OB Mod 1

BOX 12.2 RISK FACTORS FOR ADVERSE PREGNANCY OUTCOMES

-Isotretinoins -Alcohol misuse -Antiepileptic drugs -Diabetes (preconception). -Folic acid deficiency -Hepatitis B -HIV/AIDS. -Rubella seronegativity. -Obesity. -STIs -Smoking

Here is a list of list which make breastfeeding effective as a contraceptive:

A woman has not had a period since she gave birth. Infant is younger than 6 months of age. The woman breast-feeds her baby at least six times daily on both breasts. She breast-feeds her baby "on demand" at least every 4 hours. A woman does not substitute other foods for a breast-milk meal. Nighttime feedings are provided at least every 6 hours.

emergency contraception (EC) products

Combined estrogen and progestin pills, Plan B One-Step, Intrauterine & Copper-bearing IUS

Myth or Fact: Violence is a learned behavior and can be changed. The presence of drugs and alcohol can make a bad problem worse.

Fact

Myth or Fact: Violence occurs in all socioeconomic classes.

Fact

Direct and indirect questions produce the same results. "Does your partner hit you?" or "Have you ever been or are you now in an abusive relationship?" are direct questions.

If that approach feels uncomfortable, try indirect questions: "We see many women with injuries or complaints like yours and often they are being abused. Is that what is happening to you?" or "Many women in our community experience abuse from their partners. Is anything like that happening in your life?"

Areas of focus during the nursing assessment are as follows:

Medical history, Family Hx, OB/GYN Hx, Personal Hx, Physical examination, Dx testing

Oral Contraceptives, although most commonly prescribed for contraception, has long been used in the management of a wide range of conditions and has many health benefits, such as:

Reduced incidence of ovarian and endometrial cancer Prevention and treatment of endometriosis Decreased incidence of acne and hirsutism Decreased incidence of ectopic pregnancy Decreased incidence of acute PID and possible protection against PID Reduced incidence of fibrocystic breast disease Decreased perimenopausal symptoms Reduced risk of developing uterine fibroids Maintenance of bone mineral density (BMD) Improvement in asthmatic symptoms Delayed onset of multiple sclerosis and arthritis Increased menstrual cycle regularity Lower incidence of colorectal cancer Decreased number of pregnancy-related deaths by preventing pregnancy Reduced iron-deficiency anemia by treating menorrhagia Reduced incidence of dysmenorrhea (Evans & Sutton, 2015).

Why take folic acids for preconception care?

Taking folic acid reduces the incidence of neural tube defects by two thirds.

What occurs in coitus interruptus, also known as, withdrawal?

a man controls his ejaculation during sexual intercourse and ejaculates outside the vagina. It is one of the oldest and most widely used means of preventing pregnancy in the world and also one of the least effective methods in preventing pregnancy

Lactational Amenorrhea Method (LAM)

an effective temporary method of contraception used by breast-feeding mothers. It relies on physiologic changes associated with breast-feeding for contraception. Continuous breast-feeding usually can postpone ovulation and thus prevent pregnancy. Breast-feeding stimulates the hormone prolactin, which is necessary for milk production, and also inhibits the release of another hormone, gonadotropin, which is necessary for ovulation.

When should OC be taken?

at the same time, daily

vaginal ring contains both _________ and ___________ hormones. The contraceptive vaginal ring, _________ , is a flexible, soft, transparent ring that is inserted by the user for a __=_____period of continuous use followed by a ring-free week to allow withdrawal bleeding

estrogen, progesterone, NuvaRing, 3-week,

Myth or Fact: Abusers often seem normal and do not appear to suffer from personality disorders or other forms of mental illness.

fact

Myth or Fact: Battering is a pattern of coercion and control that one person exerts over another. It is repeated using a number of tactics, including intimidation, threats, physical injury, economic deprivation, isolation, and sexual abuse. The various forms of abuse utilized by batterers help to maintain power and control over their victims.

fact

Myth or Fact: One in five women is physically abused during pregnancy. The effects of violence on infant outcomes can include preterm delivery, fetal distress, low birth weight, and child abuse.

fact

Myth or Fact: One in four women will be victims of violence.

fact

Myth or Fact: The police, justice system, and society are beginning to make IPV socially unacceptable.

fact

Myth or Fact: There is as much IPV in the lesbian/gay/bisexual/transgender (LGBT) population as in heterosexual relationships with the added psychological abuse of "outing" (when one partner threatens to disclose the others sexual preference in an effort to maintain power and control).

fact

SDM identifies the 12-day "________ _______" of a woman's menstrual cycle. These 12 days take into account the life span of the women's egg (about ___ ______) and the viability of the sperm (about __ days) as well as the variation in the actual timing of ovulation from one cycle to another.

fertile window, 24 hours, 5 days

What is The Danger Assessment Tool (Box 9.3)

helps women and health care providers assess the potential for homicidal behavior in an ongoing abusive relationship.

contraceptive sponge

includes both a barrier and a spermicide, not very effective, nit protective against STI's

Injectable contraception

includes progestin-only and combination estrogen and progestin agents that provide safe and highly effective birth control for up to 3 months.

emergency contraception (EC)

reduces the risk of pregnancy after unprotected intercourse or contraceptive failure such as condom breakage

The _______________ method relies on a combination of techniques to recognize ___________. Including BBT, cervical mucus changes, alterations in the position and firmness of the cervix, and other symptoms of ovulation, such as increased libido, mittelschmerz (midcycle, lower abdominal pain at ovulation), pelvic fullness or tenderness, and breast tenderness

symptothermal, ovulation

oral contraceptives

synthetic hormones used to prevent pregnancy and treat menstrual disorders

What is preconception care?

the promotion of the health and well-being of a woman and her partner before pregnancy

cycle of violence comprises three distinct phases:

the tension-building phase, the acute battering phase, and the honeymoon phase

how does the transdermal patch work?

withdrawal bleeding occurs.

Sperm can live up to __ days after intercourse. The "unsafe period" during the menstrual cycle is thus approximately 6 days: 3 days before and 3 days after ovulation. Because body changes start to occur before ovulation, the woman can become aware of them and not have intercourse on these days or use another method to prevent pregnancy.

5 days,

Reversible Methods of Contraception: Barrier

Condom (male and female) Diaphragm Cervical cap Sponge

Types of abuse

Emotional Physical Financial Sexual

Name the nonsurgical, nonhormonal, permanent birth control method that is 99% effective. This method is for women who desire no more children as it is a permanent method of birth control.

Essure -A tiny coil (Essure) is introduced and released into the fallopian tubes through the cervix; it promotes tissue growth in the fallopian tubes, and over 3 months, the growth blocks the tubes, creating a barrier that keeps sperm from reaching the ovum, thus preventing conception

Contrary to popular belief, ECs do not induce _________ and are not related to mifepristone or RU-486, the so-called abortion pill approved by the FDA in 2000.

abortion

The sterilization procedure for women, which can be performed postpartum, after an abortion, or as an interval procedure unrelated to pregnancy; done with mini-laparotomies and laparoscopies are the two most common techniques, is called what?

Tubal ligation

Reversible Methods of Contraception: Permanent Methods

Tubal ligation or Essure for women Vasectomy for men

Many people have strong feelings about ___________ based on religious and moral beliefs.

abstinence

Contraception

any method that prevents pregnancy

What is Fertility awareness?

any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy.

_________ barriers called ___________ may be used along with mechanical barrier devices. They come in creams, jellies, foam, suppositories, and vaginal films. They chemically _______ the sperm in the vagina

chemical, spermicides , destroy

Condoms are ________ methods of contraceptives made for both males and females. The male condom is made from latex or polyurethane or natural membrane and may be coated with spermicide. When used correctly, the male condom is put on over an _____penis before it enters the vagina and is worn ___________sexual intercourse. It serves as a barrier to pregnancy by trapping seminal fluid and sperm and offers protection against _____.

barrier, erect, throughout, STI's

Contraceptive methods can be divided into what four types?

behavioral methods, barrier methods, hormonal methods, and permanent methods

If abuse is detected, immediately ________ the woman to provide _______ and to prevent potential retaliation from the abuser. Asking about abuse in front of the perpetrator may trigger an abusive episode during the interview or at home

isolate, privacy

Depo-Provera injection

intramuscular injection of progesterone every 3 months that changes uterine lining and ovum maturation

Many of these barrier methods contain _____, which is an allergy to some.

latex

The basal body temperature (BBT) refers to the ______ temperature reached on _________

lowest, awakening

Myth or Fact: IPV is only a heterosexual issue.

myth

Myth or Fact: Intimate partner violence (IPV) is typically a one time, isolated occurrence.

myth

Myth or Fact: Men have the right to discipline their partners. Battering is not a crime

myth

Myth or Fact: Only men with mental health problems commit violence against women.

myth

Myth or Fact: Pregnant women are protected from abuse by their partners.

myth

Myth or Fact: Violence occurs to only a small percentage of women.

myth

Myth or Fact: Violent tendencies have gone on for generations and are accepted

myth

Myth or Fact: Women can easily choose to leave an abusive relationship.

myth

Myth or Fact: Women provoke their partners to abuse them.

myth

Myth or Fact: Battering is not a crime Myth or Fact: In the past, our patriarchal legal system afforded men the right to physically chastise their wives and children; we no longer live under that system. Women and children are no longer considered the property of men, and violence against them is a crime in every state.

myth fact

sexual abstinence

not having vaginal or anal intercourse; pregnancy cannot occur if sperm is kept out of the vagina. It also reduces the risk of contracting HIV/AIDS and other STIs, unless body fluids are exchanged through oral sex

Prime points to stress-concerning ECs are: ECs do ___ offer any protection against STIs or _______pregnancies. ECs should not be used in place of a regular _____ _______ method, because they are ____ effective. ECs may delay the next menses, so evaluation for pregnancy is needed if menses does not occur within __ weeks after EC use. Report any severe __________ pain to health care provider immediately. ECs are regular birth control pills given at a ______ dose. ECs are _______________during pregnancy

not, future. birth control, less. 3. abdominal. higher. contraindicated

Because _______ are viewed as trustworthy and sensitive about very personal subjects, women often feel comfortable confiding in them and discussing these issues with them. As a professional nurse, the act of ___________ women seen in every health care setting is often the first step for a victim to start thinking about a better future. Remember, your words carry weight with your client who looks to you for help, support, and encouragement.

nurses, screening

battered woman syndrome

situation occurring when a woman believes that she cannot leave the abusive situation and may even go so far as to kill her abuser

Implantable Contraceptives

subdermal time-release method that delivers synthetic progestin that inhibits ovulation. Once in place, it delivers 3 years of continuous, highly effective contraception e.g. Nexplanon

the potentially fertile days up to and including the day of ovulation are called what?

the "fertile window."

Violence within these relationships may go ___________ for fear of harassment or ridicule.

unreported

Fertility awareness-based methods (FAMs)

use physical signs and symptoms that change with hormone fluctuations throughout a woman's menstrual cycle to predict a woman's fertility.

The female condom is a polyurethane pouch inserted into the _______. It consists of an outer and inner ring that is inserted vaginally and held in place by the ______ bone. They may prevent _____ transmission as well as _________

vagina, pubic, STI's, pregnancy

Gender Based Violence (GBV)

violence committed against another person precisely because of their gender, or specifically, men's violence against women which serves - by intention or effect - to perpetuate male power and control

intimate partner violence (IPV)

violence that occurs between individuals who are currently in dating, cohabitating, or marital relationships, or those who have been in such relationships in the past.

For the Two-Day Method, women observe the presence or absence of cervical secretions by examining toilet paper or underwear or by monitoring their physical sensations. Every day, the woman asks two simple questions: "Did I note any secretions yesterday?" and "Did I note any secretions today?"

" If the answer to either question is yes, she considers herself fertile and avoids unprotected intercourse. If the answers are no, she is unlikely to become pregnant from unprotected intercourse on that day

DISADVANTAGES OF ORAL CONTRACEPTIVES

*Offers no protection against STIs *Pose slightly increased risk of breast cancer *Modest risk for venous thrombosis and pulmonary emboli *Increased risk for migraine headaches *Increased risks for myocardial infarction, stroke, and hypertension or women who smoke *May increase of depression *User must remember to take pill daily *High cost for some women

ADVANTAGES OF ORAL CONTRACEPTIVES

*Regulate and shorten menstrual cycle *Decrease severe cramping and bleeding *Reduce anemia *Reduced ovarian and colorectal cancer risk *Decrease benign breast disease *Reduce risk of endometrial cancer *Improve acne *Minimize perimenopausal symptoms *Decrease incidence of rheumatoid arthritis *Improve PMS symptoms *Protect against loss of bone density

List 3 aspects to preconception care?

-Encourage folic acid 400 to 800 mcg per day -encourage proper diet and exercise. -Women should receive the influenza vaccine if planning pregnancy during flu season

Male sterilization is accomplished with a surgical procedure known as a

-Vasectomy

The exact time of ovulation cannot be determined, so __-__ days are added to the beginning and end to avoid pregnancy.

2-3 days

A single ovum is released from the ovary __days before the next menstrual period. It lives approximately __ hours. Women using this method must have regular menstrual cycles for it to be effective.

14 days, 24 hours

EARLY SIGNS OF COMPLICATIONS FOR USERS OF ORAL CONTRACEPTIVES

A = Abdominal pain may indicate liver or gallbladder problems. C = Chest pain or shortness of breath may indicate a pulmonary embolus. H = Headaches may indicate hypertension or impending stroke. E = Eye problems may indicate hypertension or an attack. S = Severe leg pain may indicate a thromboembolic event.

Reversible Methods of Contraception: Behavioral

Abstinence Fertility awareness-based methods Withdrawal (coitus interruptus) Lactational amenorrhea method (LAM)

Cervical mucus- cervical mucus ovulation method-

Cervical mucus is a jellylike vaginal discharge that comes from the cervix. The cervical mucus ovulation method is used to assess the character of the cervical mucus.

Nursing Assessments: When assessing which contraceptive method might meet the client's needs, the nurse might ask:

Do your religious beliefs interfere with any methods? Will this method interfere with your sexual pleasure? Are you aware of the various methods currently available? Is cost a major consideration, or does your insurance cover it? Does your partner influence which method you choose? Are you in a stable, monogamous relationship? Have you heard anything troubling about any of the methods? How comfortable are you touching your own body? What are your future plans for having children?

Intrauterine Contraceptives

IUD - should be in fundus - Copper-coated (Paragard, Copper-T) (T-shaped) - Saf-T-Coil (Curly T-shape) - Lippes Loop (Snake-shaped) - Hormonal (Mirena, Progestasert) (T-shaped)

Myth or Fact: Battering of women occurs only in lower socioeconomic classes.

Myth

Myth or Fact: Substance abuse causes the violence.

Myth

A few nursing diagnoses that might be appropriate based on the nurse's assessment during the decision-making process include: Deficient knowledge related to: -Methods available -Side effects/safety -Correct use of method chosen -Previous myths believed Risk for infection related to: -Unprotected sexual intercourse -Past history of STIs -Methods offering protection

Nursing diagnoses applicable to the contraceptive would be: Health-seeking behaviors related to: -Perceived need for limiting number of children -Overall health relative to contraceptives Risk for ineffective health maintenance related to: -Not being familiar with the various contraceptive methods -Being unaware of high-risk sexual behavior leading to STIs Fear related to: -Not understanding the correct procedure to use -Unintended pregnancy occurring if not used correctly -General health concerning the long-term side effects

Reversible Methods of Contraception: Hormonal

Oral contraceptive Injectable contraceptive Transdermal patch Vaginal ring Implantable contraceptive Intrauterine contraceptive Emergency contraceptive

BOX 4.7 WARNINGS FOR INTRAUTERINE SYSTEM USERS OF POTENTIAL COMPLICATIONS

P = Period late, pregnancy, abnormal spotting or bleeding A = Abdominal pain, pain with intercourse I = Infection exposure, abnormal vaginal discharge N = Not feeling well, fever, chills S = String length shorter or longer or missing

________ is a time of unique vulnerability to intimate partner violence (IPV) victimization because of changes in women's physical, social, emotional, and economic needs during __________

Pregnancy

BOX 9.2 SAVE MODEL

SCREEN all of your clients for violence by asking ASK direct questions in a nonjudgmental way VALIDATE the client by telling her EVALUATE, educate, and refer this client by asking her

Sterilization methods

Sterilization is a permanent, safe, and highly effective method of contraception for those who are certain they do not want any or any more, children.

The following guidelines are helpful in counseling and educating the client or couple about contraceptives: -Encourage the client/couple to participate in choosing a method. -Provide client education. The client/couple must become informed users before the method is chosen. -Education should be targeted to the client's level so it is understood. Provide step-by-step teaching and an opportunity for practice for certain methods (cervical caps, diaphragms, vaginal rings, and condoms).

The following guidelines are helpful in counseling and educating the client or couple about contraceptives: -Obtain written informed consents, which are needed for intrauterine contraceptives, implants, abortion, or sterilization. Informed consent implies that the client is making a knowledgeable, voluntary choice; has received complete information about the method, including the risks; and is free to change her mind before using the method or having the procedure (Schuiling & Likis, 2016). -Discuss contraindications for all selected contraceptives. -Consider the client's cultural and religious beliefs when providing care. -Address myths and misperceptions about the methods under consideration in your initial discussion of contraceptives.

Transdermal delivery of contraceptive hormones avoids what?

avoids hepatic first-pass metabolism, allowing a lower total hormone doses when compared to that of oral products that are metabolized in the liver.

Myth or Fact: Women may be willing to blame themselves for someone else's bad behavior, but nobody deserves to be beaten.

fact

Myth or Fact: Women stay in the abusive relationship because they feel they have no options.

fact

What is the goal of preconception care?

identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management interventions

Current or former husbands or lovers kill _____ _____ of the murdered women in the United States.

over half

OCs work primarily by suppressing __________ by adding _________ and ____________ to a woman's body, thus mimicking _________.

ovulation, estrogen, progesterone, pregnancy

The majority of women never tell anyone about ____. In fact, almost two-thirds of victims never report it to the police.

rape