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M6 13-005
Exam 8: Reproductive System; Family Planning & Role of the Nurse
| Term | Definition |
|---|---|
| Family Planning | Choosing if and when to have children including contraceptives to avoid pregnancy and methods to achieve pregnancy. |
| Role of the Nurse | Counselor Educator |
| Contraceptive Methods (Definition) | Methods to prevent pregnancy. |
| Contraceptive Methods: Hormonal (Temporary) | Combination Pill Morning-after pill Progestin Only |
| Female Hormones | Estrogen Proestrogen |
| Estrogen | Required for development and maintenance of female reproductive system. Develop female secondary sex characteristics. |
| Proestrogen | Diminishes endometrial tissue proliferation. Increases basal body temperature. Thickens vaginal mucosa. Relaxes uterine smooth muscle. Stimulates mammary alveolar tissue growth. Alterations in menstrual blood flow. |
| Combination Pill | Contains both estrogen and proestrogen. Taken on 5th-25th day of each cycle. Prevents ovulation, causes changes in endometrium and alterations in cervical and tubual transtport. 99% effective IF used correctly. |
| Combination Pill: Side Effects | Weight gain, N/V, spotting & breakthrough bleeding, Amenorrhea, Breast Tenderness, Headache, Chloasma, Irritability, Nervousness, Depressed, Decreased Libido |
| Combination Pill: Complications | Benign Liver Tumors Gallstones MI Thromboembolism Stroke |
| Combination Pill: Contraindications | Hx of cardiovascular liver disease HTN Breast or Pelvic Cancer Caution with DM Caution with sickle cell anemia |
| Combination Pill: Pt Teaching | Correct use of pill. Same time of day. If day missed, take 2 following day. Review S/E & contraindications Report signs of: Cramps in legs or edema. Chest pain. Periodic check ups. Danger signs. Avoid phenytoin, phenobarbital, ABx Discourage smoki |
| Contraceptive Methods: Categories | Hormonal Barrier Behavioral Surgical |
| Combination Pill: Action | Lower level of estrogen in pill prevent pituitary gland from releasing LH. With no LH present, egg does not mature and ovulation does not occur. |
| Morning After Pill | Norgestrek (500mg) and ethinyl estradiol (50mcg)(Ovral). 98.4% Effective Creates hostile uterine lining and alters tubal transport. |
| Morning After Pill: S/E & Complications | Nausea for 1-2 days Doesn’t prevent ectopic pregnancies At risk for hormonal complications of: abdominal pain chest pain cough shortness of breath headache dizziness weakness leg pain |
| Morning After Pill: Pt Teaching | Take 2 pills within 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 then combination pills |
| Progestin Only Pills: S/E & Complications | Menstrual changes Breakthrough bleeding Prolonged cycles or amenorrhea Increase in functional cysts of the ovary Increase in ectopic pregnancy |
| Progestin Only Pills: Pt Teaching | Use alternate contraception when starting or if pill is 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, convenient and highly effective method Efficacy similar to that of surgical sterilization |
| Medroxyprogesterone (Depo-Provera): S/E & Complications | Amenorrhea Headaches Bloating Weight Gain Return of fertility may take several months |
| Medroxyprogesterone (Depo-Provera): Pt Teaching | Return every 3 months for injections Discontinue method for several months before planning to conceive. |
| Levonorgestrel (Norplant) | Progestin only subdermal implant Six capsules provide protection for 5 years Continuous, long term contraception Failure rate extremely low |
| Levonorgestrel (Norplant): S/E & Complications | Menstrual irregularities Amenorrhea ABD Pain Headaches Weight Gain Surgical removal after 5 years |
| Levonorgestrel (Norplant): Pt Teaching | Effective after 24 hours Keep arm dry for 48 hours Report arm pain Implants are soft ad flexible Expect irregular bleeding Report any other changes Continue to protect against (STI) Have implants removed after 5 years |
| Barrier Methods | Diaphragms Cervical Cap Condoms |
| Diaphragms | Dome-shaped latex cap with metal ring that covers the cervix Inner surface coated w/ spermacide before insertion Provides mechanical barrier to sperm Prescription & fitting needed. 87% effective when used correctly. |
| Diaphragms: Complications | Allergy to latex or spermacide |
| Diaphragms: Pt Teaching | Demonstrate how to hold, insert and remove on model and allow practice sessions Insertion may be just prior to coitus, but removal should be 6-8 hours after Empty bowel and bladder before insertion |
| Cervical Caps | Rubber thimble shaped shield covering cervix and held in place by suction. Spermicide placed in inner surface. Fitted by professional. Effectiveness similar to diaphragm. |
| Cervical Cap: Complications | Allergy to rubber or spermicide. Possible irritation or erosion of the cervix. |
| Cervical Cap: Pt Teaching | Provide sufficient time for practice with insertion and removal Instruct on cleaning, storing and 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 and HIV |
| Male Condom: S/E & Complications | Allergy to rubber Decrease in sensation Interfere with foreplay |
| Female Condom: | Double-ring system fitted into vagina up to 8 hours before intercourse Provides protection against HIV, cytomegalovirus and Hep-B No significant side effects and generally acceptable to couple |
| Female Condom: Pt Teaching | Discuss insertion, lubrication and method of removal More expensive than male condoms |
| Other Methods | Intrauterine Device (IUD) Rhythm Method |
| Intrauterine Device (IUD) | Inserted into the uterus and are made of flexible plastic or copper wire. Can be medicated or unmedicated Contraception provided by inflammatory response in endometrium 97-99% effective |
| Intrauterine Device (IUD): S/E & Complications | Increased menstrual flow Intramenstrual bleeding and cramping Ectopic pregnancy Pelvic infection Perforation of uterus Infertility Undetected expulsion leading to pregnancy |
| Intrauterine Device (IUD): Pt Teaching | Discuss Procedure Check for string to vagina after every period Annual pelvic exams |
| Rhythm Method | Complies with all religious doctrines Abstinence during fertile portion of menstrual cycle Requires strong motivation and self control 60-65% effective Failure results from difficulty calculating day of ovulation and irregularity of menses |
| Rhythm Method: Complications | Inaccurate or incomplete knowledge of menstrual cycle |
| Rhythm Method: Patient Teaching | Discuss methods to establish baseline menstrual patterns and identify ovulation. Instruct on calendar or basal body temperature method to determine ovulation and fertile period. |
| Surgical (Permanent) Methods | Tubal sterilization Hysterectomy Vasectomy |
| Tubal Sterilization | Permanently prevents sperm and 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 Education | Ensure understanding of procedure Ensure consent form is signed Procedure may require short term hospitalization depending on procedure |
| Hysterectomy | Removal of uterus 100% effective ONLY performed for other diseased processes. Sterility secondary benefit when desired. |
| Vasectomy | Bilateral surgical ligation and resection of ductus deferens |
| Vasectomy: S/E | Hematoma Edema Psychological Adjustment |
| Vasectomy: Pt 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:
jtzuetrong
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