Contraceptives

Diaphragm and spermicide

A dome-shaped cup with a flexible rim made of silicone that fits snugly over the cervix with spermicidal cream or gel placed into the dome and around the rim. Diaphragms are available in different sizes

Disadvantage(s) of female sterilization

A surgical procedure carrying risks related to anesthesia, complications, infection, hemorrhage, or trauma Considered irreversible in the event that a client desires conception Does not protect against STI's

Male sterilization (vasectomy)

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

Female sterilization (bilateral tubal ligation)

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

Male condom

A thin rubber sheath a man wears on his penis during sexual intercourse as a contraceptive or as protection against infection. Male condoms can be made of latex, rubber, polyurethane, or natural membrane

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 w/this method because sperm are viable for 48 to 120 hr, and the ovum is viable for about 24 hr.

Client education 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

Client education for transdermal patch

Apply patch to dry skin overlying subq tissue of the buttock,abdomen,upper arm, or torso, excluding breast area Requires patch replacement once a week Apply the patch the same day of the week for 3 weeks with no application on the fourth week

Risk(s)/Possible complications

Assessment of cervical mucus characteristics can be inaccurate if mucus is mixed w/semen,blood, contraceptive foams, or discharge from infections Risk of pregnancy

Risks/possible complications/contraindications

Avoid massaging injection site following adminstration to avoid accelerating medication absorption, which will shorten duration of its effectiveness Contraindications include breast cancer, evidence of current cardiovascular disease, abnormal liver function, liver tumors, and unexplained vaginal bleeding

Risks/Contraindications for IUD

Best used by women in monogamou relationship due to the risks of STI"s Can cause irregular menstrual bleeding Risk of bacterial vaginosis, uterine perforation, or uterine expulsion Must be removed in the event of pregnancy

Hormonal Methods

Combined oral contraceptives Emergency oral contraceptive Transdermal patch Injectable progestins Contraceptive vaginal ring Implantable progestin Intrauterine device

Advantage(s) of vaginal ring

Does not have to be fitted Decreases the risk of forgetting to take the pill Vaginal route of delivery increases bioavailability of hormones enabling lower dose and reducing adverse effects

Disadvatange(s) of contraceptive sponge

Does not protect against STI's

Disadvantage(s) of vaginal ring

Does not protect against STI's Same adverse effects as oral contraceptives Some clients report discomfort during intercourse The ring can be removed for up to 3 hours without compromising effectiveness

Disadvantage(s) for transdermal patch

Does not protect against STI's Same adverse effects of oral contraceptives. Risk of deep-vein thrombosis and venous thromboembolism can be slightly higher in women using the patch becuase the hormones get into the bloodstream and are processed by the body differently than hormones from OCPs Skin reaction can occur from patch application

Surgical methods

Female sterilization (bilateral tubeligation) Male sterilization (vasectomy)

Client education for male sterilization

Following 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

Disadvantage(s) for male condom

High rate of noncompliance can reduce spontaneity of intercourse the penis must be erect to apply a condom withdrawing the penis while still erect, can interfere w/sexual intercourse

Risks/possible complications/contraindications for implantable progestin

Increased risk of ectopic pregnancy if pregnancy occurs Contraindications include unexplained vaginal bleeding, lupus, severe cirrhosis, liver tumors, and breast cancer.

Advantage(s) of basal body temperature

Inexpensive, convenient, and no adverse effects

Risks for coitus interruptus (withdrawal)

Influenced by male partner's control Leakage of fluid that contains spermatozoa prior to ejaculation can be deposited in vagina risk of pregnancy

Transcervical sterilization

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

Client education for basal body temperature

Measure oral temperature prior to getting out of bed each morning to monitor ovulation

Injectible progestins

Medroxyprogesterone is an intramuscular or subcutaneous injection given to a female client every 11 to 13 weeks

advantage(s) for 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 sexually transmitted infections (STI's) if there is no genitalia contact

Risks/possible complications/contraindications

Not for women who have abnormal pap test results or those who have a history of TSS

Risks/possible complications/contraindications for diaphragm and spermicide

Not recommended for clients who have a history of toxic shock syndrome (TSS), or frequent, recurrent urinary tract infections Increased risk of acquiring TSS, which is caused by a bacterial infection. Clinical findings include high fever, a faint feeling, 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 Risk of allergic reaction

Advantage(s) of morning-after pill (emergency oral contraceptive)

Not taken on a regular basis Anyone, regardless of age or gender, is allowed to purchase emergency oral contraceptive at a pharmacy

Advantage(s) for male condom

Protect against STI's and involves the male in the birth control method No adverse effects Readily accessible

Client education for someone considering abstinence

Refrain from sexual intercourse. This method can be associated w/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.

Risks of female sterilization

Risk of ectopic pregnancy if pregnancy occurs

Contraceptive sponge

Small,round, polyurethane sponge, containing spermicide

Client education for progestin-only pills (minipill)

Take the pill at the same time daily to ensure effectiveness secondary to a low dose of progestin The client cannot miss a pill The client can need another form of birth control during the first month of use to prevent pregnancy

Female condom

Vaginal sheath made of nitrile, a nonlatex synthetic rubber with flexible rings on both ends

Coitus interruptus (withdrawal)

Withdrawal of penis from vagina prior to ejaculation

Risks/Possible Complications/contraindications

Women who have a history of thromboembolic disorders, stroke, heart attack, coronary artery disease, gallbladder disease, cirrhosis or liver tumor, headache with focal diabetes mellitus with vascular involvement, breast or estrogen related cancers, pregnancy lactating, less than 6 weeks postpartum, 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

Advantage(s) of calendar method

most useful when combined w/basal body temperature or cervical mucus method inexpensive

Risk(s)/ possible complications/contraindications for male condom

Condoms can rupture or leak, potentially resulting in 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 lubricant should be used w/latex condoms to avoid condom breakage

Contraceptive vaginal ring

Contain etonogestrel and ethinyl estradiol that is delivered at continous levels vaginally

Transdermal contraceptive patch (ortho-evra)

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

Risks/Possible Complications/Contraindications

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

Disadvantage(s) of diaphragm and spermicide

Diaphragms are inconvenient, interfere w/spontaneity, and require reapplication w/spermicidal gel, cream, or foam w/each act of coitus to be effective Requires a prescription and a visit to a provider Must be inserted correctly to be effective Does not protect against STI's

Advantage(s) of implantable progestin (implanon/nexplanon)

Effective continuous contraception for 3 years Can be inserted immediately after abortion, miscarriage, childbirth, and while breastfeeding Reversible Can be used by mothers who are breastfeeding after 4 weeks postpartum

Client education for symptom-based method (cervical mucus)

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

Disadvantage(s) of implantable progestin

Etonogesterol can cause irregular menstrual bleeding Does not protect against STI's Adverse effects include irregular and unpredictable menstruation (most common), mood changes, headache, acne, depression, decreased bone density, and weight gain

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 fingers is greater during ovulation. This is referred to as spinnbarkeit sign.

Advantage(s) of progestin-only pills (minipill)

Fewer adverse effects when compared with a combines oral contraceptive Considered safe to take while breastfeeding

Combine 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

Disadvantage(s)

Some women are uncomfortable with touching their genitals and mucus, and therefore find this method objectionable. Does not protect against STI's.

Procedure (male sterilization)

The cutting of the vas derens 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

Procedure (female sterilization)

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

Client education for IUD

The device must be monitored monthly by clients after menstruation to ensure 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

Risks for calendar method

Various factors can affect and change the time of ovulation and cause unpredictable menstrual cycle Risk of pregnancy

Advantage(s) of injectible progestins (depo-provera)

Very effective and requires only four injections per year Does not impair lactation Possible absence of periods and decrease in bleeding decreased risk of uterine cancer if used long-term

Disadvantage(s) of calendar method

not a very reliable technique does not protect against STI's Requires accurate record-keeping Requires compliance regarding abstinence during fertile periods

disadvantage(s) for abstinence

requires self-control

Client education for transcervical sterilization

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

Disadvantage(s) of transcervical sterilization

Not reversible Not intended for use in the client who is postpartum Delay in effectiveness for 3 months. An alternative means of birth control should be used until confirmation of blocked fallopian tubes occur. Changes in menstrual patterns Does not protect against STI's

disadvantage(s) to coitus interruptus (withdrawal)

One of the least effective methods of contraception No protection against STI's

Intrauterine device (IUD)

A chemically active T-shaped device that is inserted through the cervix and placed in the uterus by the provider. Releases a chemicals substance that damages sperm in transit to the uterine tubs and prevents fertilization. The most effective contraceptive methods at preventing pregnancy are long active reversible contraceptive (LARC) methods: implant and IUDs. IUDs can be used by nulliparous and multiparous women.

Client education for vaginal ring

A client inserts 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

Client education for diaphragm and spermicide

A client should be properly fitted with a diaphragm by a provider Replaced every 2 years and refitted for a 20% weight fluctuation, after abdminal or pelvic surgery, and after every pregnancy 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 can be inserted up to 6 hr before intercourse and must stay in place 6 hr after intercourse but for no more than 24 hr. Spermicide must be reapplied with each act of coitus A client should empty her bladder prior to insertion of the diaphragm Diaphragm should be washed with mild soap and warm water after each use

A nurse in a health clinica is reviewing contraceptive use with a group of adolescent clients. What statement by an adolescent reflects understanding of the teaching

A water-soluble lubricant should be used with condoms

Advantage(s) of symptom-based method (cervical mucus)

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 be diagnostically helpful in determining the start of ovulation while breastfeeding, noting the commencement of menopause, and planning a desired pregnancy

Methods for fertility awareness-based

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

Contraindications for IUD

Active pelvic infection, abnormal uterine bleeding, severe uterine distortion; for copper IUD also wilson's diseases and copper allergy

Disadvantage(s) of injectible progestins (depo-provera)

Adverse effects include decrease in bone mineral density, weight gain, increase in depression, and irregular vaginal spotting or bleeding Does not protect against STI's Return to fertility can be delayed as long as up to 18 months after discontinuation Should only be used as a long-term method of birth control (more than 2 years) if other birth control methods are inadequate

Advantage(s) of IUD

An IUD can maintain effectiveness for 1 to 10 years (hormonal IUD 3 to 5 years; copper IUD 10 years) Can be inserted immediately after abortion, miscarriage, childbirth and while breastfeeding Contraception can be reversed with immediate return to fertility Does not interefere with spontaneity Safe for mothers who are breastfeednig it is 99% effective in preventing pregnany Hormonal IUDs: decreased menstrual pain and heavy bleeding Copper IUD: no hormones so it's safe for women cautioned against hormonal birth control methods

Client education for coitus interruptus (withdrawal)

Be aware of fluids leaking from the penis

Risks/possible complications/contraindications for vaginal ring

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

Client education for cap and spermicide

Can be inserted up to 6 hr before intercourse and needs to be left in place at least 6 hr after intercourse but for no more than 48 hr at a time. Replaced every 2 years and refitted after any gynecological surgery, birth, or any major weight fluctuation Cervical cap should be washed with mild soap and warm water after each use

Diadvantage(s) of IUD

Can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy and can be expelled A client should report to the provider late or abnormal spotting or bleeding, abdominal pain or pain with intercourse, abnormal foul-smelling vaginal discharge, fever, chills, a change in string length, or if IUD cannot be located Does not protect from STI's Hormonal IUD's: spotting, irregular bleeding, headhache, nausea, depression, breast tenderness Copper IUD: increase in menstrual pain and bleeding

Disadvantage(s) of combined oral contraceptives

Do not protect against STI's Can increase the risk of thromboembolism, stroke, heart attack, hypertension, gallbladder disease, liver tumor. Exacerbates conditions affected by fluid retention, such as migraine, epilepsy, asthma, kidney, or heart disease Adverse effects include, headache, nausea, breast tenderness, and breakthrough bleeding. (Common adverse effects of estrogen component include nausea, breast tenderness, fluid retention. Common adverse effects of progestin component include increase appetite, tiredness, depression, breast tenderness, oily skin, scalp and hirsutism.)

Advantage(s) of diaphragm and spermicide

Gives a woman more control over contraception

Advantage(s) of combined oral contraceptives

Highly effective if taken correctly and consistently Noncontraceptive benefits of combined hormonal contraception containing low-dose estrogen (less than 35 mcg) include decreased menstrual blood loss, decreased iron deficiency anemia, regulation of menorrhagia and irregular cycles, and reduced incidence of dysmenorrhea and premenstrual symptoms. Oral contraception also offers protection against endometrial, ovarian, and colon cancer, reduces the incidence of benign breast disease, improve acne and protects against the development of functional ovarian cysts.

Risks for abstinence as a form of contraception

If complete abstinence is maintained, there are no risks

Client education

It is designed to fit over the cervix, and is one size fits all Should be left in place for 6 hr after intercourse and provides protection for up to 24 hr

Disadvantage(s) of progestin-only pills (minipill)

Less effective in suppressing ovulation than combines oral contraceptives Increased occurence of ovarian cysts No protection against STI's Adverse effects include breakthrough, irregular, vaginal bleeding (frequently reported/most common); headache; nausea; and breast tenderness

Client education for combined oral contraceptives

Madication requires a prescription and follow-up appointments with provider Medication requires consistent and proper use to be effective Instruct the client to observe for adverse effects and danger signs of medication. Sign's include chest pain, shortness of breath, leg pain from a possible clot, headache, eye problems from a stroke, and hypertension In the event of a client missing a dose, take one as soon as possble; if two or three pills are missed, 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.

Advantage(s) for transdermal patch

Maintains consistent blood levels of hormone Avoid liver metabolism of medication because it is not absorbed in the gastrointestinal tract decrease risk of forgetting daily pill

Barrier Methods

Male condom Female condom Diaphragm and spermicide Cervical cap and spermicide Contraceptive sponge

Emergency oral contraceptive

Morning-after pill that prevents fertilization from taking place

Disadvantage(s) of morning-after pill (emergency oral contraceptive)

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

Advantage of female condom

Offers protection against pregnancy and STI's

Risks/possible complications/contraindications

Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes, such as anticonvulsants and some antibiotics Contraindications include; bariatric surgery, lupus, severe cirrhosis, liver tumors, current or past breast cancer

Progestin- only pills (minipill)

Oral progestins that provide the same action as combined oral contraceptives

Advantage(s) of male sterilization

Permanent contraceptive method Procedure is short, safe, and simple Sexual function is not impaired

Risks/possible complications/contraindications

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

Advantage(s) of female sterilization

Permanent contraception Can be done immediately after childbirth within 24 to 48 hours Sexual function is unaffected

Client education for morning-after pill (emergency oral contraceptive)

Pill is taken w/in 72 hours after unprotected coitus A provider will recommend an over-the-counter antiemetic to be taken 1 hr prior to each dose to counteract the adverse effects of nausea that can occur with high doses of estrogen and progestin Advise a client 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. Considered a form of "emergency birth control"

Client education for male condom

Place a condom on the erect penis, leaving an empty space at the tip for a sperm reservoir Following ejaculation, withdraw the penis from the vagina while holding the rim of the condom to prevent any semen spillage to the vulva or vaginal area Can be used in conjunction with spemicidal gel or cream to increase effectiveness

advatange(s) to coitus interruptus (withdrawal)

Possible choice for monogamous coupels who do not have another contraceptives

Disadvantage(s) of cervical cap and spermicide

Possible risk for acquiring TSS Risk for allergic reaction Does not protect against STI's

Advantage(s) of transcervical sterilization

Quick procedure that requires no general anesthesia nonhormonal means of birth control 99.8% effective preventing pregnancy rapid return to normal activities of daily living

Complications

Rare, but can include, bleeding, infection, and anesthesia reaction

Disadvantage(s) of basal body temperature

Reliability can be influenced by many variables that can cause inaccurate interpretation of temperature changes, such as stress, fatigue,illness,alcohol, and warmth of sleeping environment Does not protect against STI's

Implantable progestin (implanon/nexplanon)

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

Disadvantage(s) of male sterilization

Requires surgery Reversal possible but not always successful Does not protect against STI's

Risk(s) of basal body temperature

Risk of pregnancy

Risks/Possible complications/contraindications

Same as those of oral contraceptives avoid applying of patch to skin rashes or lesions Less effective in women greater than 198 lbs

Example for calculating calendar method

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

A nurse is instructing a client who is taking an oral contraceptive about danger signs to report her provider. The nurse determines the client understands the teaching when the client states the need to report what

Shortness of breath; shortness of breath can indicate a pulmonary embolus or myocardial infarction and should be reported to the provider immediately

Cervical cap and spermicide

Silicone rubber cap that fits snugly around the base of the cervix. Cervical caps come in three sizes.

Client education for injectible progestins (depo-provera)

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 w/in 5 days following delivery. For breastfeeding women, injection should start in the 6th week postpartum. Advise clients to keep follow-up appointments Maintain adequate intake of calcium and vitamin D

Basal body temperature

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

Client education for female condom

The closed end of the pouch is inserted into the vagina by the client prior to intercourse and anchored around the cervix. The open ring covers the labia. The condom is removed and thrown away after intercourse

Natural Family Planning (fertility awareness-based)

The general title for the scientific, natural and moral methods of family planning that can help married couples either achieve or postpone pregnancies

A nurse is teaching a client about potential adverse effects of implantable porgestins. Which adverse effects shoudl the nurse include

Weight gain Irregular vaginal bleeding Breast changes

A nurse in a clinic is teaching a client about her new prescription for medroxyprogesterone. What information should the nurse include in the teaching.

You should increase your intake of calcium Irregular vaginal spotting can occur

Client education for implantable progestin (implanon/nexplanon)

avoid trauma to the area of implantation