MVU NURS 620 Exam 4
What are we thinking about with contraceptive issues? - ANSWER •Almost half of pregnancies each year are
... [Show More] unintended
•About half of all unintended pregnancies end in abortion
•No method is 100% effective
•Religious, ethical, and cultural reasons why women may refuse contraception
Initial evaluation for contraceptives - ANSWER •Medical history- any contraindications or risk factors for contraceptives?
•Obstetric and GYN history
•Physical exam
-Pap Smear- when was their last one?
-Wet mount
-GC/chlamydia DNA probe test
HIV & syphillis testing annually if they are sexually active.
Birth control and disease prevention - ANSWER •Gynecological history and physical exam essential and should address
-Risk for STIs and history of BC methods- nothing but condoms reduce risk for STI's.
-Sexual dysfunction/concerns
-Health promotion (weight gain is it a concern, are they already over weight)
-Menstrual cycle information
-Medications used (what problems has the patient had in the past with contraceptive methods)
-Previous Pap smears and resolutions
-Cigarette, alcohol, and drug use/abuse
Methods of contraception (chance) - ANSWER •Chance
-Failure rate is 85% per year
Method of contraception •Coitus Interruptus - ANSWER -Withdrawal of penis before ejaculation
-Failure rate is @ 27%
-Not ideal, but better than no method - (failure rate similar to barrier methods)
-Advantages - no artificial barriers, chemicals, or devices
method of contraception •Fertility Awareness Method - ANSWER -Periodic Abstinence (Natural Family Planning) - avoidance of intercourse during fertile periods
-Basal Body Temperature (BBT) and Cervical Mucus Changes - Basal body temp. and cervical mucus characteristics are recorded daily; unprotected intercourse is permitted only after signs of ovulation have subsided
-Failure rate is 25% during first year
-Can be effective if couples are motivated, but usually requires education
Methods of contraception -Barrier Methods - ANSWER •Protect against pregnancy and STIs
•Condoms, foams, suppositories, sponge, films, gels, diaphragm
•Nonoxyl-9 is a spermicide
-Its use may increase the transmission of STIs including HIV
•Available OTC (except for diaphragm)
•Disadvantage - possible allergic reaction (latex), messy
•Failure rate is @ 20%
Hormonal contraceptives - ANSWER •Combination birth control pills - both estrogen and progesterone
•Progestin-only or minipills
•Depo Provera injections
•Newer methods - patch, ring, progestin IUD, nexplanon
•Do not protect from STIs or HIV
•.1 to 5% failure rate (just depends on use)
Action of Oral Contraceptive Pills (OCPs) - ANSWER •Inhibits ovulation
•Thins endometrium
•Thickens cervical mucus
•Must take pill at the same time each day
Combination Oral Pill - ANSWER •Estrogen/Progestin combination
•28 pill pack
-Take 3 weeks of active pills, 1 week of sugar pills
-Many different forms
•Ovcon, Ortho Tri-Cyclen and so on (lots of different forms)
-Relatively inexpensive, easy to obtain and not long term
-Can be stopped at any point
-Regular cycles, tend to be shorter and lighter
-Help with acne
noncontraceptive benefits (aka benefits of birth control) - ANSWER •Decreased menstrual flow, cramps, and PMS symptoms, improves acne
•Protection against endometrial and ovarian cancer, ovarian cysts, ectopic pregnancy
•Protection against PID
•Safe in women over 35 if non-smokers
•Good menstrual cycle control (28-365 day regimens)
Contraindications of contraceptives - ANSWER **Absolute Contraindications
•Clotting disorder or family history of thrombophilia
•Cardiovascular disease
•Cerebrovascular disease
•Cancer
•Liver disease
•Pregnancy
•Undiagnosed vaginal bleeding
*Relative Contraindications
•Smokers > 35 y/o
•HTN
•DM
•Migraines (especially if they begin or worsen while using OCPs)
•Lactation
•Obesity
•Age over 50
•Active gallbladder disease
•Sickle cell disease
•Hyperlipidemia
Side effects of contraceptives - ANSWER •CVA, MI, thromboembolic events
•Side effects n/v, HA, dizziness, edema, ↑ appetite, fatigue, depression, oily skin, yeast infections, break through bleeding/spotting
•Decreased action if taking antibiotics or anticonvulsants
Missed pill scheduling for oral contraceptives - ANSWER •Need to take pill daily for 99% effectiveness
•With missed pill effectiveness rate drops
-Missed pill scheduling
•1 pill take as soon as you remember, you may take 2 pills in one day
•2 or more pills, take most recent pill missed ASAP, do not take more than 2 pills in one day. Do not take any earlier missed pills. Continue rest of pack as usual
-Must use backup contraceptive or abstain from sex until 7 days of no missed pills
3 Month Oral Pill - ANSWER •Combination estrogen/progestin
•Take 11 weeks of active pills, 1 week of sugar pills
-Cycle every 3 months
-Same missed pill scheduling
-Same risk profile
-Benefit of decreased cycles
•Good for women who have dysmenorrhea or menorrhagia
Patch or vaginal ring - ANSWER •Same hormones, action, risks, contraindications, benefits
•Ortho Evr [Show Less]