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NUR 126 > Wk 12 Reproductive > Flashcards

Wk 12 Reproductive Flashcards

1
Q

Describe the contraceptive methods:

Surgical sterilization method - VASECTOMY

A

Male sterilization

  • incision into the scrotum to tie, cauterize and remove a section of the vas deferens.
  • sperm no longer able to pass into the semen
  • 2 samples must be clear of sperm for up to 3 months after procedure
  • post op care: support scrotum for 2 days, ice area for 4 hours, mild analgesic, avoid strenuous activity for 1 week
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2
Q

Describe the contraceptive methods:

Surgical sterilization method - TUBAL LIGATION

A

Female sterilization
-cutting/occluding the fallopian tubes to prevent fertilzation
-during 48 hours of vaginal birth
Disadvantages:
-general anethesia as OPS
-pregnancy after tubal, is often a tubal pregnancy
-has more risks/difficult/expensive than vasectomy
Post Op:
-no sex for 2 weeks
-notify care giver if heavy bright red vaginal bleeding
-no strenuous activites for one week
-tampon use after 1 week post op

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3
Q

Describe the contraceptive methods:

Hormonal contraceptives - ORAL CONTRACEPTIVES (PROGESTIN ONLY)

A

Advantages:
-fertility returns in 3 months
-decrease cancer risk (ovarian, endometrial, colorectal)
-improves acne
-can take with history of thrombophlebitis
-reduce dysmenorrha, amenorrha may occur
Disadvantages:
-avoids estrogen
-thicken cervical mucus to prevent sperm penetration
-spinnbarkeit mucus is the stringy stretchy quality of cervical mucus found especially around the time of ovulation
-break through bleeding and right time errors

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4
Q

Describe the contraceptive methods:

Hormonal contraceptives - ORAL CONTRACEPTIVES (estrogen and progestin)

A

-Most common oral contraceptive
-inhibits maturation of the follicle and ovulation
-thickening of the cervical mucus
-tubal motility is slowed: endometrium less favorable
Monophasic pills: estrogen and progestin does remain constant
Multiphasic pills: estrogen and progestin doses vary to help reduce side effects, pills muct be taken in proper order
Disadvantages (including risks):
-DVT, PE, MI, CVA (smokers), HTN
-HA
-ab pain
-gallbladder disease
-eye changes
-cervical cancer
-no std protection
**not recommended for 35+ years if a smoker

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5
Q

Describe the contraceptive methods:

Hormonal contraceptives - INJECTION (IM OR SUB Q)

A

Medroxyprogesterone (Depo-Provera) is progestin
-admin every 12 weeks
- stops ovulation by suppressing the release of gonadotrophic hormones
Advantages:
-doesn’t inhibit sexual response
-except abstinence, most efffective method
-helps prevent endometrial cancer
Disadvantages:
-injection every 12 weeks
-can be expensive
-pregnancy may not take place for 18 months
-no std protection
-may cause HA, fatigue, nervousness, weight gain, increased appetitie
-thrombosis/thromboembolism risk
-irregular spotting
-decreased libido and breast changes
-decreased bone mineral density, do not take for over 2 years

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6
Q

Describe the contraceptive methods:

Hormonal contraceptives - TRANSDERMAL PATCH

A
  • Ortho Evra release estrogen and progestin
  • may shower/swim/exercise
  • placed ab, buttock, upper torso or upper arm
  • apply new patch to alternating sites every 7 days, no patch on 4th week
  • thromboembolism risk is higher (estrogen exposure 60% higher over time
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7
Q

Describe the contraceptive methods:

Hormonal contraceptives - VAGINAL RING

A
  • delivers continuous progesterone and estradiol
  • worn for 3 weeks followed by a week without, replace with new ring
  • no fitting needed
  • may experience vaginitis, leukorrhea, vaginal discomfort
  • $30-$200 month cost
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8
Q

Describe the contraceptive methods:

Hormonal contraceptives - IMPLANT

A

-progestin continuously released; approved 2006
-single rod left in place for 3 years
Advantages:
-reversible
-not related to coitus
-safe for breastfeeding
Side effect:
-irregular bleeding
Disadvantages:
-minor surgical procedure to insert and remove
-no std protection

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9
Q

Describe the contraceptive methods:

Intrauterine devices - IUD

A 
Intrauterine device
-small T-shaped device, bendable arms
-2 strings
-check strings after menstruation
-remove if pregnant
-inserted during a period when the cervix is slightly open
Advantages:
-doesn't inhibit sexual spontaneity
-copper IUD can be 10 years, Mirena for 5 years
-fertility returns when removed
-cost effective
Disadvantages:
-may cause infection
-risk of uterine rupture
-contraindicated in women with history of PID, ectopic pregnancy, bleeding disorders and abnormalities of the uterus
-no std protection
Teaching:
-check for strings
-inform of infections: vaginal disharge, pain, itching, low pelvic pain, fever
-signs of pregnancy should be reported to provider to r/o ectopic
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10
Q

Define: anovulatory

A

menstrual cycle in which ovulation does not occur

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11
Q

Define: basal body temperature

A

body temperature at rest

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12
Q

Define: coitus interruptus

A

withdrawal of the penis before ejaculation

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13
Q

Define: infertility

A

inability to conceive while having unprotected sex (2-3x weekly) for 1 year.
Primary: unable to conceive
Secondary: unable to conceive but have conceived at least one time

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14
Q

Define: natural family planning

A

predicting ovulation based on normal changes in a woman’s body

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15
Q

Define: spinnbareit

A

clear, slipper, stretchy quality of cervical mucus during ovulation

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16
Q

Describe the contraceptive methods:

chemical barrier method

A 
spermicides: barriers that kill sperm
creams/gels used with mechanical barriers (diaphragm/cervical caps)
-insert 30 min before
-last 1-8 hours
-no douching for 6 hours
Advantages:
-over the counter
-inexpensive
-easy to use
Disadvantages:
-no std protection
-genital irritation, infection
-decrease spontaneity
-messy and interfere with sensation
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17
Q

Describe the contraceptive methods:

male condom - mechanical barrier

A

Advantages:
-std protection
-inexpensive
-readily available
Disadvantages:
-may require lubrication
-natural membrane condoms do not prevent std’s
-latex allergy
-interferes with spontaneity and sensation
-condom are affected by some vaginal medications
-failure rate 15-20%

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18
Q

Describe the contraceptive methods:

female condom - mechanical barrier

A

Polyurethane or nitrile sheath inserted into vagina
Advantages:
-std protection
Disadvantages:
-cannot be used with male condoms due to adherence to each other
-must plan ahead

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19
Q

Unintended pregnancies are those that are unwanted or that occur when not ready for parenthood due to?

A

Economic hardship
Health problems
Interfere with education or career goals
Other disruptions in lives of women/their families

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20
Q

Describe the contraceptive methods:

Contraceptive sponge - mechanical barrier

A

Small round sponge that contains spermicide
One size
Protect for up to 24 hours
Leave in place for 6 hours after coitus
Failure rate 40% parous women and 20% nulliparous women
Advantages:
-inexpensive
-good choice for those who can’t use hormonal contraceptives
Disadvantages:
-cannot use with history of TSS
-no std protection

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21
Q

Describe the contraceptive methods:

Diaphragm - mechanical barrier

A 
Spermicide cream/gel placed in dome and around rim
Datex, covers cervix
Keep in place for 6 hours post coitus, no longer than 24 hours to prevent infections
Disadvantages:
-gynecologic exam to ensure proper fit
-replace if 10lb weight loss/gain
-can be damaged by oil based lubricants, vaginal meds for infections
-UTI
-insertion and removal
-messiness of spermicide
-insert 6 hours before
-TSS
-irritation of tissue and infection
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22
Q

Describe the contraceptive methods:

Cervical Cap - mechanical barrier

A 
Smaller than diaphragm
Fits over cervix, suction
Do not remove for 6 hours after coitus
Advantages:
-no pressure on the bladder
-can stay in place for 48 hours
Disadvantages:
-fitted by healthcare provider
-can dislodge, must check placement
-avoid with history of TSS
23
Q

Describe the contraceptive methods:

Lea’s Shied - mechanical barrier

A 
Silicone device that fits over cervix
Advantages:
-central valve to allow drainage of cervical secretions
-loops for ease of removal
-no fitting by healthcare provider
Disadvantages:
-requires prescription
-remain in place for 8 hours, no longer than 48 hours due to infection
-not to be used during menses
24
Q

What is birth control pills serious complications

“ACHES”

A 
Abdominal pain
Chest pain/SOB
Headaches
Eye problems
Severe leg pain
25
Q

Emergency contraception

Plan B

A

One-Step or Next Choice

  • ASAP within 72 hours of coitus
  • OTC if 17 years or older
  • Delays or inhibits ovulation and interfere with corpus luteum function
  • ineffective once implantation has occurred
26
Q

Infertility:

Male problems

A

Sperm: 35-200 million average number - volume, concentration, morphology, motility, liquefaction examined.
Causes: infection, illness, toxins, drugs, anatomy, alcohol
Erection difficulties: spinal cord injury, drugs, chronic illness, psych
Ejaculation: abnormal- diabetic, neurological disorders, drugs, alcohol
Seminal fluid: thickened fluid, pH off or lacks nutrients.
Abnormal amounts, consistency or chemical composition suggest obstruction, inflammation or infection

27
Q

Infertility:

Female problems - ovulation disorders

A

Ovulation disorders:
-polycystic ovary syndrome, obesity, aging oocytes, chemotherapy, alcohol, smoking, amenorrhea, high androgen levels, toxins, drugs, environmental agents

28
Q

Infertility:

Female problems - Fallopian tubes

A

Fallopian tubes:

  • Obstruction from std’s; chlamydia, gonorrhea.
  • endometrium does not support pregnancy; endometriosis causes tubal adhesion and can distort tubal anatomy
29
Q

Infertility:

Female problems - Cervix

A

Cervix:

  • low estrogen can lead to cervical mucus thickening
  • polyps or scarring from past infection/surgery can cause obstruction
30
Q

Infertility:

Female problems - Recurrent fetal loss

A

Recurrent fetal loss:

  • abnormal fetal chromosomes
  • abnormal cervix or uterus
  • endocrine abnormalities
  • immunologic factors
  • accutane, alcohol, cigarettes, anesthetics,
  • infection
31
Q

Preconception counseling

A

Counceling:

  • preconception diet (folic acid)
  • avoidance of teratogens
  • evaluate risk for birth defect and reduce risks
  • women over 35 are greater risk of chromosomal defects
  • couples should be cautioned that all test may be normal and conception will not occur
  • unexplained infertility is 20% of cases
  • even with poor test results, pregnancy may still occur
32
Q

Preconception Assessment

A

Assessment:

  • complete history and physical exam of couple
  • assessment of reproductive tract
  • may have abnormal uterus and tubes resulting from exposure to diethystilbestrol (DES)
  • history of infections of the GU
  • bi-manual exam of the internal organs
33
Q

Preconception Diagnostic test

A

Test:

Individualized from simple to more complex and expensive test

34
Q

Sexually Transmitted Infections

Prevention

A

Prevention:

  • reduce number of partners
  • know you partners
  • practice low risk sex
  • avoid exchange of body fluids
  • bacterial infection are treated
35
Q

Most common STD in women

A 
HPV
Chlamydia
Gonorrhea
Herpes simplex virus type 2
Syphilis
HIV
36
Q

STD - Chlamydia

A

Bacterial infection
Most common/fastest spreading in American women
Often asymptomatic and highly destructive
Untreated leads to acute salpingitis or PID
Cervical ulceration can increase risk of HIV
20 yrs and younger highest ate
30 yrs and older lower rate

37
Q

STD - Chlmydia screening and diagnosis

A

All pregnant women tested
Symptoms: yellowish vaginal discharge and painful urination
Cultures and nucleic acid amplification most sensitive

38
Q

STD - Chlmydia treatment

A

Doxycycline, axithromycin, ofloxacin, levofloxacin, erythromycin
Take as directed
Use condoms until cured
Inform all sexual partners for treatment
No sexual activity until all meds are completed

39
Q

STD - Gonorrhea

A

Oldest communicable disease in Us
600,000 new cases each year
Drug resistant cases increasing
Majority are 20 yrs or younger and multiple partners
Most are 20 yrs or younger, young adults and African Americans

40
Q

STD - Gonorrhea symptoms

A

Often asymptomatic, 1/3 of infection in adolescents go unnoticed
Purulent endocervical discharge, minimal or absent
C/O pelvic or lower abdominal pain
Anal infection may be asymptomatic or present with rectal itching, fullness, pressure, pain, purulent discharge, diarrhea, bloody stool
Vaginal discharge, dysuria, swollen reddened labia, painful coitus
**men have more specific symptoms

41
Q

STD - Gonorrhea screening and diagnosis

A

All high risk and pregnant women should be screened
Culture obtained from the endocervix, rectum, pharynx if indicated
Co-infections are common. Test for chlamydia and syphilis

42
Q

STD - Gonorrhea treatment

A

Cefixime (oral) or ceftriaxone (IM)
20-50% also have chlamydia and need additional antibiotics
Recent sexual partners need to be tested
Reinfection most common treatment failure
Women are counseled to us condoms
Women with gonorrhea should be confidentially test for HIV

43
Q 
STD - Trichomoniasis
Causes
Symptoms
Diagnosis
Treatment
A

Causes by Trichomonas vaginalis; protozon
Symptoms:
Purulent vaginal discharge; tin or frothy
Malodorous and yellow/green or brownish gray
Vulvar itching, edema and redness
Diagnosis:
Microscopic ID of the organism on wet mount
Treatment:
Flagyl or Tinidazole (Tindamax) single oral dose. Must avoid alcohol for 72 hours

44
Q

STD - Syphilis (Treponema Pallidum: spirochete)
Transmission
Stats

A

Entry through microscopic abrasions in the subcut tissues.
Can be transmitted by kissing, biting or oral/genital sex
Trans-placental transmission during pregnancy
Highest rates 20-24 years old
Untreated leads to serious systemic disease and even death

45
Q

STD - Syphilis

4 types

A

Primary syphilis
Secondary syphilis
Latent Phase
Tertiary syphilis

46
Q

STD - shyphilis

Primary syphilis

A

Primary lesions “chancre” 5-90 day after infection
Serologic test is negative in primary stage
If untreated, chancre heals in 6 weeks
Disease is highly infectious in this stage

47
Q

STD - Syphilis

Secondary syphilis

A

Occurs 6 weeks-6 months after chancre
Characterized by widespread symmetric maculopapular rash on the palm and soles and generalized lymphadenopathy
May also have fever, HA, malaise
Condylomata lata (broad, painless, pink/gray wart like lesions) may develop on the vulva, perineum or anus

48
Q

STD - syphilis

Latent Phase

A

Asymptomatic for majority of individuals

Untreated, 1/3 will develop tertiary syphilis

49
Q

STD - syphilis

Tertiary syphilis

A

Neurological, cardiovascular, musculoskeletal or multi organ system complications

50
Q

STD - syphilis
Screening
Diagnosis

A

All diagnosed with STD or HIV should be screened for syphilis
All pregnant women screened at first prenatal visit, late third trimester and at birth if high risk
Exam of primary and secondary lesions and serology during latency and late infection
Up to 1/3 of people in early primary syphilis may have non-reactive serologic test (neg results)

51
Q

STD - syphilis

Antibody test

A

VDRL (Venereal Disease Research Laboratories ) and RPR (rapid plasma reagin)
RPR is preferred tests to confirm a positive VDRL
False positives can occur with acute infections, autoimmune disorders, malignancy, pregnancy, and drug additions

52
Q

STD - syphilis

Treatment

A

Treatment:
penicillin G IM
PCN allergy; doxycycline, ceftraxone, doycycline
Tetracycline and doxycycline contraindicated in pregnancy

53
Q

STD - syphilis

Teaching

A

Teaching:
abstinence until treatment is completed, primary/secondary is gone and serology evidence of care
monthly follow up for repeated treatment
Emphasize long term serologic testing, even if asymptomatic
notify all partners
disease is reportable, preventative measures must be taken

NUR 126 (23 decks)

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