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68wm6 p2 Fam Plan
Family Planning and the Role of the Nurse
Question | Answer |
---|---|
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 |