MVU NURS 620 Exam 4

MVU NURS 620 Exam 4 What are we thinking about with contraceptive issues? - ANSWER •Almost half of pregnancies each year are unintended •About half of all unintended pregnancies end in abortion •No method is 10 ...

MVU NURS 620 Exam 4 What are we thinking about with contraceptive issues? - ANSWER •Almost half of pregnancies each year are 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