OB Chapter 31
Latex dome similar to cap but larger; should be kept in place 6 hours before and after intercourse; puts pressure on urethra It is surrounded by a flexible spring or coil Diaphragm may provide SOME STD protection Should not be used by women with (2)? The cervix should be felt through the center Risk for? Put what on it? Keep in for how long? Puts pressure on what?
Diaphragm latex allergy or toxic shock syndrome Bladder infection Spermicide 6 hours after Puts pressure on urethra
A woman has just been diagnosed as being 2 months pregnant. She is upset and states, "This is not possible, my husband had a vasectomy 3 months ago, and he should be sterile." The nurse should respond to this woman with the knowledge that a vasectomy:
Does not render a man sterile for about 3 months.
A pregnant woman has requested a tubal ligation for contraception. The nurse is aware that this surgery can occur:
During the postpartum period prior to being discharged from the hospital.
A woman is being admitted to the outpatient surgical unit for a tubal ligation. She states to the nurse, "I know I have to go through with the surgery since I have already signed all the papers, but I was thinking this morning how wonderful it would be to have another baby." The nurse's next action should be to:
Inform the surgeon of the woman's feelings
During a breast exam, the midwife notes that the woman has a transdermal contraceptive patch applied to her breast. The midwife should:
Inform the woman that the patch should not be applied to the breast.
Small, medicated, T-shaped device inserted into the uterine cavity that prevents ovulation? ^it can be inserted _ weeks postpartum? What releases copper which impedes sperm motility and inflames the endometrium? ^this stays in place for how long? ^it can also be used as an emergency contraceptive is used within 5 days of unprotected sex Mirena causes cervical mucous to thicken so the sperm cannot enter ^this contains progestin that causes an inflammatory response ^this stays active for how long? Contraindications include (5)? Teaching for an IUD?
Intrauterine devices 6 ParaGard T 10 years 5 years Hx of ectopic pregnancies, bleeding disorders, pelvic infections, recent STD's, or abnormal uterus Check the thread each month
Nurses working with adolescent women should include questions regarding sexuality when gathering data for a reproductive health history. Which of the following principles should guide the nurse when interviewing the adolescent?
Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly.
Oral pills that inhibit ovulation, thicken? Not recommended for women who? (3) Combined estrogen-progestin contraceptives (COCs): more common; shorter, lighter periods ^it prevents? Progestin only (POPs): minipill; taken daily with no hormone-free days; no estrogen ^suitable for women who have? ^due to the lack of estrogen with POP, there is a risk for? Make sure she is maintaining? Progestin-only emergency contraception (EC) "morning after pill": taken after unprotected intercourse; use immediately or within 120 hours "Plan B" is available for ? "Ella" requires a ? Teaching with oral contraceptives? PP and lactating women should avoid combining contraceptive because of the risk of (2)?
Mucus Smoke, have thrombophlebitis, or had a stroke The proliferation of follicles and prevents the endometrium from proliferating -VTE or heart disease, smokers, breastfeeders, and those with uncontrolled HTN -Irregular bleeding and spotting, depression, and mood changes -a consistent blood hormone level all ages prescription Teach how to begin use and that back up methods are needed if doses are missed VTE and decreased milk production
A woman calls the clinic early on a Monday morning stating that she needs a prescription for emergency contraception. On questioning by the nurse, the woman states that her boyfriend's condom was displaced during intercourse on Saturday night. The nurse should make an appointment for the woman:
On Monday.
Used monthly (3)? IUD and implants are most effective because they are _ and _?
Oral contraceptives, ring, and patch long acting and reversible
A lactating woman asks the nurse about contraception. She states that she has always used a combination pill and would like to continue with that method. The nurse should advise the woman that:
Progestin-only contraceptives may be started 6 weeks after birth.
A woman taking an oral contraceptive as her birth control method of choice should notify her health care provider immediately if she notes which of the following?
Swelling and pain in one of her legs
Minilaparotomy: _ is used to lift uterus upward toward incision?
Tenaculum
Rare, potentially fatal condition caused by toxin-producing strains of Staphylococcus aureus? The toxin alters capillary permeability allowing intravascular fluid to leak from the blood vessels Symptoms? Prevent?
Toxic Shock Syndrome Sudden, spiking fever, flu like symptoms, hypotension, sunburn rash, or skin peeling from palms and soles Change tampons every 4 hours and use sanitary pads at night. Don't use sponges, caps during menses and remove it when you're supposed to. Wash hands before insertion
Permanent contraception used in women over 30 years of age. Although it can be reversed, it is not always successful. This is called? ^avoid (3)? A tubal ligation can be done in the pp period via? Sterilization of the male? How long may it take for complete sterilization to occur? Semen analysis is done at? ^avoid?
Tubal sterilization/ligation avoid intercourse, heavy lifting, or strenuous exercise for a week after. Minilaparatomy incision Vasectomy (vas deferens) Up to 3 months 8-16 weeks avoid intercourse, heavy lifting, or strenuous exercise for a week after.
To increase the effective rate of male condoms, the female partner may:
Use a spermicide.
soft, flexible ring containing estrogen & progestin inserted into vagina for 3 weeks; 1 week is 'ring-free. Made of what material? The steroid hormones are absorbed into the vaginal mucosa Prescription? If it comes out? Common SE?
Vinyl; Contraceptive vaginal ring (Nuva Ring) Does require a prescription and women needs to insert it herself If the ring comes out, it should be re inserted within 3 hours Headaches
A woman called the clinic desiring to start on medroxyprogesterone acetate (Depo-Provera) for contraception. The nurse should make an appointment for the woman:
Within 5 days after her next menstrual period.
A 26-year-old woman is considering medroxyprogesterone acetate (Depo-Provera) as the form of contraception that is best for her. To assist this woman with making a decision concerning this method of contraception, the nurse would tell her that Depo-Provera:
Would require that she return to the clinic every 3 months.
Least reliable method of contraception is? Most reliable contraception is
breastfeeding and withdrawal (pulling out) abstinence
For perimenopausal women, those over 35, smoke, or have other risk factors should not use combined oral contraceptives as it increases the risk of?
coronary artery disease
estrogen & progestin skin patch to suppress ovulation; how to cycle the patches? Patch is applied to clean, dry, non irritated skin New patch should be applied where and when? Example of a patch?
new patch every week for 3 weeks; removed for 1 week New patch should be applied on a new site each week on the same day Transdermal contraceptive patch (Ortho Evra) The patch can be applied to the abdomen, buttocks, or upper arm
Natural family planning. Avoidance of intercourse during fertile periods: Calendar method? Standard days method? Basal body temperature method? Cervical mucus method? ^the stretchable mucus is called?
no sex during ovulation using colored beads to keep track temp slightly increase after ovulation and decrease during ovulation Clear, wet, slippery mucus can stretch a couple days after ovulation. Spinnbarkeit (raw egg whites)
The nurse determines that teaching about contraceptives is effective when the client makes which statement?
"Condoms have very few side effects."
A woman is being counseled concerning the calendar method type of natural family planning. The woman states that her cycles run from 27 to 29 days. The nurse teaches the woman that ovulation will probably occur on about days
13 to 15. Ovulation occurs approximately 14 days before the onset of menses
Injections and implants: Alters the normal hormonal fluctuations of the menstrual cycle Injections: Depo-Provera (injectable progestin IM or SQ): prevents ovulation for _ weeks; no estrogen; can decrease _? Women who take these need (3)? Discontinue using Depo after using it for _ years? Fertility can be delayed for how long with use?
15; BMD calcium, vitamin D, and do weight bearing exercises 2 6 months to a year The injection is best given within 5 days of the menstrual period. If given later in the cycle, an additional form of contraception should be used for the first week
Implants: Implanon (progestin-rod implant SQ): provides _ years of contraception It thickens cervical mucus to prevent sperm permeability and makes endometrium unfavorable ^it inhibits ovulation
3
Male & female condom: STD protection Sponge: absorbs semen & contains spermicide (no STD protection) Must use water soluble lubricant for condoms because oil can cause latex deterioration Don't use a male and female condom at the same time, use only one Sponges should be kept in place for how long after intercourse?
6 hours
Barrier methods Prevent sperm from entering the cervix by destroying or creating a partition; avoids use of systemic hormones ^Protects against STD's It can interfere with spontaneity Chemical Barriers -Spermicides (cream or gel): kill sperm; no protection from STDs No douching for? Other examples are Foams, tablets, films or suppositories
6 hours after
A woman is requesting information concerning contraception. She is sexually active with multiple partners and is concerned about sexually transmitted diseases. When doing client teaching, the nurse should be aware that the contraceptive method that offers the most protection against sexually transmitted diseases is:
A male condom.
Oral contraceptives-warning signs Other problems include?
ACHES A-Abdominal pain C-Chest pain; cough H-Headaches; HTN E-Eye problems; loss of vision S-Swelling and severe leg pain jaundice, depression, and breast lumps
A woman who is 6 weeks postpartum and lactating is being counseled about contraception. She states that she desires to have a type of birth control that she does not have to "think about." She has three children, so it should be effective and she is in a monogamous relationship. She has a history of blood clots. One appropriate choice of birth control that the nurse can recommend is:
An intrauterine device.
A woman comes to the clinic stating that she is going on a hiking trip that will last 2 months. She states, "I have heard there are things that can be done to prevent me from having a period during that time." The nurse's response should be based on the knowledge that:
Certain oral contraceptive pills may be taking consecutively for 2 months to delay menses.
Placed over cervix to prevent sperm from entering; smaller than diaphragm; size-fitted by health care provider ^should not be used during _? Or with a history of _? Cervical cap may provide SOME STD protection Stays in for _ hours after sex? no longer than _ hours?
Cervical cap Menses; Toxic shock syndrome 8; 48
A woman asks the nurse about the "new vaginal ring everyone is talking about for birth control." When counseling the woman about this method of contraception, the nurse should assess for the woman's:
Comfort level about self-insertion of the ring every 3 weeks.
When counseling teenagers about contraception, it is important to teach them methods that do not require a clinic visit. Which of the following methods do not require a clinic appointment or prescription? (Select all that apply).
Condoms and spermicides
The prevention of pregnancy? Choosing if and when to have children? Pregnancies should be more then _ months apart to avoid problems?
Contraception Family planning 6 months
