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N352: Practice of Nursing I > OB Module 6: Family Planning > Flashcards

OB Module 6: Family Planning Flashcards

1
Q

Nearly half of all pregnancies in the US are ___

A

unintended

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2
Q

Every year __% of women 15-44 yo who dont use birth control during vaginal intercourse become pregnany

A

85%

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3
Q

What are the most common forms of contraception in the US?

A
  1. Female Sterilization - 10.7 mil
  2. Oral Contraceptive Pills - 10.4 mil
  3. Male condoms - 7.9 mil
  4. Male Sterilization - 4.2 mil
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4
Q

Why is it interesting that the most common form of contraception is female sterilization by a large margin?

A
  1. There is a comparatively low rate of male sterilization
  2. This is due in part to women having to take ownership of the contraceptive use issue often
  3. It is an invasive procedure that opens the abdomen and uses anesthesia so there are hazards
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5
Q

OCs and BCPs

A

Oral Contraceptives and Birth Control Pills

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6
Q

Barrier Methods for contraception

A

condoms

diaphragms

contraceptive sponge

cervical cap

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7
Q

A shot or an implant like depo is what kind of contraceptive method?

A

Long Acting Hormonal Methods

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8
Q

IUD

A

Intrauterine Devices

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9
Q

What are the various contraceptives that one can use?

A

OCs and BCPs

Barrier methods

IUDs

Long Acting hormonal methods

spermicides

hormonal contraceptive patch

hormonal contraceptive vaginal ring

natural family planning

lactation amenorrhea method

surgical or procedural sterilization

emergency contraception

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10
Q

When is another name for emergency contraception

A

Plan B

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11
Q

What are the different types of contraceptive uses

A

Typical

Perfect

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12
Q

Typical Use

A

User effectiveness

the use of any given method by a typical couple

the typical user may not use the method with every act of intercourse or may not consistently or correctly use the product

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13
Q

Perfect Use

A

Theoretical Effectiveness

Method used consistently and correctly according to a specified set of rules or guidelines with very act of intercourse

statistics are based on the theory of perfect use

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14
Q

Rates of ___ use are lower than __ use

A

typical; perfect

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15
Q

Periodic abstinence like calendar, ovulation method, symptothermal, and post ovulation are what kind of contraception?

A

family planning

they have only typical use ratings rather than perfect

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16
Q

When is a pregnancy cap more effective

A

if it is a primiparous woman than a multiparous woman since the cervix will alter after L&D and the cap may not fit right

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17
Q

Why is withdrawal a bad method of contraception?

A

Pre ejaculate has sperm in it too in some amount

Pull out game weak regardless of what you do

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18
Q

Why does Nuvaring have only perfect use rates and not typical

A

it is put in and left in so there is not much typical use occurring

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19
Q

Why can male sterilization still have a failure rate?

A

Some guys are not good at going back until sperm levels hit zero while others do not always use protection in the meanwhile

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20
Q

Emergency contraception has the highest rate of prevention when…

A

it is started within 72 hours

the sooner started the higher the contraceptive success rate

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21
Q

Factors to Consider when Choosing a Contraceptive

A

She can be comfortable with

Her partner can be comfortable with

Is as effective as she needs for it to be effective

Is cost effective or low cost

Is easily hidden if need be

Prevents STD transmission if necessary

Separates the act of intercourse from contraception if needed

Allows for immediate use if spontaneity is an issue

May be easily reversible or permanent

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22
Q

What is one of the most cost effective contraceptives and why

A

IUD

the initial payoff is larger but you get protection for years

It ends up being a low cost in the long run but it must be aid upfront

It is also secretive and good for prevention in adolescents, abused women, and prevention of STDs

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23
Q

Factors to take into consideration while counseling regarding contraceptive choices?

A

Medical history and risk factors

effects an unwanted pregnancy would have at this point in the patients life

potential for multiple partners in reproductive life span especially in the next few years

patients comfort level touching her body and her lovers body

maturity level

frequency of intercourse

patients ability to understand instructions

patients access to the health care setting

methods used to date and her perceptions regarding these contraceptive methods as well

the patients weight

the patients ability to consistently use the method

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24
Q

If there is a need to prevent pregnancy and prevent STD transmission, what may the patient be advised to do?

A

Combine two methods to enhance pregnancy prevention but also prevent STD transmission

ex: Condoms and spermicidal foam or Condoms and OCs

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25
Q

What is important for the patient to know when starting a new method of contraception

A

that she is using the method on a trial basis and that if she finds that the method is not working well for her and her partner that she then needs to return for further counseling and a trial of another method

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26
Q

What should the provider do before the client leaves the clinic with a new barrier method of contraception

A

give clear and simple instructions on how to use the method

have the patient demonstrate the use of any barrier method before leaving the clinic setting as leaving something like a diaphragm in place could have risks

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27
Q

It will be important to __ __ with the patient how she will discuss contraception with her partner

A

role play

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28
Q

Why is it particularly important to act out discussion with a partner

A

this is especially important if the method will involve his cooperation or use at the time of sexual activity

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29
Q

How can cultural issues come into play when choosing a contraceptive

A

they can come into play regarding the mothers expectations for her daughter in contrast to the cultural norms in the culture they are now acclimating to

the cultural issues and this patients beliefs and values regarding health and the potential impact of chemicals introduced into the body effect her choices regarding birth control

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30
Q

How does the patients education level impact choosing a method of contraception? What does it not impact?

A

it affects her ability to comprehend explanations regarding methods and anatomy with ease

but it does not insure her having a comfort level touching her own body or that of her lover in a sexual context

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31
Q

OTC Contraceptive Methods

A

Condoms
Female Condoms
Sponge
Contraceptive Film
Spermicide

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32
Q

Barrier Methods of Contraception

A

Condoms
Diaphragms
Contraceptive sponges
Cervical Caps

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33
Q

What is the major advantage of condom use

A

the additional barrier of STDs

they are often recommended for this use in addition to other methods for this very purpose

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34
Q

What is the rate of conception like with condoms?

A

Not great when condoms are used along

14% failure rate for typical use and 3% perfect use

more protection can be gleaned though when used with a spermicide foam, cream, jelly, suppository or film however.

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35
Q

Why has male condom use rose in recent years?

A

generally it is used more over the concern of AIDS or STDs

incidence increased in all ages but particularly in 20-24 year range and 25-29 year range

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36
Q

How does the Female Condom work

A

The same way as a male one - a barrier to sperm

Thin polyurethane acting as a sheath with 2 soft flexible rings at either end and is worn internally by the woman during coitus

Polyurethane covers one ring sitting against the cervix and acting as an anchor, the second is larger and remains outside the body and covers part of the peritoneum and labia

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37
Q

When can the female condom be inserted and when can it be removed?

A

it can be inserted as much as 8 hours prior to sex and should be removed immediately after sex

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38
Q

Never use a female condom with …

A

a male condom

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39
Q

Diaphragm

A

made of thin flexible silicone rubber and looks like a small dome or cup

Has a flexible ring around the edge

Inserted into the vagina prior to sexual intercourse

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40
Q

What should be used alongside the diaphragm and why?

A

Should be used with spermicidal cream or jelly to increase its effectiveness

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41
Q

A diaphragm needs what before use?

A

to be fitted by a health care provider

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42
Q

How often should the diaphragm be fitted and why

A

provider should be checking the fit every year in case the patient gained or lost weight, became pregnant, or gave birth as the diaphragm would likely no longer fit

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43
Q

How does the diaphragm work

A

by creating a barrier between sperm and the uterus

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44
Q

Where is the diaphragm placed

A

behind the pubic bone to completely cover the cervix

this prevents sperm deposited in intercourse from entering the cervix

any spermicide placed inside of the dome and around the rim of the diaphragm also helps kill any sperm that comes into contact with it

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45
Q

When can diaphragms be inserted and how often should spermicide be added?

A

Diaphragm can be put in 6 hours prior to intercourse

Spermicide will need to be added in the vagina every 2 hours or each time she has intercourse

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46
Q

How long can a diaphragm be left in and why

A

no more than 24 hours

if left longer there is risk for Toxic Shock Syndrome (TSS)

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47
Q

Advantages of using a diaphragm

A

easy to insert and remove

inexpensive and reusable

if inserted correctly, diaphragm cannot be felt by either partner

does not effect future fertility or the patients menstrual cycle

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48
Q

Disadvantages of the diaphragm

A

if left for longer than 24 hours you have TSS risk

continual use of spermicide can be irritating to the lining of the vagina and possibly increase risk of STD contraction

can increase the likelihood of bladder infections - because of push on urethra and urinary stasis that can occur as a result

does not protect against STDs - to do that she would need a condom everytime she has sex

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49
Q

How does the cervical cap work

A

like a diaphragm, it is a dome covering the cervix with a brim holding the cap in place tightly and a groove that can hold spermicidal jelly or cream

It prevents sperm from entering the uterus

however unlike the diaphragm, it is smaller and fits more tightly around the cervix when in place

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50
Q

What is a cervical cap made of?

A

silicone rubber

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51
Q

A cervical cap must be …

A

fitted by a health care provider

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52
Q

When does/can the cervical cap be inserted?

A

it must be done just prior to intercourse

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53
Q

How much spermicide is applied to a cervical cap

A

about a half teaspoon will need to be applied on the groove

a small amount is also applied to the bowl and brim of the cap

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54
Q

How long can a cervical cap be left in place and how often is spermicide applied

A

Can be left in place for 48 hours

spermicide does not need to be reapplied every time the patient has sex

HOWEVER the cap must be left in place for at least 8 hours post intercourse

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55
Q

Advantages of a Cervical Cap

A

doesnt affect fertility or menstrual cycle

can be left in vagina for 48 hours

usually unnoticeable to both partners

requires less spermicides than the diaphragm which increases the pleasure of oral sex

56
Q

Disadvantages of a Cervical Cap

A

must be prescribed by a health care provider

can be difficult to insert properly and may become dislodged during intercourse

unlike some other kinds of birth control it is not effective protection against STDS

57
Q

Contraceptive Sponge

A

small disposable sponges made of polyurethane foam and are infused with spermicide

they work by blocking sperm from entering the uterus and also by absorbing and killing sperm

58
Q

What must be done prior to use of a contraceptive sponge

A

it must be moistened before use with water so that it becomes foamy and then inserted into the vagina, positioned so it sits over the cervix

59
Q

How is the contraceptive sponge similar and dissimilar to the diaphragm

A

like the diaphragm it can be worn for 12-24 hours

unlike the diaphragm it offers continuous protection during that time regardless of how often the patient is having sex

60
Q

How long should the sponge be left in place after sex

A

it must be left for at least 6 hours before removal

61
Q

There is risk for toxic shock syndrome with a contraceptive sponge if…

A

the sponge is left in for more than 30 hours

62
Q

What are the failure rates like for contraceptive sponges

A

they can vary widely between 9% to 40% depending on whether or not the patient has had a child and whether or not she put the sponge in correctly

women who have given birth vaginally are much more likely to have this method fail

63
Q

What is associated with the use of hormonal contraceptives

A

it is associated with increased risks of several cardiovascular conditions including MI, stroke, venous thromboembolism, DVT, retinal vein thrombosis and PE

64
Q

Hormonal contraceptives should be used if a woman ___. Why?

A

Smokes

Smoking is associated with an increased risk of serious cardiovascular SE alongside hormonal contraceptive use

Women who are on hormonal contraceptives should be strongly advised not to smoke

65
Q

How do Oral Contraceptives (BCP and OC) work

A

they work by suppressing ovulation by inducing a pseudo pregnant state

they thin the uterine lining and change the consistency of the mucus in a womans cervix making it harder for sperm to move into contact with an egg

66
Q

What do all combination OCs contain and how does that compare to OCs from 20-30 years ago

A

all combination OCs contain 20-50 mcg of estrogen and that is 25% less than the OCs made 20-30 years ago

67
Q

What are the 3 types of OCs

A

Combination Pill

Mini Pill

Emergency Contraceptive Pill

68
Q

What is the most widely prescribed form of contraception

A

the combination pill (OC)

69
Q

The combination pill contains ___ and ___

A

estrogen and progestin

(but different formulations have different doses so prescription is based on pt hx and may alter amounts)

70
Q

How may formulations and doses of combination pills differ?

A
  1. Some require taking a constant dose of both medications (est and progest) for 21 days followed by a week of placebo tablets
  2. Others vary the dose of estrogen and/or progestin that a woman gets throughout her cycle, or adds 5 additional days of tables of estrogen at the end of the 21 day cycle
  3. some newer preps allow 3 months of continuous use
71
Q

Advantages of OCs

A

safe simple and convenient

one of the most effective form of reversible birth control

perfect use - fewer than 1 pregnancy per 100 women if taken as directed

typical use - fewer than 8 pregnancies per 100 women

fewer menstrual cramps and lighter periods

72
Q

Absolute Contraindications to Oral contraceptive Use

A

Hx of thrombophlebitis or clotting disorders

Cardiovascular or CAD

known or suspected breast cancer

known or suspected endometrial cancer

undiagnosed genital bleeding

cholestatic jaundice

impaired liver function

hepatic adenomas, cancers or tumors

known or suspected pregnancy

Type II Hyperlipidemia

factor 5 Leiden mutation

at age 35 if the patient is a smoker she needs to come off OCPs

73
Q

What are some coincidental benefits of OCs other than preventing pregnancy

A

improved acne

protection against ovarian cysts and endometrial cancer

decreased premenstrual symptoms, depression, and HAs

decreased iron deficiency anemia related to heavy periods

decreased vaginal dryness and painful intercourse associated with the changes of peri menopause

74
Q

Possible side effects of oral contraceptives

A

bleeding between periods

breast tenderness

HA

nausea

weight gain or weight loss

change in sexual desire

depression

mood changes

75
Q

What is the acronym for potentially life threatening side effects from Ocs

A

ACHES

acronym used in teaching warning signs of a serious problem with pill use to patients

76
Q

What does ACHES stand for

A

Abdominal pain

Chest pain

Headaches

Eye problems

Severe leg pain

77
Q

What may abdominal pain after OC use indicate

A

blood clot in the pelvis or liver

benign liver tumor or gall bladder disease

78
Q

What may chest pain after OC use indicate and what are some s/s

A

blood clot in lungs

heart attack

angina - heart pain

breast lumps

79
Q

What may headaches after OC use indicate and what are some s/s

A

stroke

migraine headache with neurological problems including blurred vision, spots, zigzag lines, weakness, difficulty speaking

other headaches caused by pills

high BP

80
Q

What may eye problems after OC use indicate and what are some s/s

A

stroke

blurred vision

double vision

loss of vision

migraine with neurological symptoms

blood clots in the eyes

change in the shape of the cornea ( contacts don’t fit)

81
Q

What may severe leg pain after OC use indicate

A

inflammation and blood clots of a vein in the leg

82
Q

What are some medicines that can decrease the efficacy of oral contraceptives

A

oral antibiotics

rifampin

dilantin

phenobarbital

st johns wart (OTC use often times)

83
Q

What needs to be done if someone starts taking a medication that decreases OC efficacy?

A

She will need to use some other form of contraception for a month period and then she can restart the pill administration in the next month

84
Q

What is the percent of accidental pregnancies (failure) with progestin only OCs for perfect users

A

0.5%

85
Q

What is the percent of accidental pregnancies (failure) with Combined estrogen and progesterone OTCs for perfect users

A

0.1%

86
Q

What is the overall typical use failure rate of OCs

A

3%

87
Q

Why are progestin only pills mostly used by breastfeeding mothers? What is the drawback?

A

There is a small error of dosing so it MUST be taken at the same time everyday not just everyday

However, it does not interfere with milk production and lactation

88
Q

NuvaRing

A

Contraceptive Ring / “The Ring”

Reversible prescription method of birth control

Small flexible ring that is inserted into the vagina once a month

It releases synthetic estrogen and progestin to protect against pregnancy for one month

89
Q

How long does the NuvaRinga stay in place

A

It is placed one a month and left ion place for 3 weeks and is removed for the remaining week

90
Q

How do the NuvaRing hormones work at preventing pregnancy?

A

They primarily keep the ovaries from releasing an egg (prevent ovulation)

thickens cervical mucus which prevents the sperm from joining an egg

thins the lining of the uterus (in theory this could prevent pregnancy by interfering with the implantation of a fertilized egg)

91
Q

OrthoEvra Patch

A

contraceptive patch

reversible prescription method of birth control

thin, beige, plastic patch that sticks to the skin of the buttocks, stomach, upper outer arm, or upper torso

it releases synthetic estrogen and progestin to protect against pregnancy for 1 month

92
Q

How oftne is a new contraceptive patch placed and how long is on for ?

A

It is placed once a week for 3 weeks in a row with no patch on the fourth week of the month

93
Q

Why has the contraceptive patch fallen out of favor

A

there are concerns recently about an increased risk for thrombophlebitis with the patch

94
Q

Why does this fourth week of no use occur with a lot of hormonal contraceptives

A

to allow for menstruation

95
Q

IUD

A

intrauterine devices

they are T shaped and made of plastic

some have copper wire coating while others release hormones

are long term dwelling

96
Q

How are IUDs placed

A

they are inserted by an OBGYN provider in an outpatient clinic setting

97
Q

ParaGard

A

Copper T 380A

an IUD containing copper

can be left in place for 12 years of use

98
Q

Mirena

A

an IUD that continuously releases a small amount of the hormone progestin

it continues to be effective for 5 years

99
Q

How do IUDs work

A

they prevent sperm from joining with an egg by impacting the way sperm move (the hormone in Mirena increase the IUD effectiveness)

It ends up thickening cervical mucus which provides a barrier that prevents sperm from entering the uterus

prevents some women’s ovaries from releasing eggs (Stops ovulation)

IUDs end up altering the lining of the uterus

100
Q

How can a woman make sure an IUID is in place?

A

there is a string attached at the base of the T that hands gown through the cervix and into the vagina and a woman can feel it in her vagina

101
Q

How is an IUD removed

A

using the string

102
Q

IUD failure rate decreases…

A

by continuously being in place

103
Q

What is one of the most effective reversible methods of birth control

A

IUDs

104
Q

How many woman using ParaGard or Mirena out of 100 will become pregnant during the first year of typical use?

A

One or fewer

105
Q

How many women will get pregnant with perfect IUD use

A

fewer than one

the risk of pregnancy’s decreases even more with continued use

106
Q

___ is the most popular form of reversible birth control in the world with __ ___ women using them

A

IUDs; 85+ million

107
Q

Advantages of IUDs

A

may improve sex life as there is nothing to place before, and some state they feel more free to be spontaneous since they do not have to worry

ability to become pregnant can return quickly when use is stopped

a very private method of birth control - no packaging or evidence of use that might embarrass some users

108
Q

IUDs are a good choice for what kinds of women

A

ones that want a long term birth control method

ones that are breastfeeding

ones that cannot or do not want to use a hormonal method

109
Q

Contraindications to IUD use

A

pregnancy

cervical cancer that isnt treated

cancer of the uterus

pelvic tuberculosis

allergy to copper (ParaGard only)

Wilson’s Disease (ParaGard only)

Severe liver disease (Mirena only)

Breast cancer (Mirena Only)\

unexplained vaginal bleeding

pelvic infection following childbirth or an abortion in the last 3 months

past or current sexually transmitted infections or other pelvic infections

110
Q

Wilson’s Disease

A

inability for the body to clear copper

cannot use a copper based IUD like ParaGard with this disease

111
Q

Depoprovera and Lunelle

A

2 contraceptive shots

sometimes called DMPA for Depoprovera

112
Q

DMPA can prevent pregnancy for how long

A

13 weeks

113
Q

Lunelle prevents pregnancy for how long

A

a month

114
Q

How does Depoprovera and Lunelle work

A

they primarily prevent the ovaries from releasing an egg (ovulation)

it thickens cervical mucus to prevent sperm from reaching the egg

alters the lining of the uterus, which in theory, may prevent implantation of a fertilized egg

115
Q

___ is one of the most effective reversible methods of birth control with only 3 out of 1000 women who use it correctly and consistently getting pregnant during the first year of use

A

Depoprovera

116
Q

__ in 100 women will become pregnant with typical use of Depoprovera

A

3 in 100

117
Q

Why does Depoprovera have a typical use rating if it is a shot

A

it only lasts consistently for 13 weeks and some may not return for a follow up shot

118
Q

What is important to educate regarding the use of Depoprovera

A

it can impede ovulation in some women for up to 18 months so it is not a good short term use method if they eventually want to have a baby

119
Q

What are common side effects of Depoprovera and Lunelle

A

decreased menstrual flow

weight gain

120
Q

Implanon

A

an implantable method of birth control

similar to norplant but it is one rod instead of five that is matchstick in size

it is placed under the skin on the inner side of the upper arm and releases a low steady dose of progestin to prevent pregnancy

121
Q

Implanon is __% effective in preventing pregnancy when implanted properly

A

99%

122
Q

How long can Implanon be left in place and when can it be removed

A

it can be left in place for up to 3 years and removed at any time

123
Q

What are some side effects of Implanon

A

irregular menstrual bleeding and spotting - it may stop menstruation all together

acne

headaches

breast tenderness

weight changes

increased risk of blood clots, particularly in women who smoke, like other hormonal contraceptives

124
Q

Why is it important to mention potential cessation of menstruation to those with Implanon

A

some take comfort in having a period as reassurance they are no pregnant so they should know

125
Q

Female Sterilization

A

“Tubal Ligation”

Segment is cut from both fallopian tubes and the ends of the tubes are then burned, tied, or clamped

126
Q

Female sterilization has a very high rate of efficacy for contraception, but what is one problem?

A

due to how vascular the area is and how prone it is to healing, there is a high failure rate if the procedure is done immediately after a delivery

127
Q

What are some surgical risks for tubal ligation

A

infection

uterine

perforation

those who had tubes tied and then become pregnant are more likely to have an ectopic pregnancy

also menstrual cycle disturbances and gynecological problems can occur with having tubes tied

128
Q

Vasectomy

A

simple procedure involving severing the vas deferens in a man

it can be done in a doctors office and is considered a permanent form of contraception

it usually takes less than 30 minutes and local anesthesia is given to make it less painful

129
Q

What are common side effects or complications of a vasectomy

A

swelling

bruising

most common complication: infection

130
Q

How long does it take after a vasectomy until a man is actually sterile

A

several months - 15 to 20 ejaculates

they will need to go in for periodic checks during the months following the vasectomy to evaluate the level of sperm in the ejaculate

131
Q

Emergency Contraception (EC)`

A

“morning after pill” or “Plan B”

can prevent pregnancy AFTER unprotected vaginal intercourse

132
Q

How soon must EC be started after unprotected intercourse?

A

within 120 hours (5 days)

however the sooner it is started the better with a 75-89% effectiveness rate when done within 72 hours

133
Q

How does EC work

A

contains hormones found in birth control pills and prevents pregnancy by stopping ovulation or fertilization

theoretically it can also prevent implantation but it has not been proven scientifically

134
Q

Will EC cause abortion or affect an existing pregnancy

A

No, however a woman should not use EC if pregnant

135
Q

How can family planning affect average income per capita?

A

smaller families share income among fewer people allowing higher average income per capita

a family of a certain size may be below poverty line, but with one less member they may rise above the poverty threshold

136
Q

Why can family planning help lower maternal mortality and morbidity

A

fewer pregnancies lead to lower maternal mortality and morbidity and often to more education and economic opportunities for women

a mothers death and disability can drive a family into poverty since her ability to earn income can lead the family out of poverty

137
Q

What is the global perspective of family planning

A

high fertility undermines the education of children, especially girls

larger families have less to invest in the education of each child

early pregnancy interrupts young women’s schooling and in large families mothers often remove daughters from school to help care for siblings

less education typically implies increased poverty for the family as well as the inter generational transmission of poverty

N352: Practice of Nursing I (14 decks)

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