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68wm6 p2 Fam Plan

Family Planning and the Role of the Nurse

QuestionAnswer
Contraception is used by what percentage of women? 89%
How many pregnancies are unintended? half
Why is sterilization considered a permanent end to fertility? because reversal surgery is difficult, expensive, not always successful, and often not covered by insurance
What is the second leading method of femal contraception? Sterilization
When is Tubal ligation surgery (sterilization) easiest to perform? during C/section or in first 48 hrs after vaginal birth when tubes are directly below abdominal wall
How is a tubal ligation surgery performed? Cutting or mechanically occluding the fallopian tubes by removing a section and tying the ends, or by using clips, bands, or rings or destroying a portion of the tubes with electrocoagulation.
How long must an outpatient for tubal ligation be on rest? 24 hrs
How long must an outpatient for tubal ligation avoid intercourse? one week
In a tubal ligation PT, what S/Sx must the physician be notified about? *Fever. *Fainting. *Severe pain. *Bleeding or discharge from the incision
How is a vasectomy (sterilization) performed? small incision or puncture in the scrotum is made to lift out the vas deferens
True or False: After a vasectomy, a male ejaculates no semen False. After vasectomy, semen no longer contains sperm but still present
How long must a vasectomy outpatient be put on rest? 48 hrs
How is swelling from vasectomy managed? Ice to area
How long must a vasectomy outpatient recieve scrotal support? 2 days
How long must a vasectomy outpatient avoid strenuous activity? one week
In a vasectomy PT, what S/Sx must the physician be notified of? *Fever. *Severe pain. *Bleeding or discharge at the site. *Swelling more than twice the normal size. *Painful nodule
What are barrier contraceptives? *Condoms *Diaphragm. *Sponge. *Cervical Cap. *Lea’s Shield
What is Norplant? *Progestin Implant, consists of six flexible capsules inserted SQ into upper inner arm under local anesthesia. ***No longer available in the US.
What is Implanon? *Single-Rod Progestin Implant that is expected to receive US FDA approval soon. *Implant is 4 cm long. *Releases progestin continuously to provide 3 years of contraception. *Inhibits ovulation and thickens cervical mucus
What is Depo-Provera? Injectable progestin that prevents ovulation for 12 wks.
What is the failure rate of depo-provera? 3%
What is the major reason for discontinuation of depo-provera? Menstrual irregularities
What are COMMON adverse effects of depo-provera? *Spotting and breakthrough bleeding are common. *Amenorrhea occurs in 30% to 50% of women at 1 yr and increased with longer use
What are adverse effects of Depo-Provera? *Weight gain up to 4 lbs per yr for some. *Headaches. *Nervousness. *Decreased libido. *Breast discomfort. *Depression
Depo-provera is not recommended for use longer than what? 2 years
How long after discontinuation of depo-provera does fertility return? Approximately 10 - 18 months
When is depo-provera best given? within 5 days of period
What is needed if depo-provera is given later than 5 days after period or if the PT is more than 1 week late returning for subsequent injection? Backup contraception
What is the leading contraceptive method in the US? Oral Contraceptives
If oral contraceptives are used perfectly, how many women still become pregnant? 3 in a 1000
What is the failure rate for oral contraceptives in the TYPICAL user? 8%
What does combination oral contraceptives contain? Estrogen and progestin
What is the mechanism of action for combination oral contraceptives? *Causes thickening of cervical mucus, which prevents sperm from entering the upper genital tract. *Blocks luteinizing hormone thus inhibiting maturation of the follicle and ovulation
what is the frequency that combination oral contraception is taken? Taken once a day for 21 days with 7 days "off"
What do mini-pills contain? Only progestin
what is the frequency that combination oral contraception is taken? Taken daily with no hormone free days
What is the mechanism of action for mini-pills? Causes thickening of cervical mucus to prevent sperm penetration
What avoids side effects and risk factors associated with estrogen for women who can’t take estrogen Mini-pills since they only contain progestin
What are the benefits of oral contraceptives? *Reduction of heavy menstrual bleeding *Decrease in PMS *Improved bone density *Regular cycles *Dysmenorrhea *Acne reduction *Anemia
What increase risks while taking oral contraceptives? Smoking (25 daily, 15 daily after 30yrs of age)
Oral contraceptives are safe to use in older women until when? Menopause
What percentage of users discontinue oral contraceptives after one year due to adverse effects? 32%
What are the adverse effects of oral contraceptives? *Nausea. *Breast tenderness. *Weight gain or loss. *Fluid retention. *Amenorrhea. *Melasma
What is melasma? dark skin discoloration that appears on sun-exposed areas of the face
When does the oral contraceptive cycle usually start? Usually starts on the first Sunday after the first day of menses
How do transdermal patch contraceptives work? Releases small amounts of estrogen and progestin to suppress ovulation and thicken cervical mucus
Though transdermal contraceptives have the same effectiveness of their oral counterparts, why may they be considered more effective? Because its only used once a week as opposed to daily
Where are transdermal contraceptives applied? to clean, dry skin on abdomen, upper torso, buttocks, or upper outer arm
Where are transdermal contraceptive patches NOT applied? To the breasts
How often is the transdermal contraceptive patch site rotated, and the frequency of use? New patch is applied at a different site weekly on the same day of the week for 3 weeks and worn continuously for 7 days, then no patch for one week at which time menstrual cycle comes
What are the adverse effects of transdermal contraceptive patches? *Breakthrough bleeding *Breast tenderness. *Headaches. *Skin reactions
As an adverse effect, when is breakthrough bleeding most common in PT with transdermal patch contraceptives? During the first two cycles
Who are transdermal contraceptive patches not to be used in? Women over 198lbs
What is a vaginal ring? Soft flexible vinyl ring inserted into the vagina and left in place for 3 weeks
What do vaginal rings release? small amounts of progestin and estrogen continuously to prevent ovulation
What happens at the end of the 3rd week wearing a vaginal ring? Ring should be removed and bleeding starts
Where must a vaginal ring be placed? placed high into the vagina against vaginal wall
What are the adverse effects of vaginal rings? *Headache. *Nausea. *Breast tenderness. *Vaginitis. *Expulsion. *Vaginal discharge or discomfort
What is the most common adverse effect of vaginal rings? Headache
How long after ovulation does menses start? 14 days
When is the effectiveness of plan B at its highest? If used within 72 hours, though it may be used as long as 120 hours later
By what percentage does plan B reduce the risk of pregnancy? 89%
What may be used as an emergency contraceptive besides plan B? Combined OCs in higher than usual doses
Using combined OC as an emergency contraceptive reduces the risk of pregnancy by what percentage? 75%
What is the most common adverse effect of vaginal rings? Headache
What does IUD stand for? Intra-Uterine Device
What are the types of IUD? *Copper T 380a (ParaGard). *LNGIUS or Mirena.
What is more effective than any other contraceptive method, including sterilization? Mirena
What is the mechanism of action for IUDs? Sterile inflammatory response resulting in a spermicidal intrauterine environment
ParaGard is effective for how long? 10 years
Mirena is effective for how long? 5 years
What are the side effects of IUDs? *Cramping and bleeding with insertion. *Complications include perforation of the uterus at time of insertion. *Expulsion
What percentage of IUD users experience expulsion? 2% to 10% or users
What is a common reason for removal of the copper IUD? Menhorrhagia
Fill in the blanks: Irregular periods with _____ _____ may occur during early months with Mirena but may be followed by _________ light spotting, Amenorrhea
Pregnancies that do occure while using an IUD, what is more likely to happen? more likely to be ectopic or result in spontaneous abortion or preterm birth
Who are IUDs NOT recommended for? *Nulliparous women. *History of PID. *History of ectopics, bleeding disorders, or uterine abnormalities
How often should the user check for the “tail” or plastic strings extending from the IUD into the vagina *Weekly during the first 4 weeks of use. *Monthly after menses. *If signs of expulsion
What are signs of expulsion? cramping or unexpected bleeding
Cream and gel chemical barrier contraceptives are generally used with what? mechanical barriers such as diaphragm or cervical cap
What chemical barrier contraceptive may be used alone? *Foams *Foaming tablets *Suppositories *vaginal film
Spermicides have a failure rate of what percent? 29%
Spermacides are best when used with what? mechanical barrier contraceptives
Fill in the blanks: Vaginal films and suppositories must ____ before they become effective, which takes about _____ min melt, 15
How long are vaginal films and suppositories effective? 1 hour
What is the third most popular contraceptive? Male condom
Which condom is the ONLY condom that protects against STDs? 1)Polyurethane, 2)Natural membrane, 3)Latex Only latex condoms provide this protection
What is the typical failure rate of condoms? 15%
What is the typical failure rate of diaphragms? 16%
True or False: Diaphragms are a good contraceptive choice because the PT can administer them themselves False. Must be fitted by a health care provider
What can damage diaphragm mechanical barrier contraceptives? May be damaged by oil-based lubricants and some meds used for vaginal infections
What is the failure rate of female condoms? 21%
What cant be used with female condoms? Male condoms
What contraceptive is made from a soft polyurethane that contains spermacides? Sponge
How long does a sponge provide contraception without need for added spermacides? 24 hours
How is the mechanical barrier contraceptive sponge prepared? *Sponge is moistened with water. *Folded with the concave “dimple” inside. *Loop on the outside of the fold. *Inserted into the vagina. *Released so the “dimple” covers the cervix
How long after sex should the sponge remain in place? At least 6 hours
A sponge should be left in the vagina for no longer than what? 30 hours
How long can a cervical cap be left in place? 48 hours
The cervical cap should remain in the vagina for how long after sex? 6 hours
What is Device made of silicone with a central valve and a loop to allow easy removal? Leas shield
How long after intercourse must a leas shield be left in place? 8 hours after, and no longer than 24 hours.
While wearing a leas shield, what must be added for repeated intercourse? More spermicides
How long do sperm survive in the female genital tract? 24 hours, although some sperm live up to 5 days
What are natural contraceptive methods? *Calendar Method. *Standard Days Method. *Basal Body Temperature. *Cervical Mucus. *Symptothermal Method
When predicting ovulation as a contraceptive PERFECTLY, what is the failure rate? 2% - 5%
What is the TYPICAL failure rate of contraception by predicting ovulation? 25%
What is the calendar method of contraception? Based on the timing of ovulation approx 14 days before the onset of menses. To determine the range in cycle length, woman keeps track of cycles for 6 months and uses it to estimate when ovulation will occur. COUPLES MUS ABSTAIN DURING FERTILE PERIODS.
What is the standard days method of contraception? *Uses a string of color coded beads to keep track of days of each cycle. *Is designed for women with cycles that vary from 26 to 32 days. *Days 8 through 19 are considered fertile days.
What days of the standard days method of contraception are considered fertile days? days 8 - 19
For basal body temperature contraception method, when is temp taken? a) Woman chart oral temp each am before getting out of bed as activity causes temp to rise
How high does temperature rise with ovulation? 0.4 to 0.8 degrees
In the cervical mucus contraceptive planning method, when must the couple avoid intercourse? c) Couple must avoid intercourse from the time clear stretchy mucus is first present to 4 days after the end of the slippery mucus
What is the symptothermal contraceptive planning method? combines calendar, basal body temp and cervical mucus methods.
What are the least reliable methods of contraception? *Breastfeeding *Coitus Interruptus
What may contraceptive medication use with St. Johns wort do? Decrease contraceptive efficacy and cause breakthrough bleeding and irregular menses
Smoking while taking estrogen may increase the risk of what? thromboembolic phenomena
Penicillins taken with oral contraceptives may cause what? Reduced efficacy
Side effects of contraceptive therapy that should be reported include Blurred vision, leg pain, chest pain, spotting, and missed periods
Where should I.M. contraceptives be administered? gluteal or deltoid muscle
If the period between I.M. contraception injections is >14 wk, what should be done before next dose is administered? Check for pregnancy
How long must another form of contraception be used when BEGINNING oral contraceptives? 3 weeks
How often must papanicolaou smears be conducted while on oral contraceptives? Every 6 - 12 months
How often must mammogram be conducted while on oral contraceptives? Every 12 months or as directed
Created by: Shanejqb