ATI Chapter 1 Maternal Newborn: Contraception

Combined oral contraceptives definition

Hormonal contraception containing estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation

Implantable Progestin Etonogestrol (implanon) risks/complications/contraindications

Increased risk of ectopic pregnancy if pregnancy occurs.

Intrauterine device (IUD) Client instruction

The device must be monitored monthly by clients after menstruation to ensure the presence of the small string that hangs from the device into the upper part of the vagina to rule out migration or expulsion of the device.

Minipill disadvantages

›Less effective in suppressing ovulation than combined oral contraceptives. ›Pill increases occurrence of ovarian cysts. ›Pill does not protect against STIs. ›Users frequently report breakthrough, irregular, vaginal bleeding, and decreased libido. ›Increases appetite

transdermal patch advantages

›Maintains consistent blood levels of hormone. ›Avoids liver metabolism of medication because it is not absorbed in the gastrointestinal tract. ›Decreases risk of forgetting daily pill

Risks/possible complications/ contraindications of coitus interruptus

›Male partner's control can make this an effective method. ›Leakage of fluid that contains spermatozoa prior to ejaculation can be depositedin vagina. ›Risk of pregnancy.

Intrauterine device (IUD) definition

A chemically active T-shaped device that is inserted through a woman's cervix and placed in the uterus by the provider. Releases a chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization

Diaphragm and spermicide definition

A dome-shaped cup with a flexible rim made of latex or silicone that fits snugly overthe cervix with spermicidal cream or gel placed into the dome and around the rim.

Female sterilization (bilateral tubal ligation: salpingectom) surgical procedure: Disadvantages

A surgical procedure carrying risks related to anesthesia, complications, infection, hemorrhage, or trauma.›Considered irreversible in the event that a client desires conception.

Male sterilization (vasectomy) definition

A surgical procedure consisting of ligation and severance of the vas deferens

Female sterilization (bilateral tubal ligation: salpingectom) surgical procedure definition

A surgical procedure consisting of severance and/or burning or blocking the fallopian tubes to prevent fertilization.

Male sterilization (vasectomy) Advantages

A vasectomy is a permanent contraceptive method.›Procedure is short, safe, and simple. ›Sexual function is not impaired

Client instructions for BBT

A woman is instructed to measure oral temperature prior to getting out of bed each morning to monitor ovulation.

Calendar method

A woman records her menstrual cycle by calculating her fertile period based on the assumption that ovulation occurs about 14 days before the onset of her next menstrual cycle, and avoids intercourse during that period. Also taken into account is the timing of intercourse with this method because sperm are viable for 48-120 hr, and the ovum is viable for 24 hr

Injectable progestins (Depo Provera) definition

An intramuscular injection given to a female client every 11 to 13 weeks

Abstinence

Abstaining from having sexual intercourse eliminates the possibility of sperm entering a woman's vagina

Risk factors of symptom based method

Assessment of cervical mucus characteristics may be inaccurate if mucus is mixedwith semen, blood, contraceptive foams, or discharge from infections.›Risk of pregnancy

Injectable progestins (Depo Provera) risks/complications/contraindications

Avoid massaging injection site following administration to avoid accelerating medication absorption, which will shorten the duration of its effectiveness

Implantable Progestin Etonogestrol (implanon) Client instruction

Avoid trauma to the area of implantation

Disadvantages of BBT

BBT reliability can be influenced by many variables that can cause inaccurate interpretation of temperature changes, such as stress, fatigue, illness, alcohol, and warmth or coolness of sleeping environment.

Client instructions for coitus interruptus

Be aware of fluids leaking from the penis.

Male sterilization (vasectomy) risks/complications/contraindications

Complications are rare, but may include bleeding, infection, and anesthesia reaction

Contraceptive Vaginal Ring (Nuvaring) definition

Contains etonogestrel and ethinyl estradiol that is delivered at continuous levels vaginally

Transdermal patch definition

Contains norelgestromin (progesterone) and ethinyl estradiol, which is delivered at continuous levels through the skin into subcutaneous tissue

SyMptoM-bASEd MEthod (cERvicAL MUcUs)

Fertility awareness method based on ovulation. Ovulation occurs approximately 14 days prior to the next menstrual cycle, which is when a woman is fertile. Following ovulation, the cervical mucus becomes thin and flexible under the influence of estrogen and progesterone to allow for sperm viability and motility. The ability for the mucus to stretch between the fingers is greatest during ovulation. This is referred to as spinnbarkeit sig

Male sterilization (vasectomy) Client education

Following the procedure, scrotal support and moderate activity for a couple of days is recommended to reduce discomfort.›Sterility is delayed until the proximal portion of the vas deferens is cleared of all remaining sperm (approximately 20 ejaculations). ›Alternate forms of birth control must be used until the vas deferens is cleared of sperm.›Follow up is important for sperm count

Advantages of BBT

Inexpensive, convenient, and no side effects

Emergency oral contraception definition

Morning after pill that prevents fertilization from taking place

Disadvantages of coitus interruptus

Most ineffective method of contraception.›No protection against STIs

Transcervical Sterilization (essure) client instruction

Normal activities may be resumed by most clients within 1 day of the procedure

Minipill definition

Oral progestins that provide the same action as combined oral contraceptives.

Female sterilization (bilateral tubal ligation: salpingectom) surgical procedure: Advantages

Permanent contraception.›Sexual function is unaffected

Advantages of coitus interruptus

Possible choice for monogamous couples with no other option for birth control, such as those opposed to birth control due to religious conviction

Advantages of using condoms

Protects against STIs and involves the male in the birth control method

Abstinence client instructions

Refrain from sexual intercourse. This method can be associated with saying "no," but it also can incorporate saying "yes" to other gratifying sexual activities, such as affectionate touching, communication, holding hands, kissing, massage, and oral and manual stimulation

Implantable Progestin Etonogestrol (implanon) definition

Requires a minor surgical procedure to subdermally implant and remove a single rod containing etonogestrel on the inner side of the upper aspect of the arm.

Male sterilization disadvantages

Requires surgery. ›Considered irreversible in the event that a client desires conception.

Female sterilization (bilateral tubal ligation: salpingectom) surgical procedure: Risks/complications/contraindications

Risk of ectopic pregnancy if pregnancy occurs.

Risks/possible complications/ contraindications of BBT

Risk of pregnancy

Disadvantages of symptom based method

Some women may be uncomfortable with touching their genitals and mucus and,therefore, will find this method objectionable

Basal Body Temperature (BBT)

Temperature can drop slightly at the time of ovulation. This can be used to facilitate conception, or be used as a natural contraceptive.

Male sterilization (vasectomy) Procedure

The cutting of the vas deferens in the male as a form of permanent sterilization. Reinforce the need for alternate forms of birth control for approximately 20 ejaculations or 1 week to several months to allow all of the sperm to clear the vas deferens. This will ensure complete male infertility.

Female sterilization (bilateral tubal ligation: salpingectom) surgical procedure: Client Instruction

The cutting, burning, or blocking of the fallopian tubes to prevent the ovum from being fertilized by the sperm

Diaphragm and spermicide advantages

This barrier method eliminates surgery and gives a woman more control over contraception

Transcervical Sterilization (essure) definition

›Insertion of small flexible agents through the vagina and cervix into the fallopian tubes. This results in the development of scar tissue in the tubes preventing conception. ›Examination must be done after 3 months to ensure fallopian tubes are blocked

Coitus Interruptus

Withdrawal method; Man withdraws penis from vagina prior to ejaculation

Transdermal patch client instructions

›A client applies the patch to dry skin overlying subcutaneous tissue of the buttock,abdomen, upper arm, or torso, excluding breast area. ›Requires patch replacement once a week. ›Patch is applied the same day of the week for 3 weeks with no application of thepatch on the fourth week.

Contraceptive Vaginal Ring (Nuvaring) Client education

›A client inserts the ring vaginally. ›Requires ring replacement after 3 weeks, and placement of new vaginal ring within 7 days. Insertion should occur on the same day of the week monthly

Minipill client instructions

›A client should take the pill at the same time daily to ensure effectiveness secondary to a low dose of progestin. ›A client cannot miss a pill. ›A client may need another form of birth control during the first month of use to prevent pregnancy

Diaphragm and spermicide risks/complications/contraindications

›A diaphragm is not recommended for clients who have a history of toxic shock syndrome (TSS), or frequent, recurrent urinary tract infections. ›Increased risk of acquiring TSS. ›TSS is caused by a bacterial infection. Signs and symptoms include high fever, a faint feeling and drop in blood pressure, watery diarrhea, headache, and muscle aches. ›Proper hand hygiene aids in prevention of TSS, as well as removing diaphragm promptly at 6 hr following coitus. ›Diaphragms made of latex should not be worn by those who are sensitive or allergic to latex.

Diaphragm and spermicide client instructions

›A female client should be fitted with a diaphragm properly by a provider. ›A client must be refitted by the provider every 2 years, if there is a 7 kg (15 lb) weight change, full-term pregnancy, or second-term abortion. ›Requires proper insertion and removal. Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or cream that is applied to the cervical side of the dome and around the rim. The diaphragm must remain in place for at least 6 hr after coitus. ›Spermicide must be reapplied with each act of coitus. ›A client should empty her bladder prior to insertion of the diaphragm

Client instructions regarding condoms

›A man places a condom on his erect penis, leaving an empty space at the tip for a sperm reservoir. ›Following ejaculation, a man withdraws his penis from the woman's vagina while holding the rim of the condom to prevent any semen spillage to the woman's vulva or vaginal area. ›May be used in conjunction with spermicidal gel or cream to increase effectiveness

Advantages of symptom based method

›A woman can become knowledgeable in recognizing her own mucus characteristics at ovulation, and self-evaluation can be very accurate. ›Self-evaluation of cervical mucus can also be diagnostically helpful in determiningthe start of ovulation while breastfeeding, in noting the commencement of menopause, and in planning a desired pregnancy

Client instructions for calendar method

›Accurately record the number of days in each cycle counting from the first day of menses for a period of at least six cycles. ›The start of the fertile period is figured by subtracting 18 days from the number of days in the woman's shortest cycle. ›The end of the fertile period is established by subtracting 11 days from the number of days of the longest cycle. For example:»Shortest cycle, 26 - 18 = 8th day»Longest cycle, 30 - 11 = 19th day»Fertile period is days 8 through 19. ›Refrain from intercourse during these days to avoid conception

Intrauterine device (IUD) disadvantages

›An IUD can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy. ›A client should report to the provider late or abnormal spotting or bleeding, abdominal pain or pain with intercourse, abnormal or foul-smelling vaginal discharge, fever, chills, a change in string length, or if IUD cannot be located. ›An IUD does not protect from STIs

Intrauterine device (IUD) advantages

›An IUD can maintain effectiveness for 1 to 10 years. ›Contraception can be reversed. ›Does not interfere with spontaneity. ›Safe for mothers who are breastfeeding. ›It is 99% effective in preventing pregnancy

Intrauterine device (IUD) risks/complications/contraindications

›Best used by women in a monogamous relationship due to the risks of STIs. ›May cause irregular menstrual bleeding. ›A risk of bacterial vaginosis, uterine perforation, or uterine expulsion. ›Must be removed in the event of pregnancy

Contraceptive Vaginal Ring (Nuvaring) risks/complications/contraindication

›Blood clots, hypertension, stroke, heart attack. ›Vaginal irritation, increased vaginal secretions, headache, weight gain, and nausea

Injectable progestins (Depo Provera)Disadvantages

›Can prolong amenorrhea.›Irregular or unpredictable bleeding or spotting.›Increases the risk of thromboembolism. ›Decreases bone mineral density (loss of calcium).›Does not protect against STIs. ›Should only be used as a long-term method of birth control (more than 2 years) if other birth control methods are inadequate

Risks/possible complications/ contraindications of condom use

›Condoms can rupture or leak, thus potentially resulting in an unwanted pregnancy. ›Condoms have a one-time usage, which creates a replacement cost. ›Condoms made of latex should not be worn by those who are sensitive or allergic to latex. ›Only water-soluble lubricants should be used with latex condoms to avoid condom breakage

Emergency oral contraception risks/complications/contraindication

›Contraindicated if a client is pregnant or has undiagnosed abnormal vaginal bleeding. ›If menstruation does not start within 1 week of expected date, a client maybe pregnant

Diaphragm and spermicide disadvantages

›Diaphragms are inconvenient, interfere with spontaneity, and require reapplication with spermicidal gel, cream, or foam with each act of coitus to be effective. ›Requires a prescription and a visit to a provider. ›Must be inserted correctly to be effective.

Implantable Progestin Etonogestrol (implanon) Advantages

›Effective continuous contraception for 3 years. ›Reversible. ›Can be used by mothers who are breastfeeding after 4 weeks postpartum

Client instructions for cervical mucus (symptom based method)

›Engage in good hand hygiene prior to and following assessment. ›Begin examining mucus from the last day of the menstrual cycle. ›Mucus is obtained from the vaginal introitus. It is not necessary to reach into the vagina to the cervix. ›Do not douche prior to assessment

Implantable Progestin Etonogestrol (implanon) Disadvantages

›Etonogestrel can cause irregular menstrual bleeding. ›Etonogestrel does not protect against STIs. ›Most common side effect is irregular and unpredictable menstruation. ›Headache.

Disadvantages of using condoms

›High rate of noncompliance. ›May reduce spontaneity of intercourse. ›The penis must be erect to apply a condom. ›If the penis is withdrawn while still erect, this can interfere with sexual intercourse

Combined oral contraceptives advantages

›Highly effective if taken correctly and consistently. ›Medication can alleviate dysmenorrhea by decreasing menstrual flow and menstrual cramps. ›Reduces acne

Combined oral contraceptives client instructions

›Medication that requires a prescription and follow-up appointments with the provider. ›Medication requires consistent and proper use to be effective. ›A client is instructed in observing for side effects and danger signs of medication. Signs include chest pain, shortness of breath, leg pain from a possible clot, headache, or eye problems from a stroke, or hypertension. ›In the event of a client missing a dose, the nurse should instruct the client that ifone pill is missed, take one as soon as possible; if two or three pills are missed, instruct the client to follow the manufacturer's instructions. Instruct the client on the use of alternative forms of contraception or abstinence to prevent pregnancy until regular dosing is resumed.

Minipill advantages

›Minipill has fewer side effects when compared with a combined oral contraceptive. ›Considered safe to take while breastfeeding

Advantages of abstinence

›Most effective method of birth control. ›Abstinence during fertile periods (rhythm method) can be used, but it requires an understanding of the menstrual cycle and fertility awareness. ›Can eliminate the risk of STIs if there is no genitalia contact

Advantages of calendar method

›Most useful when combined with basal body temperature or cervical mucus method. ›Inexpensive

Emergency oral contraception disadvantages

›Nausea, heavier than normal menstrual bleeding, lower abdominal pain, fatigue,and headache. ›Does not provide long-term contraception. ›Does not terminate an established pregnancy. ›Does not protect against STI

Disadvantages of the calendar method

›Not a very reliable technique. ›Requires accurate record keeping. ›Requires compliance in regard to abstinence during fertile period

Transcervical Sterilization (essure) disadvantages

›Not reversible. ›Not intended for use in the client who is postpartum. ›Delay in effectiveness for 3 months. Therefore, an alternative means of birth control should be used until confirmation of blocked fallopian tubes occurs. ›Changes in menstrual patterns.

Minipill risks/complications/contraindications

›Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes, such as anticonvulsants and some antibiotics.

Combined oral contraceptives disadvantages

›Oral contraceptives do not protect against STIs. ›Birth control pills can increase the risk of thromboses, breast tenderness, scant or missed menstruation, stroke, nausea, headaches, and hormone-dependent cancers. ›Exacerbates conditions affected by fluid retention such as migraine, epilepsy, asthma, kidney, or heart disease

transdermal patch disadvantages

›Patch does not protect against STIs. ›Poses same side effects as oral contraceptives. ›Skin reaction may occur from patch application

Transcervical Sterilization (essure) risks/complications/contraindications

›Perforation can occur ›Unwanted pregnancy can occur if a client has unprotected sexual intercourse during the first 3 months following the procedure. ›Increased risk of ectopic pregnancy if pregnancy occurs

Emergency oral contraception advantages

›Pill is not taken on a regular basis. ›Can be obtained without a prescription by women 15 years and older

Emergency oral contraception client instructions

›Pill is taken within 72 hr after unprotected coitus.›A provider will recommend an over-the-counter antiemetic to be taken 1 hr prior to each dose to counteract the side effects of nausea that can occur with high doses of estrogen and progestin. ›Advise a woman to be evaluated for pregnancy if menstruation does not begin within 21 days. ›Provide client with counseling about contraception and modification of sexual behaviors that are risky. ›Is considered a form of "emergency birth control.

Transcervical Sterilization (essure) advantages

›Quick procedure that requires no general anesthesia. ›Nonhormonal means of birth control. ›Essure is 99.8% effective in preventing pregnancy. ›Rapid return to normal activities of daily living.

transdermal patch risks/complications/contraindications

›Same as those of oral contraceptives ›Avoid applying of patch to skin rashes or lesions

Injectable progestins (Depo Provera) Client education

›Start of injections should be during the first 5 days of a client's menstrual cycle and every 11 to 13 weeks thereafter. Injections in postpartum nonbreastfeeding women should begin within 5 days following delivery. For breastfeeding women, injections should start in the sixth week postpartum. ›Advise clients to keep follow-up appointments. ›A client should maintain an adequate intake of calcium and vitamin D

Contraceptive Vaginal Ring (Nuvaring) Advantages

›Vaginal ring does not have to be fitted. ›Decreases the risk of forgetting to take the pill.

Contraceptive Vaginal Ring (Nuvaring) Disadvantages

›Vaginal ring does not protect against STIs. ›Poses the same side effects as oral contraceptives. ›Some clients report discomfort during intercourse

Risks/possible complications/ contraindications calendar method

›Various factors can affect and change the time of ovulation and cause unpredictable menstrual cycles. ›Risk of pregnancy

Injectable progestins (Depo Provera) Advantages

›Very effective and requires only four injections per year. ›Does not impair lactation

Combined oral contraceptives risks/complications/contraindications

›Women with a history of blood clots, stroke, cardiac problems, breast or estrogen-related cancers, pregnancy, or smoking (if over 35 years of age), are advised not to take oral contraceptive medications. ›Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes, such as anticonvulsants and some antibiotics.