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Family Planning

MAMC exam 8 family planning & the role of the nurse

define family planning choosing if & when to have children including contraceptives to avoid pregnancy & methods to achieve pregnancy
role of nurse in family planning counselor educator
categories of contraceptive methods hormonal barrier behavioral surgical
hormonal contraceptive methods temporary combination pill, morning-after pill, progestin only
estrogen required for development & maintenance of femal reproductive system develop female secondary sex characteristics
progesterone diminishes endometrial tissue proliferation increases basal body temp thickens vaginal mucosa relaxes uterine smooth muscle stimulates mammary alveolar tissue growth alterations in menstrual blood flow
combination pills contains both estrogen & progesterone taken on 5th-25th day of each cycle prevents ovulation, causes changes in edometrium & alterations in cervical mucus & tubal transport 99% effective IF used correctly
side effects of the combination pill weight gain N/V spotting & breakthrough bleeding amenorrhea breast tenderness headache chloasma irritability nervousness depression decreased libido
complications of the combination pill benign liver tumors gallstones MI throboembolism stroke
contraindications of the combination pill history of cardiovascular or liver disease HTN breast or pelvic cancer caution with DM and sickle cell anemia
patient teaching for the combination pill correct use take pill same time each day if day missed, take 2 the next day review side effects & contraindications report signs of cramps, edema in legs, chest pain periodic checkup danger signs avoid phenytoin, phenobarbial, antiobiotics, smoking
morning after pill norgestrel & ethinyl estradiol 98.4% effective creates hostile uterine lining & alters tubal transport
side effects & complications of the morning after pill nausea 1-2 days doesn't prevent ectopic pregnancies at risk for hormonal complications of: ABD pain, chest pain, cough, SOB, headache, dizziness, weakness, leg pain
patient teaching for the morning after pill take 2 pills with 72 hours of coitus repeat if vomiting occurs take 2nd dose 12 hours later menses should return within 2-3 weeks start ongoing method of contraception immediately after menses
progestin only pills taken daily with no pill-free days preferred for breast feeding women inhibits ovulation thickens cervical mucus alters uterine lining lower cardiovascular risk than combination pill
side effects & complications of progestin only pills menstrual changes breakthrough bleeding prolonged cycles or amenorrhea increase in function cysts of the ovary increase in ectopic pregnancy
patient teaching for progestin only pills use alternate contraception when starting pill or if pill missed take pill at same time every day keep record of menses and get pregnancy test if 2 weeks late
medroxyprogesterone (Depo-Provera) progestin only drug given by injection every 3 months private, convenience & highly effective method efficacy similar to that of surgical sterilization
side effects & complications of medroxyprogesterone amenorrhea headaches bloating weight gain return of fertility may take several months
patient teaching for medroxyprogesterone return every 3 months for injections discontinue method for several months before planning to conceive
levonorgestrel (Norplant) progestin only subdermal implant 6 capsules provide protection for 5 years continuous, long term contraception failure rate extremely low
side effects & complications of levonorgestrel menstrual irregularities amenorrhea ABD pain headaches weight gain surgical removal after 5 years
patient teaching for levonorgestrel effective after 24 hours keep arm dry 48 hours after insertion report arm pain implants are soft & flexible & can't break expect irregular bleeding report any other changes continue to protect against STDs have implants removed after 5 years
barrier methods for contraceptive diaphragm cervical cap condoms
diaphragms dome shaped latex cap with metal ring that covers the cervix inner surface coated with spermicide before insertion provides mechanical barrier to sperm prescription needed; fitted by professional 87% effective when used correctly
complications of diaphragms allergy to latex or spermicide
patient teaching for diaphragms demonstrate hold to hold, insert, remove on model insertion may be just prior, but removal should be 6-8 hours after empty bowel & bladder before insertion instruction on proper cleaning, storage, & inspecting refit post-pregnancy/weight change
cervical caps rubber thimble shaped shield covering cervix & held in place by suction spermicide placed in inner surface fitted by professional effectiveness similar to diaphragm
complications of cervical caps alergy to rubber or spermicide possible irritation or erosion of the cervix
cervical cap patient teaching provide sufficient time for practice with insertion & removal instructio on cleaning, storing, inspecting for damage
male condom thin rubber sheath fitting over an erect penis providing mechanical barrier to sperm 85% effective if no failure from tearing or slipping provides some protection against STIs
side effects & complications of male condoms allergy to rubber decrease in sensation interference with foreplay
female condom double ring system fitted into vagina up to 8 hours before intercourse provides protection against HIV & cytomegalovirus & hepatitis B no significant side effects & generally acceptable to couple
female condom patient teaching discuss insertion, lubrication, & removal method more expensive than male condoms
intrauterine device (IUD) inserted into the uterus & are made of flexible plastic or copper wire can be medicated or unmedicated contraception provided by inflammatory response in endometrium 97-99% effective
IUD side effects & complications increased menstrual flow intramunstrual bleeding & cramping ectopic pregnancy pelvic infection perforation of uterus infertility undetected expulsion leading to pregnancy
IUD patient teaching discuss procedure check for string in vagina after every period annual pelvic exams
rhythm method complies with all religious doctrines abstinence during fertile portion of menstrual cycle requires strong motivation & self-control 60-65% effective failure results from difficulty calculating day of ovulation & irregularity of menses
rhythm method complications inaccurate or incomplete knowledge of menstrual cycle
rhythm method patient teaching discuss methods to establish baseline menstrual patterns & identify ovulation instruct on calendar or basal body temp method to determine ovulation & fertile period
surgical methods of contraceptions permanent tubal sterilization hysterectomy vasectomy
tubal sterilization permanently prevents sperm & ovum from meeting achieved through crushing, ligating, clipping, or plugging of fallopian tubes nearly 100% effective failure due to recanalazation of fallopian tubes
tubal sterilization complications bowel injury hemorrhage infection
tubal sterilization patient teaching ensure understanding of procedure consent signed procedure may require short term hospilization dependingon procedure
hysterectomy removal of uterus 100% effective ONLY performed for other diseae processes sterility secondary benefit when desired
vasectomy bilateral surgical ligation & resection of ductus deferens
vasectomy side effects hematoma edema psychological adjustment
vasectomy patient teaching outpatient procedure taking 15-30 minutes alternatives form of contraception is needed until no sperm are seen on examination explain procedure does not affect masculinity
Created by: ealongo
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