OB E-4 L-1 Contraception Ch 12 (pg. 324-326); • Chapter 19: Infections pp 513-519

TSS toxic shock syndrome

A cervical cap or diaphragm is not recommended for the client with Hx of ___________?

does not require daily intake; does not affect breast feeding

Advantage of Depo-provera?

21 days, 7 days out

Being an estrogen progesterone mix, the vaginal ring is in place for ______ days and is 99% effective?

30hrs Toxic Shock Syndrom

Contraceptive sponges need to be moistened before insertion and should not be worn for greater than _____hrs?

discomfort to user or partner; increased bleeding during menses; increased risk of pelvic infection; mid cycle bleeding; dysmenoria; expulsion of device; risk of perforation with insertion;

Disadvantages of Copper T IUD

yes

Do you need a prescription for a copper T?

multiparous due to change in cervix shape

Greater risk of failure in usage of cervical caps in _________ women?

may take several cycles for it to return

How does the patch effect fertility?

at least 6hrs but not more than 24hrs or increased risk of toxic shock syndrome and UTI

How long after sex must the diaphragm remain in place and for up to how many hours before the risk of toxic shock syndrome and UTI?

10 yrs

How long can the Copper T(paraguard) IUD be left in place?

90 days; better to get next dose early than late

How long is a woman covered who uses Depo-provera progestin only hormone contraceptive?

6hrs; 48 hrs or toxic shock/UTI

How long must the cervical cap stay in place after intercourse? how long after sex can it stay in place?

immediate return of fertility; must be taken same time qDay

How long till fertility returns when using mini pills progestin-only contraceptives and is there flexibility in admin?

q2yrs; up to 6hrs prior to sex

How often should a diaphragm be replaced and how long before coitus can it be placed?

10% ?

If there is a weight gain/loss of greater than ______%, a woman MUST be refitted for a cervical cap?

20%

If there is a weight gain/loss of greater than ______%, a woman MUST be refitted for a diaphragm

amenorrhea

Levonorgestrel releasing system- the mirena IUD has all the advantages of the Copper T plus _______ after approximately 3 months of use

do not rub injection site

Main thing to remember when administering the Depo-provera injection?

damage

Once the Cervical cap is removed, it must be assessed for _______?

damage

Once the diaphragm is removed, it must be assessed for _______?

cervical cap or diaphragm

PID pelvic inflammatory disease, HPV, Cervicitis, previous abnormal paps smears, cervical cancers, & undiagnosed bleeding are not good candidates for _____ or _____?

check for the string to make sure its still in place at end of mentral cycle

Patient teaching for IUD?

take every day at same time (drops to 66% effective if variation in time of day)

Patient teaching for a patient on oral contraceptive?

not really enough research

The implantable progestin (implanton) is FDA approved but is not widely used why?

99%

The oral hormonal method of contraceptive is _____% effective when taken daily?

1 patch per week for 3 weeks then non for menses

The transdermal patch for hormonal methods of contraception is 99% effective and combines estrogen/progestin, how many patches per week for how many weeks?

Contraceptive sponge

This non-hormonal barrier contraceptive has a high risk of unintended pregnancies and HIV, but there is no effect on fertility and no prescription needed?

menses

To reduce the risk of TSS, instruct the client that the cervical cap is not to be used during ________?

P- period late (pregnancy A- abdominal pain or pain w/ coitus I- Infection exposure or vaginal discharge N- not feeling well, fever, or chills (infection) S- string missing, shorter or longer (IUD expulsion)

Warning signs that indicate infection or ectopic pregnancy with usage of IUD can be remembered by PAINS. identify this acronym

Rifampin, isoniazid, anti-convulsants (topiramate), griseofulvin (anti-fungal), Anti-HIV protease inhibitors, warfarin

What 6 medications decrease effectiveness of oral contraceptives?

prescription needed; must be fitted; does not provide protection against STI's; requires extensive education

What are four disadvantage of a cervical cap?

prescription needed; must be fitted; does not provide protection against STI's; requires extensive education

What are four disadvantage of a diaphragm?

High initial cost but no maintenance; does not interact with meds; safe for breast feeding; continuous protection; high rate of effectiveness

What are the advantages of Copper T IUD

bilateral tubal ligation, vasectomy

What are the two permanent methods of contraception?

Decrease effectiveness of oral contraceptives

What do Rifampin (TB), Isoniazid (TB), anti-convulsants (Topiramate), Griseofulvin (fungal), and anti HIV protease inhibitors, and warfarin have to do with oral contraceptives?

many girls are uncomfortable inserting it into themselves

What is a disadvantage of the vaginal ring, cervical cap, and a diaphragm?

no effect on fertility and decreased cost

What is an advantage of using a diaphragm and cervical cap?

no effect on fertility and decreased cost

What is an advantage of using a diaphragm with spermicide?

ACHES A-abdominal pain C- chest pain or shortness of breath H- headaches E- eye problems S- Severe leg pain

What is the acronym to remember signs of potential complications with oral contraceptives?

sperm count must reach zero then no longer need contraception.

What is the purpose of follow up appointments for a vasectomy?

post partum, risk of infection/ change of shape(4-6wks for cervix to go from 10cm back to normal)

What part of the birthing cycle is the cervical cap not intended for usage and why?

breast feeding moms; DVT; thromboembolitic d/o

What would be an example of a progestin only mini pills- hormone contraceptive candidate?

Copper T

Which IUD has an increased risk of ectopic pregnancy?

Mirena

Which IUD has less in-between cycle bleeding?

multipara...military?? (couldn't hear) or multiple sex partners (no protection against STI's)

Who is the copper T IUD not recommended for?

only necessary initially

With the cervical cap, how many times do you need to reapply spermicide for repeated acts of intercourse?

Do need, No protection

With the patch and oral contraception you _____ need a prescription and there ______ protection agains STI's?

less GI upset (oral makes upset GI especially with increased iron);

advantages of transdermal patch

Hx of thromboembolitic d/o, breast cancer or estrogen dependent tumors, CAD, cerebrovascular disease, impaired liver function, if smoker over than 35, headaches with focal neurological symptoms, HTN, diabetes

contraindications of estrogen/progestin contraceptives

weight gain, glucose intolerance; lipid changes; decrease in bone density

disadvantages of Depo-provera?

replaced q5yrs, instability of endometrial lining (first 3 months),

disadvantages of mirena

same as patch ???

disadvantages of the ring?

72 hours is cut off

emergency contraceptive must be taken within ______ hours after sex.

calcium for decrease in bone density

remind moms to have adequate ______ when using Depo-provera?

200lbs

the patch is less effective for woman who weigh more than ______lbs?

Mini pills (oral), Depo-provera (injectable), Implanon (implantable)

what are the Progestin only hormonal contraceptives?