Contraception and Abortion Flashcards
(37 cards)
Contraception
-Intentional prevention of pregnancy
-Nurses Role
Explore best options for individuals:
-Reliability issues
-Relative cost
-Protection for STI’s
-Partners willingness
EDUCATION!
Inital Visit
Thorough History
- Menstrual
- Obstetric
- Medical
- Social
Initial Visit
Physical Examination - pelvic examination
Labratory tests
-Factors affecting methods of contraception
Frequency of intercourse Motivation to prevent pregnancies Understanding of how to use the method Provision of short-term or long-term protection Likelihood of pregnancy for individual Consistent use of method
Methods: Coitus interruptus
- Failure rate of 19%
- No protection against STI’s
Fertility Awareness Methods (FAM):
Identify
- Infertile phase: before ovulation
- Fertile phase: about 5-7 days around mid-cycle; including several days before and during ovulation and the day afterward
- Infertile phase: after ovulation
Pitfalls of using FAM
- Restriction on sexual spontaneity
- Rigorous daily monitoring
- Required training
- Risk of pregnancy during prolonged training
- Risk of pregnancy high on unsafe days
- Failure 25%
Types of FAM
- Periodic Absinence or Natural Family Planning
- Supported by Catholic Church
- Abstienence 3-4 days before and after ovulation
- Problem: ovulation can be unpredictable
- —–irregular menstrual cycles (short or long)
Barrier Methods
Protection
- Pregnancy
- STIs
-Types Spermicides Condoms Diaphragms Cervical Caps Contraceptive Sponge
Spermicides
- Avoid nonoxynol (N-9) if at high risk
- Diaphragms, condoms, cervical caps
- Can actually help transmit diseases
failure rate of 29% when used alone
Condoms
- STI protection
- Avoid oil- based lubricants
- Watch for latex allergy!!!
- Failure rate of 15%
Diaphragms
-Should be largest she can tolerate
-Use with spermicide (avoid N-9)
-16% failure
-Annual gynecological exam
-Refitted for weight fluctations and after pregnancies
-Toxic Shock Syndrome
Prompt removal (6-8 hours)
Signs: sunburn type of rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden high fever and vomitting
Cervical Caps
- Remain in place 6-48 hours
- Used with spermicide
- Dont use during menstruation and 6 weeks postpartum (risk of TSS)
- Failure 40% for parous and 20% for nulliparous
Hormonal Methods
- More than 30 formulations avaliable
- combined with estrogen-progestin
- or progestin only
Hormonal Methods
Administration:
- Oral
- Transdermal
- Vaginally
- Implantation
- Injection
- Combined Estrogen-Progestin
Hormonal Methods
-Suppresses action of hypothalamus and anterior pituitary = insufficient secretion of FSH and LH - no ovulation
Maturation of endometrium altered
-Less favorable for implantation
Cervical mucus thick
-Progestin influence
Withdrawl bleeding
- occurs 1-4 days after last pill taken
- less profuse than regular period with shorter duration
- Must be examined before prescription
TAKE AT SAME TIME EACH DAY
Maintains correct hormonal levels
Hormonal Methods: Benefits
- Decreased menstrual blood loss
- Decreased iron-deficency anemia
- Regulation of menorrhagia
- Regulation of irregular cycles
- Reduced incidence of dysmenorrhea & PMS
- Improve acne
- Decease ovarian cyst development
- Effectiveness: almost 100%
Risks of Hormonal Methods
Contraindications:
-History of thromboembolic disease, CVA, coronary artery disease, breast cancer, liver problems, lactation less than 6 weeks postpartum, smoker older than 35, headaches, hypertension, and diabetes (more than 20 years) with vascular disease
Signs of Potential Complications
A-abdominal pain (liver/gallbladder)
C-chest pain or shortness of breath (clots in lungs/heart)
H-Headaches (hypertension)
E-eye problems (vascular accident or hypertension)
S-severe leg pain (thromboembolic process)
Right product- lowest dose of hormones that prevents ovulation with fewest and least harmful side effects
Oral contraceptives and other meds
- Anticonvulsants decrease effectiveness of oral contraceptives
- Systemic antifungals
- Antituberculosis drugs
- Anti-HIV protease inhibitors
- Watch for over the counter medications!
- Broad spectrum antibiotics
Nursing Interventions
-Look at history of oral contraceptive use, side effects during past use, menstrual history, medical history, and drug interactions
Post oral contraceptives
- Fertility rate may be lower the first 3-12 months
- Amenorrhea most likely related to woman’s menstrual cycle before taking the pill
Medroxyprogesterone Acetate Depo-Provera
- Given IM -150 mg
- Deltoid or gluteus maximus
- Administer the first 5 days of menstrual cycle
- Every 11-13 weeks
- Do not massage area after administration
- —can shortern period of effectiveness
Depo Provera
-Does not impair lactation
-Return to fertility may be dalyed up to 18 months
-Failure rate 3%
Significant bone mineral density loss
-May not be reversible
-Counsel about calcium intake and exercise
Emergency Contracpetion
Plan B
- Over the counter sale (women 18 years and older)
- Take ASAP but within 120 hours of unprotected sex or birth control mishap
- side effect: nausea
- No medical contraindications
- If no period in 21 days- check for pregnancy
- Ineffective if pregnant !!!
