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Family Planning
MAMC exam 8 family planning & the role of the nurse
| Question | Answer |
|---|---|
| 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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