotional, low changes, very expensive)

Question 48

responses to infertility Pt 2

Answer 48

•Reactions during evaluation and treatment
-Influences on decision-making
-Social, cultural, religious values
-Difficulty of treatment
-Probability of success (25-35%)
-Financial concerns (30k-100k)
-Psychological reactions
-Guilt
-partner blaming
-Isolation
-Depression

Question 49

Outcomes after infertility tx

Answer 49

•Pregnancy loss after infertility therapy
•Parenthood after infertility therapy •Choosing adoption

Question 50

All STD TX’s

Answer 50

Trichomoniasis = Antibiotic
Chlamydia = Antibiotic
Gonorrhea = Antibiotic
Syphilis = Antibiotic
Herpes = Antivirals (no cure only tx)

HPV = no tx available (gardacil shot if infection isn’t already present)

Question 51

Antiviral vs antibacterial meds

Answer 51

Antiviral: medications that help your body fight off certain viruses that can cause disease. Antiviral drugs are also preventive. They can protect you from getting viral infections or spreading a virus to others.

Antibiotics: Antibiotics are powerful drugs that are used to fight infections. Not all infections are treated with antibiotics. While antibiotics may be effective against infections caused by bacteria (germs), they are not effective against viruses.