MAMC exam 8 family planning & the role of the nurse
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| define family planning | choosing if & when to have children including contraceptives to avoid pregnancy & methods to achieve pregnancy
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| role of nurse in family planning | counselor
educator
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| categories of contraceptive methods | hormonal
barrier
behavioral
surgical
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| hormonal contraceptive methods | temporary
combination pill, morning-after pill, progestin only
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| estrogen | required for development & maintenance of femal reproductive system
develop female secondary sex characteristics
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| 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
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| 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
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| side effects of the combination pill | weight gain
N/V
spotting & breakthrough bleeding
amenorrhea
breast tenderness
headache
chloasma
irritability
nervousness
depression
decreased libido
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| complications of the combination pill | benign liver tumors
gallstones
MI
throboembolism
stroke
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| contraindications of the combination pill | history of cardiovascular or liver disease
HTN
breast or pelvic cancer
caution with DM and sickle cell anemia
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| 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
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| morning after pill | norgestrel & ethinyl estradiol
98.4% effective
creates hostile uterine lining & alters tubal transport
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| 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
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| 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
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| 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
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| 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
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| 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
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| medroxyprogesterone (Depo-Provera) | progestin only drug given by injection every 3 months private, convenience & highly effective method efficacy similar to that of surgical sterilization
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| side effects & complications of medroxyprogesterone | amenorrhea headaches bloating weight gain return of fertility may take several months
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| patient teaching for medroxyprogesterone | return every 3 months for injections discontinue method for several months before planning to conceive
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| levonorgestrel (Norplant) | progestin only subdermal implant 6 capsules provide protection for 5 years continuous, long term contraception failure rate extremely low
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| side effects & complications of levonorgestrel | menstrual irregularities amenorrhea ABD pain headaches weight gain surgical removal after 5 years
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| 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
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| barrier methods for contraceptive | diaphragm cervical cap condoms
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| 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
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| complications of diaphragms | allergy to latex or spermicide
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| 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
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| 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
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| complications of cervical caps | alergy to rubber or spermicide possible irritation or erosion of the cervix
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| cervical cap patient teaching | provide sufficient time for practice with insertion & removal instructio on cleaning, storing, inspecting for damage
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| 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
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| side effects & complications of male condoms | allergy to rubber decrease in sensation interference with foreplay
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| 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
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| female condom patient teaching | discuss insertion, lubrication, & removal method more expensive than male condoms
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| 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
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| IUD side effects & complications | increased menstrual flow intramunstrual bleeding & cramping ectopic pregnancy pelvic infection perforation of uterus infertility undetected expulsion leading to pregnancy
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| IUD patient teaching | discuss procedure check for string in vagina after every period annual pelvic exams
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| 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
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| rhythm method complications | inaccurate or incomplete knowledge of menstrual cycle
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| 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
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| surgical methods of contraceptions | permanent tubal sterilization hysterectomy vasectomy
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| 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
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| tubal sterilization complications | bowel injury hemorrhage infection
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| tubal sterilization patient teaching | ensure understanding of procedure consent signed procedure may require short term hospilization dependingon procedure
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| hysterectomy | removal of uterus 100% effective ONLY performed for other diseae processes sterility secondary benefit when desired
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| vasectomy | bilateral surgical ligation & resection of ductus deferens
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| vasectomy side effects | hematoma edema psychological adjustment
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| 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
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