ATI OB Book Ch 1 Contraception

Disadvantages of diaphragm and spermicide

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

Disadvantages of combined oral contraceptives

Do not protect against STIs. Increased risk of thrombosis, breast tenderness, scant or missed menstruation, stroke, nausea, headache, hormone-dependent cancer. Exacerbates conditions affected by fluid retention like migraine, epilepsy, asthma, kidney or heart disease.******

Advantages of contraceptive vaginal ring

Does not have to be fitted. Decreases risk of forgetting to take pill.

Disadvantages of transdermal contraceptive patch

Does not protect against STIs. Same side effects as oral contraceptives. Skin reaction may occur from patch application.

Disadvantages of contraceptive vaginal ring

Does not protect against STIs. Same side effects as oral contraceptives. Some clients report discomfort during intercourse. Vaginal irritation, vaginal secretions, headache, weight gain, nausea.

Diaphragm and spermicide

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

Advantages of implantable progestin etonogestrel

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

Risks, complications, contraindications for minipill

Effectiveness decreases when taking medications that affect liver enzymes such as anticonvulsants and some antibiotics.

Disadvantages of implantable progestin etonogestrel

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

Nursing interventions regarding contraception

Expected outcome for family planning is preventing pregnancy until desired time. Support client in making decision that is best for her situation.

Using calendar method, calculate fertile period for the following: Shortest cycle 26 days and longest cycle 30 days.

Fertile period is days 8-19. Refrain from intercourse during this time.

Symptom-based method

Fertility awareness method based on ovulation. Ovulation occurs about 14 days prior to next menses, which is when a woman is fertile. Uses spinnbarkeit sign to determine time of ovulation.

Advantages of minipill

Fewer side effects than combined oral contraceptive pill. Considered safe when breastfeeding.******

Spinnbarkeit sign

Following ovulation, cervical mucus becomes thin and flexible under influence of estrogen and progesterone to allow for sperm viability and motility. Ability of mucus to stretch between fingers is greatest during ovulation. This is called spinnbarkeit sign.******

Client instructions for symptom-based method

Good hand hygiene following assessment. Begin examining mucus from last day of menstrual cycle. Mucus is obtained from vaginal introitus. Do not douche prior to assessment.

Disadvantages of condoms

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

Advantages of combined oral contraceptives

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

Combined oral contraceptives

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.

Risks, complications, contraindications for implantable progestin etonogestrel

Increased risk of ectopic pregnancy if pregnancy occurs.

Risks, complications, contraindications for diaphragm and spermicide

Increased risk of toxic shock syndrome. Not recommended for clients with history of toxic shock. Proper hand hygiene and removing diaphragm promptly 6 hours after coitus help prevent toxic shock. Not recommended for clients with frequent recurrent UTI. Not for people with latex allergy.******

Advantages of basal body temperature

Inexpensive. Convenient. No side effects.

Essure

Insertion of small flexible agents through vagina and cervix into fallopian tubes. Results in development of scar tissue in tubes preventing conception. Done under conscious sedation. Go in with hysteroscope and insert. Must use different method of birth control for 3 months and then return to office for hysterosalpingogram to show if tubes are blocked. Permanent birth control. Avoids general anesthesia.

Injectable progestins

Intramuscular injection given to client every 11 to 13 weeks. Depo-Provera. Also available subcutaneous.

Danger signs to report for IUD

Late or abnormal spotting or bleeding, abdominal pain or shoulder pain, pain with intercourse, abnormal or foul-smelling vaginal discharge, fever, chills, change in string length, or if IUD cannot be located.

Risks, complications, contraindications for coitus interruptus

Leakage of fluid that contains sperm prior to ejaculation can be deposited in vagina. Risk of pregnancy.

Disadvantages of minipill

Less effective in suppressing ovulation than combined oral contraceptive. Increases occurrence of ovarian cysts. Does not protect against STIs. User frequently report breakthrough irregular vaginal bleeding and decreased libido. Increases appetite.

Coitus interruptus

Man withdraws penis from vagina prior to ejaculation.

Risks, complications, contraindications for symptom-based method

May be inaccurate if mucus is mixed with semen, blood, contraceptive foam, or discharge from infection. Risk of pregnancy.

Client instructions for basal body temperature

Measure oral temperature prior to getting out of bed each morning to monitor for ovulation. Use with calendar method.

Emergency oral contraceptive

Morning after pill that prevents fertilization from taking place. Considered a form of "emergency birth control." Does not terminate established pregnancy. Prevents fertilization. Does not prevent implantation of fertilized egg.

Advantages of abstinence

Most effective method of birth control. Abstinence during fertile periods can be used (rhythm method), but requires understanding of menstrual cycle and fertility awareness. No STDs if no genitalia contact.

Disadvantages of coitus interruptus

Most ineffective method of contraception. No protection against STDs.

Advantages of calendar method

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

Client instructions for IUD

Must be monitored monthly by client after menstruation to ensure presence of small string that hangs from device into upper part of vagina to rule out migration or expulsion of device. Report danger signs to provider.

Methods of contraception

Natural family planning. Barrier methods. Hormonal methods. Intrauterine methods. Surgery/procedures.

Disadvantages of emergency oral contraceptive

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

Risks, complications, contraindications for abstinence

No risks if abstinence is complete.

Client instructions for Essure

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

Disadvantages of Essure

Not reversible. Not intended for use in client who is postpartum. Delay in effectiveness for 3 months. Use birth control until blocked tubes confirmed. Changes in menstrual patterns.

Advantages of emergency oral contraceptive

Not taken on regular basis. Can be obtained without prescription for women 15 years and older.

Disadvantages of calendar method

Not very reliable. Requires accurate record-keeping. Requires compliance with regard to abstinence.

Minipill

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

Risks, complications, contraindications for Essure

Perforation can occur. Unwanted pregnancy can occur if client has unprotected sex during first 3 months following procedure. Increased risk of ectopic pregnancy if pregnancy occurs.

Advantages of female sterilization

Permanent contraception. Sexual function is unaffected.

Client instructions for condoms

Place condom on erect penis, leaving empty space at tip for sperm reservoir. Following ejaculation, withdraw penis from vagina while holding rim of condom to prevent semen spillage. Increased effectiveness if used with spermicidal cream or gel.

Advantages of coitus interruptus

Possible choice for monogamous couple with no other options for birth control such as objection to birth control by religious preference. Male partner's control can make this method effective.

Advantages of condoms

Protects against STIs. Involves male in birth control process.

Advantages of Essure

Quick procedure, no general anesthesia. Nonhormonal birth control. 99.8% effective in preventing pregnancy. Rapid return to normal ADLs.

Client instructions for abstinence

Refrain from sexual intercourse. Associated with saying "no," but can say "yes" to other gratifying sexual activities like affectionate touch, communication, holding hands, kissing, massage, oral and manual stimulation.

Disadvantages of basal body temperature

Reliability can be influenced by many variables that can cause inaccurate interpretation of temperature changes: Stress, fatigue, illness, alcohol, and warmth or coolness of sleeping environment.

Implantable progestin etonogestrel

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

Client instructions for combined oral contraceptives

Requires prescription and followup with provider. Requires consent and proper use to be effective. Observe for side effects and danger signs. Missed dose: If one pill, take one as soon as possible. If 2 or 3, follow manufacturer's instructions. Use alternative forms of contraception or abstinence until regular dosing is resumed.

Disadvantages of abstinence

Requires self-control.

Risks, complications, contraindications for basal body temperature

Risk of pregnancy.

Risks, complications, contraindications for transdermal contraceptive patch

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

Client instructions for diaphragm and spermicide

Should be fitted properly by provider. Must be refitted 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. Empty bladder prior to insertion. Apply spermicide on cervical side of dome and around rim. Insert vaginally prior to coitus. Must remain in place at least 6 hours after coitus. Spermicide must be reapplied with each act of coitus.

3 types of IUD

Skyla: Effective x 3 years. Smaller in size and fewer hormones. Good for nulliparous women because it is easier to get into the uterus because smaller. Mirena: Effective x 5 years. Paragard: Nonhormonal, effective x 10 years. Paragard is copper and creates environment not friendly to sperm. Egg can be fertilized, but does not implant. However, many women have heavy bad periods.

Disadvantages of symptom-based method

Some women may be uncomfortable with touching their genitals and mucus and therefore object to this method.

Client instructions for injectable progestins

Start of injections should be during first 5 days of menstrual cycle and every 11-13 weeks thereafter. Injections in postpartum nonbreastfeeding women should begin within 5 days following delivery. For breastfeeding women, injections should start in 6th week postpartum once milk supply is established (or can interfere with milk). Client should keep followup appointments. Maintain adequate intake of calcium and vitamin D or can cause osteoporosis.

Contraception

Strategies or devices used to reduce risk of fertilization or implantation in an attempt to prevent pregnancy.

Disadvantages of female sterilization

Surgical procedure carrying risks related to anesthesia, complications, infection, hemorrhage, or trauma. Considered irreversible in event client desires conception.

Client instructions for minipill

Take pill at same time daily to ensure effectiveness secondary to low dose of progestin. Client cannot miss pill. Client may need another form of birth control during first month of use to prevent pregnancy.

Client instructions for emergency oral contraceptive

Take within 72 hours after unprotected coitus. Provider will recommend over-the-counter antiemetic to be taken 1 hour prior to each dose to counteract side effect of nausea that can occur with high doses of estrogen and progestin. Advise woman to be evaluated for pregnancy if menstruation does not begin within 21 days. Counsel client about contraception and modifying risky sexual behavior.

Basal body temperature

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

Condoms

Thin, flexible sheath worn on penis during intercourse to prevent semen from entering uterus.

Risks, complications, contraindications for calendar method

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

Advantages of injectable progestins

Very effective and require only 4 injections per year. Does not impair lactation.

Calendar method

Woman records menstrual cycle by calculating fertile period based on assumption that ovulation occurs about 14 days before onset of menses and avoids intercourse during that period. Also taken into account is timing of intercourse because sperm are viable for 48-120 hours and ovum for 24 hours.

Risks, complications, contraindications for combined oral contraceptives

Women with 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 contraceptives. Effectiveness decreases when taking medications that affect liver enzymes such as anticonvulsants and some antibiotics.

When in cycle ovulation occurs

14 days before onset of menses.

Advantages of symptom-based method

A woman can become knowledgeable in recognizing her own mucus characteristics, and self-evaluation can be accurate. Self-evaluation of mucus can also help determine start of ovulation while breastfeeding, noting commencement of menopause, and in planning desired pregnancy.

Abstinence

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

Most effective method of contraception

Abstinence.

Natural family planning methods

Abstinence. Coitus interruptus (withdrawal). Calendar method. Basal body temperature. Symptom-based method (cervical mucus).

Client instructions for calendar method

Accurately record number of days in each cycle counting from first day of menses for at least 6 cycles. To estimate start of fertile period, subtract 18 days from number of days in woman's shortest cycle. To estimate end of fertile period, subtract 11 days from number of days in longest cycle. Refrain from menses during fertile period.******

Risks, complications, contraindications for injectable progestins

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

Client instructions for implantable progestin etonogestrel

Avoid trauma to area of implantation.

Advantages of diaphragm and spermicide

Barrier method eliminates surgery and gives woman more control over contraception.

Client instructions for coitus interruptus

Be aware of fluids leaking from penis.

Risks, complications, contraindications for IUD

Best for use in monogamous relationship because of risk of STIs. May cause irregular menstrual bleeding. Risk of bacterial vaginosis, uterine perforation, or uterine expulsion. Must be removed in event of pregnancy.

Female sterilization

Bilateral tubal ligation or salpingectomy. Surgical procedure consisting of severance and/or burning or blocking the fallopian tubes to prevent fertilization.

Risks, complications, contraindications for contraceptive vaginal ring

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

Disadvantages of IUD

Can increase risk of PID, uterine perforation, or ectopic pregnancy. Does not protect from STIs.

Advantages of IUD

Can maintain effectiveness for 1-10 years. Contraception can be reversed. Does not interfere with spontaneity. Safe with breastfeeding. 99% effective in preventing pregnancy.

Disadvantages of injectable progestins

Can prolong amenorrhea. Irregular or unpredictable bleeding or spotting, especially during first 6 months, but not so much after. Increased risk of thromboembolism. Decreased bone mineral density (loss of calcium). Does not protect against STIs. Should only be used as long-term contraception (more than 2 years) if other birth control methods are inadequate.

Toxic shock syndrome

Caused by bacterial infection. Signs and symptoms include high fever, faint feeling, drop in blood pressure, watery diarrhea, headache, muscle aches.

Intrauterine device (IUD)

Chemically active T-shaped device inserted through cervix and placed in uterus by provider. Releases chemical substance that damages sperm in transit to uterine tubes and prevents fertilization.

Danger signs of oral contraceptive side effects

Chest pain, shortness of breath, leg pain from possible clot, headache, eye problems from stroke, hypertension.

Client instructions for transdermal contraceptive patch

Client applies patch to dry skin overlying subcutaneous tissue of buttock, abdomen, upper arm, or torso, excluding breast area. Replace patch once a week. Apply on same day of week for 3 weeks and do not apply on fourth week.

Client instructions for contraceptive vaginal ring

Client inserts ring vaginally. Requires ring replacement after 3 weeks, and placement of new vaginal ring within 7 days. Insertion should occur on same day of week monthly. The week the ring is out, woman gets period.

Nursing assessment regarding contraception

Client's need/desire for contraception. Client's preferences. Include discussion of risks, benefits, alternatives. Sexual partner often involved in decision (e.g., tubal ligation, vasectomy). Postpartum discharge instructions should include discussion of future contraceptive plans.

Most ineffective method for contraception

Coitus interruptus.

Hormonal methods

Combined oral contraceptives. Minipill. Emergency oral contraceptive. Transdermal contraceptive patch. Injectable progestins (Depo-Provera). Contraceptive vaginal ring (Nuvaring). Implantable progestin etonogestrel (Implanon). IUD.

Barrier methods

Comdoms. Diaphragm and spermicide.

Risks, complications, contraindications for condoms

Condoms can rupture or leak, resulting in pregnancy. One-time use, can be costly. No latex condoms if allergic. Only water-soluble lubricants to avoid condom breakage.

Advantages of transdermal contraceptive patch

Consistent blood levels of hormone. Avoids liver metabolism of medication because it is not absorbed in GI tract. Decreases risk of missing daily pill.

Contraceptive vaginal ring

Contains etonogestrel and ethinyl estradiol that is delivered at continuous levels vaginally. Nuvaring. One of more popular methods.

Transdermal contraceptive patch

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

Contraceptive procedures and surgery

Contraceptive vaginal ring (Nuvaring). Implantable progestin etonogestrel (Implanon). IUD. Transcervical sterilization (Essure). Female sterilization (bilateral tubal ligation or salpingectomy). Male sterilization (vasectomy).

Risks, complications, contraindications for emergency oral contraceptive

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