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?