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M6 13-005

Exam 8: Reproductive System; Family Planning & Role of the Nurse

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