family planning. contraceptives nursing plays a primary role in providing education about...
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Contraceptives
• Nursing plays a primary role in providing education about contraceptive choices and teaching about the use of different methods
Contraceptives
• Educate about “safe sex” practices
• Be sure to F/U in 1 – 3 weeks on the effectiveness of the method chosen
The Ideal Method Should Be
• Safe
• 100% effective
• Free of SE
• Easily obtainable
• Affordable
• Acceptable to the user & sexual partner
• Free of effects on future pregnancies
Oral Contraceptives “The Pill”
• Prevents ovulation; mimics the hormonal state of pregnancy– Increased estrogen--- Diminishes hypothalamic
effect on GrHR--- Inhibits the release of FSH / LH------NO OVULATION OCCURS
– Progestin• Affects cervical mucus & endometrial lining
Oral Contraceptives “The Pill”
• Monophasic– Provides fixed doses of both estrogen and
progestin throughout the 21 day cycle
• Triphasic– Vary both estrogen / progestin throughout the
cycle– Mimics woman’s natural hormonal pattern
Oral Contraceptives “The Pill”
• Side effects & contraindications– P. 107 Pillitteria– Absolute– Possible
• “ACHES” – Should call health care provider immediately
Oral Contraceptives Client Education
• A= Abdominal pain
• C= Chest pain
• H= Headache (severe)
• E= Eye problems (loss or blurring)
• S= Severe leg pain (calf or thigh)
Oral Contraceptives Client Education
• Missed pills
• Drugs (barbiturates, griseofulvin, isoniazide, penicillin, tetracycline decreases the effectiveness of the pill
• Avoid if BF’ing until milk supply is well established
• Discontinue if pregnancy occurs
Oral Contraceptives Client Education
• Adolescent girls should have well established menstrual periods (2 years) prior to starting the pill
• When to start pills– 1st Sunday after beginning period; after
childbirth Sunday 2 weeks post delivery; post Ab – 1st Sunday after procedure
Emergency Contraception
• “morning after pill”
• 75% effectiveness rate
• Combination estrogen/progestin
• Progestin only – < NV– 89% effective
Emergency Contraception
• Can be taken immediately and up to 72 hrs• Taken 2 doses; 2nd dose taken 12 hrs first• Major SE – Nausea
– Call health care provider if severe – may prescribe antiemetics
• Next period should begin within 2 – 3 weeks• START IMMEDIATELY WITH AN
ACCEPTABLE METHOD OF BIRTHCONTROL
Norplant Implants
• Long acting hormonal method
• 6 silastic membrane capsules filled with
35 mg progestin
Inserted upper arm
Last for 5 years
Norplant Implants
• Effective within 24 hours after insertion
• Mode of action: suppress ovulation, thicken cervical mucus, creates a thin atrophic endometrium, causes more rapid tubal transport of ovum
Norplant Implants
• Does not suppress lactation
• Side Effects– Menstrual irregularities– Amenorrhea after a few months– Abdominal pain– H/A– Hair growth / hair loss
Norplant Implants
• Contraindications– Liver Dz– Pregnancy– Unexplained vaginal bleeding– Breast CA– Hx thrombophlebitis
Depo- Provera (DMPA)
• Medroxyprogesterone Acetate
• Injectable progestin
• Mode of action: prevents ovulation, thickens cervical mucus
Depo- Provera (DMPA)
• Dose 150 mg single dose vial
• IM – Do Not massage (hastens absorption and shortens the period of effectiveness
• Given with 5 days of onset of period
• Within 5 days from delivery
Depo- Provera (DMPA)
• Contraception begins immediately and last for 3 months
• Instruct client to F/U for injection 2 weeks before 3 months is up
• Usually will not have period after 1 year of use
Depo- Provera (DMPA)
• Side effects and contraindications same as Norplant
• 99.7 percent effective
• ***May be used during lactation
• Women who plan to get pregnant within 6 – 9 months suggest another method
Intrauterine Device
• Progestasert & Paragard 380A• Device inserted into uterus• Mode of action
– Inhibits migration of sperm– Speeds ovum transport– Local inflammatory response in uterine cavity-
endotoxins are releases that destroys sperm– Cervical mucus
Intrauterine Device
• Side Effects– Increased Bleeding (anemia)– Dysmenorrhea– Pelvic Infections– Ectopic Pregnancy– Uterine perforation
Intrauterine Device
• Contraindications– Multiple sexual partners (risk for STD’s)– Active, recent, or chronic pelvic infection– Postpartum endometritis or septic abortion– Pregnancy– Endometrial or cervical malignancy– Valvular heart disease– Immunosuppression
Intrauterine Device – Client Education
• Palpating string – check before intercourse and after each period
• Inspect pads and tampons for an expelled IUD
• Advise alternate contraception 1st month after insertion
Intrauterine Device – Client Education
• Teach PAINS• P – period late, abnormal spotting or
bleeding• A – abdominal pain, pain with intercourse• I – infection exposure, abnormal vaginal
discharge• N – not feeling well, fever, chills• S – string missing, shorter or longer
Intrauterine Device – Client Education
• Advise to wait 3 months after removal before becoming pregnant – this reduces the risk of ectopic pregnancy
• Annual F/U
Diaphragm
• Mechanical Barrier to entry of sperm into the cervix
• Used with a spermicide cream or jelly provides additional protection
Diaphragm
• Safe
• Flexibility according to frequency of intercourse
• Used with spermicide protects against STD
Diaphragm
• Contraindications– Hx of TSS– Allergy to latex or spermicide– Recurrent UTI– Inability to learn insertion technique (mentally
or physically challenged)– Abnormalities of vaginal anatomy that prevents
a good fit or stable placement – uterine prolapse, extreme retroversion
Diaphragm – Client Education
• S/S TSS
• Annual visits
• Needs to be refitted after significant weight gain > 10 lbs, pelvic surgery, full term delivery (after pregnancy should wait about 12 weeks PP before using the diaphragm)
Diaphragm – Client Education
• May be left in place up to 12 – 24 hrs
• Must be left in place 6 hrs after intercourse
• May be inserted up to 2 hrs before intercourse
• Must be fitted by MD or NP
Cervical Cap
• Barrier method; soft rubber dome with a flexible rim
• Shaped like a thimble
• Filled with spermicide
• Inserted prior to intercourse & should be left in place at least 8 hours
• Should not be worn longer than 24 hours
Cervical Cap
• Complications– Cervical trauma
• Client should have F/U 3 months then annually
• Contraindications – p. 114
Cervical Cap – Client Education
• Practice insertion & removal• Cap should not be worn during periods• Cleaning – mild soap & water• Check for tears• Do not use petroleum products• Schedule RTC 3 months • Should be refitted after delivery, gyn surgery,
significant weight gain / loss
Male Condom
• Covers penis acts as a mechanical barrier to prevent sperm from entering the vagina
• Protects against STD’s
• Inexpensive & available without a prescription
Male Condom
• Contraindications– Allergy to latex or collagenous tissue– Inability to maintain erections– Inability to use properly
Male Condom – Client Education
• Application and removal – put on before vaginal penetration; leave space in tip
• Should not be lubricated with petroleum
• Store in cool dry place (not wallet)
• To maximize protection against STD’s use with spermicide
Female Condom
• Vaginal Pouch
• Flexible ring that fits over cervix
• Provides some protection against STD’s
• May be inserted up to 8 hours before intercourse
• Expensive
• One time use
Vaginal Spermicides
• Creates a physical barrier and also kills sperm secondary to a chemical action
• Safe & Simple
• Preps include: jellies, creams, foam, suppositories, tablets, thin square film
Vaginal Spermicides
• Inserted into the vagina about 5 – 10 minutes before intercourse; usually are effective for 2 hours
• Tablets and suppositories take longer to dissolve – insert 10 – 30 minutes prior to intercourse
Vaginal Spermicides
• Contraindications– Allergy to spermicidal– Inability to use consistently at the time of
intercourse– Physical / mental delays– Cervicitis
Vaginal Spermicides – Client Education
• Consistent use
• Times of insertion
• Good contraceptive to use during the immediate PP period
• Need to add more if intercourse is repeated
Breast Feeding
• Prolongs anovulation for a certain period of time, but is not always effective and ovulation may return before menstruation reoccurs and PREGNANCY may result
• Not an absolutely reliable method
Fertility Awareness Methods
• Rely on ovulation prediction by the couple
• Important points– Ovulation occurs 14 days before the beginning
of the next menses– Ovum can be fertilized for 24 hours; sperm are
viable for 72 hrs– Regular cycles can vary by +/- 2 days
Fertility Awareness Methods
• Important points– Period of abstinence must be at least 8 days due
to variability of menstrual cycles– *Risk of fertility is often 15 or more days, or
about half the cycle
Fertility Awareness Methods
• Calendar Method
• Basal Body Temperature Method
• Cervical Mucus
• Symptothermal Method
• Ovulation Predictor Test