Class 11: Contraception & Reproduction Choices Flashcards
(134 cards)
1
Q
what are categories of contraception (5)
A
- hormonal
- non-hormonal
- natural
- permanent
- emergency
2
Q
what are examples of hormonal types of contraception (2)
A
- OCP
- IUD/IUS
3
Q
what are examples of non-hormonal types of contraception
A
- condoms (male and female)
4
Q
what are examples of natural types of contraception (3)
A
- withdrawal
- fertility awareness
- lactational amenorrhea method
5
Q
what are examples of permanent types of contraception (2)
A
- vasectomy
- tubal ligation
6
Q
what are considered the most (1-2 pregnancies/100 people)effective methods of contraception (5)
A
- progestin only IUS
- progestin implant (0.5/1000) (Nexplanon)
- vasectomy
- tubal ligation/occlusion
- non-hormonal IUD - copper
7
Q
what are considered the mid-range (4-9 pregnancies/100 people) effective methods of contraception (6)
A
- combined estrogen & progestin oral pills – COC
- patch
- vaginal ring
- lactational amenorrhea
- progestin only injection
- progestin only mini - pill
8
Q
what are the least effective (>13 pregnancies/100 people) methods of contraception (3)
A
- withdrawal
- fertility awareness
- barriers: condoms
9
Q
there are more contraindications to estrogen or progesterone?? what does this mean?
A
- more contraindications to estrogen than progesterone = some people may need progesterone only pill
10
Q
how do hormonal pills vary
A
- some have steady state of hormones
- or ones which fluctuate week by week
11
Q
what type of IUDs are extremely effective?
A
- hormonal IUDs
12
Q
what is nexplanon
A
- progesterone-only implant injected into inner arm
13
Q
describe the release of hormones via nexplanon, how long does it stay in?
A
- releases hormones slowly
- stays in for 3 years
14
Q
how often and where is a progestin injection given?
A
- given in muscle once every 12-15 weeks
15
Q
which is more effective: progestin only pill or combined
A
- combined
16
Q
what is imp to note with progestin only pills to prevent decreased effectiveness
A
- taken at exact same time every day
17
Q
describe reversal of tubal ligation
A
- very difficult to reverse
18
Q
describe the presence of hormones in a copper IUD
A
- contains no hormones
19
Q
what is lactational amenorrhea
A
- protection provided by chest feeding
20
Q
with lactational amenorrhea, what should still be used?
A
- condom
21
Q
ovulation may still occur w lactational amenorrhea if..
A
- if breastfeeding is infrequent (less than q4h in day or 6 hrs at night)
22
Q
what should be assessed r/t contraception (10)
A
- reproductive health history (include STIs)
- general & current medical history
- meds
- current knowledge on reproduction, sexual health, contraception, and STIs
- ability to access (afford)
- efficacy
- adherence
- protection from STIs
- comfort
- contraindications
23
Q
define efficacy r/t contraception
A
- how important it is that you do not become pregnancy
24
Q
what should be recommended if the pt absolutely does not want to become pregnant?
A
- high effectiveness methods of contraceptions
25
describe adherence r/t contraceptions
- how well someone will be able to stick to the contraceptive method
ex. if cant remember to take pill every day, look at other options
26
what is the only thing that protects against STIs
- condoms
27
due to the protection condoms provide against STIs, when should condoms for sure be used? (2)
- if you don't know someone's STI status
- or are not monogamous
28
what should be considered r/t comfort w contraception
- invasive vs noninvasive
ex. some dont want IUDs
29
describe the need for parent consent for medical treatment in canada
- in Canada, an adolescent does not require parental consent for medical treatment including contraception
30
what is included in hormonal contraception (6)
- combined oral contraceptive (COC)
- progestin-only pill (POP)
- injectable contraception
- vaginal ring
- contraceptive patch
- intrauterine contraception (IUS/IUD/IUC)
31
what are side effects to monitor for with hormonal contraception
ACHES
32
what does ACHES stand for
Abdominal pain
Chest pain/dyspnea
Headache (severe)
Eye problems
Swelling & leg pain
33
why is it important to assess for abdominal pain w hormonal contraception
- increased risk for liver or gallbladder problems
34
why is it important to monitor the "CHES" of ACHES with hormonal contraception
- related to clotting or strokes
35
what is the MOA of COC (4)
- suppresses ovulation
- endometrial changes to reduce chance of implantation (decreases proliferation)
- thickens cervical mucus
- impairs motility of fallopian tubes
36
what are benefits of COC (4)
- shorter menses
- regular cycle
- reversible
- reduces risk of endometrial & ovarian cancer
37
what are risks of COC (2)
- VTE
- side effects
38
what are contraindications of COC (10)
- smoking and age >35
- HTN
- VTE
- heart disease
- CVA
- breast cancer
- liver disease
- migraines w aura
- diabetes w complications
- AUB
39
what is a risk associated w COC
- clotting
40
define: aura
- visual disturbances prior to migraine
ex. lights, spots
41
with diabetes, what should be considered with COC contraception
- weigh risk of pregnancy (very risky) against risk of taking pill
42
what is AUB? what should be done w this prior to prescribing a hormonal pill to regulate
- abnormal uterine bleeding
- should investigate why this is happening
43
what is the MOA of POP (4)
- suppresses ovulation
- endometrial changes to reduce chance of implantation (decreases proliferation)
- thickens cervical mucus
- impairs the motility of fallopian tubes
44
what are benefits of POP (4)
- can be used when estrogen is contraindicated
- shorter menses
- regular cycle
- reversible
45
what are risks w POP
- side effects
46
what are contraindications to POP (3)
- breast cancer
- AUB
- liver disease
47
what is an imp consideration w POP
- take at same time every day
48
what is imp to note w suppressing of ovulation w COC vs POP
- POP not as consistent in suppressing ovulation
49
is there any STI protection with oral contraceptive pills?
- no
50
intrauterine contraception is placed where? by who?
- in the uterus by a provider
51
what options are available w intrauterine contraception (2)
- hormonal option
- non hormonal options (copper)
52
describe the effectiveness and reversibility of intrauterine contraception
- highly effective
- reseversible
53
in a hormonal IUD, what hormones are present
- no estrogen, just progestin
54
describe menses w hormonal IUDs
- menses may stop completely
- or reduce flow of menses
55
describe menses w non hormonal IUDs
- often heavier menstrual flow & cramping
56
what are risks w IUD (3)
- infection
- rupture of uterus
- expulsion
57
what protection against STIs does intrauterine contraception provide?
- no protection
58
what should be checked before inserting intrauterine contraception
- should check for infection within the genital tract before inserting --> may swab
59
describe the return of fertility after removal of an IUD
- fertility returns quickly
60
when does follow up occur w intrauterine contraception
- follow up after 1st menstrual cycle
61
failure of intrauterine contraception is related to..
- it falling out
62
an IUD may fall out with.. (2)
- early PP
- uterine structure issues
63
what should be felt outside the cervix w an IUD? what should happen if they are not felt?
- strings
- if not in place, get an ultrasound
64
what are 2 types of condoms
- male
- female
65
what is the MOA of condoms
- barrier method
66
what are benefits of condoms (2)
- protection from STIs
- protection from pregnancy
67
what are risks of condoms (2)
- improper use
- breaks
68
what are contraindications to condoms
- latex allergies
69
see box 8-9 p.159 in txtbook on info to teach pts on the proper use of condoms
*know, will likely test on*
70
what is the failure rate of condoms
- with correct & consistent use 2%
- with typical use 15%
71
what are types of natural contraceptives (4)
- withdrawal
- fertility awareness
- lactational amenorrhea method
- abstinence
72
what are the least effective contraceptive methods
- fertility awareness
73
how many become pregnant w withdrawal
22/100 / year
74
how many become pregnant w fertility awareness
24/100 /year
75
how many become pregnant w lactational amenorrhea method
2/100 /year in first 6 months PP
76
what are benefits of natural contraceptives (2)
- no hormones
- no devices
77
what are risks of natural contraceptives
- higher risk of failure w most (except abstinence) compared w other methods
78
describe the protection against STIs natural contraceptives provide
- no protection from STIs except abstinence
79
what is fertility awareness
- tracking cycle and most fertile periods & avoiding sex during those time frames
80
what are types of permanent contraceptives (3)
- vasectomy
- tubal ligations
- tubal occlusion
81
what is the MOA of permanent contraceptives
- surgical interventions to prevent pregnancy
82
what is a benefit of permanent contraceptives
- very effective
83
describe the reversibility of permanent contraceptives
- not easily reversible
84
what is a risk associated w permanent contraceptives
- complications from the procedure are possible
85
what is a contraindication for permanent contraceptives
- not for those who desire pregnancy in the feture
86
describe protection against STIs permanent contraceptives provide
- without condoms, no protection from STIs
87
describe the invasiveness of vasectomies
- much less invasive than tubal ligation & occlusion
- done in 15 min, outpt procedure
88
what is included in emergency contraception (2)
- oral medication
- or copper IUD
89
what is the MOA of oral EC pills
- prevent ovulation
90
when should plan B be taken
- take asap (best within 24 hrs, most effective early on) or up to 5 days after intercourse
91
the oral EC pill ella requires?
- prescription
92
when should ella be taken
- more effective than Plan B over the 5 days after intercourse
93
what is the MOA of copper IUD
- inhibits fertilization and implantation
94
when can a copper IUD be inserted as EC
- can be inserted within 7 days of unprotected intercourse
95
what is the most effective EC
- copper IUD
96
what are contraindications for oral EC
- none
97
when should menses return after use of a copper IUD for EC? what if it doesnt return by then
- should occur in 3-4 weeks after insertion
- if not by then, pregnancy test
98
when should menses return after use of oral EC? what if it doesnt return by then?
- 21 days
- if no menses after 21 days, test for pregnancy
99
what should be considered w use of EC
- need to test and treat STIs
- review reproductive plan & offer reliable contraceptive methods
100
semen can live for up to..
7 days
101
describe how BMI impacts the effectiveness of plan B
- people with high BMI will have lower effectiveness on plan B
102
oral EC only works if...
- if there has not been ovulation (early in cycle)
103
a medical abortion in MB can be provided for __ weeks gestation
9
104
what can be used for medical abortion (2)
- mifepristone
- misoprostol
105
surgical abortion can be provided in clinic for up to __ weeks gestation
16 weeks
106
surgical abortion can be provided in hospital for up to __ weeks gestation
19+6 weeks
107
with a medical abortion, they may require ____ if not sure about last menses
- ultrasound
108
describe the cost for abortion services in MB
- no cost at women's health clinic, HSC, or brandon hospital if you have a MB healthcare card or provincial coverage
109
to receive a medical abortion, access to ___ is required
ultrasound
110
what is important consider w abortion services
- accessibility --> everything in winnipeg or brandon, not easily accessible up north
111
what is imp to note in women who get an abortion and are Rh-
- Rh- women with a negative coomb's test will require Rh immune globulin
112
all people seeking care for abortion services should have..
- access to informed and trained providers to counsel on their options, procedures, risks, follow-up care, and post-abortion contraception
113
what should all people have before receiving an abortion (5)
physical exam including:
- height
- weight
- pelvic exam
- VS
- Rh bloodwork
114
what is included in nursing care for abortion (3)
- preop
- op
- and postop care
115
what is given w surgical abortion services
- IV meds to provide analgesia & reduce anxiety
116
what type of surgical abortion is provided?
- aspiration
117
describe aspiration
- freezing injected into cervix
- cervix is dilated
- suction tube inserted into uterus
118
who must complete a sugrical abortion
- a licensed provider (physician)
119
describe the time requirement of a surgical abortion
- relatively quick & completed in 1 appt
120
what is included in the nursing role for surgical abortions (9)
- history
- pre-op
- VS
- lab tests
- education
- review record for signed consent
- IV
- op and postop care
- discharge teaching
121
what is important discharge teaching for a surgical abortion
- cant drive themselves home afterwards
122
describe partner support during a surgical abortion
- no partner support during procedure
123
describe the dosage of mifepristone & misoprostol for a medical abortion
- mifepristone po x 1, then misoprostol 4 tabs po x1 24-48 hrs later
124
what are side effects of misoprostol
- NV
- fever
- chills
- diarrhea
125
what is expected w a medical abortion? when should this reduce?
- heavy bleeding
- should reduce on 2nd day
126
describe success on medical abortion
98/100
127
what is required after a medical abortion
follow up appointment
128
what occurs in the follow up appt after a medical abortion
- bloodwork (HCG)
- appt w provider
129
how long after taking misoprostol will bleeding & cramping occur?
- start 30 min - 4h after
130
what is a benefit of medical abortion (3)
- can control time & place
- can take meds home
- can control who they are with
131
what is included in discharge teaching after abortion (6)
- tampons should be avoided
- normal personal hygeine
- intercourse
- waste for S&S of infection
- watch for abnormally heavy bleeding/clots larger than a lemon
- contraception --> you can get pregnant at any time
132
menses should return how long after abortion?
in 4-6 weeks
133
what is a sign of heavy bleeding after abortion
- more than 4 pads soaked in 2 hrs
134
what are S&S of infection after abortion (3)
- fever greater than 38
- purulent vaginal discharge
- uterine tenderness
