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Family Planning

Family Planning. 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.

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Family Planning

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  1. Family Planning

  2. Contraceptives • Nursing plays a primary role in providing education about contraceptive choices and teaching about the use of different methods

  3. Contraceptives • Educate about “safe sex” practices • Be sure to F/U in 1 – 3 weeks on the effectiveness of the method chosen

  4. 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

  5. Abstinence • Compliance • 0 % failure rate • Most effective way to prevent STD

  6. 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

  7. 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

  8. Oral Contraceptives “The Pill” • Side effects & contraindications • P. 107 Pillitteria • Absolute • Possible • “ACHES” – Should call health care provider immediately

  9. 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)

  10. 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

  11. 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

  12. Emergency Contraception • “morning after pill” • 75% effectiveness rate • Combination estrogen/progestin • Progestin only • < NV • 89% effective

  13. 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

  14. Norplant Implants • Long acting hormonal method • 6 silastic membrane capsules filled with 35 mg progestin Inserted upper arm Last for 5 years

  15. 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

  16. Norplant Implants • Does not suppress lactation • Side Effects • Menstrual irregularities • Amenorrhea after a few months • Abdominal pain • H/A • Hair growth / hair loss

  17. Norplant Implants • Contraindications • Liver Dz • Pregnancy • Unexplained vaginal bleeding • Breast CA • Hx thrombophlebitis

  18. Depo- Provera (DMPA) • Medroxyprogesterone Acetate • Injectable progestin • Mode of action: prevents ovulation, thickens cervical mucus

  19. 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

  20. 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

  21. 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

  22. 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

  23. Intrauterine Device • Side Effects • Increased Bleeding (anemia) • Dysmenorrhea • Pelvic Infections • Ectopic Pregnancy • Uterine perforation

  24. 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

  25. 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

  26. 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

  27. Intrauterine Device – Client Education • Advise to wait 3 months after removal before becoming pregnant – this reduces the risk of ectopic pregnancy • Annual F/U

  28. Diaphragm • Mechanical Barrier to entry of sperm into the cervix • Used with a spermicide cream or jelly provides additional protection

  29. Diaphragm • Safe • Flexibility according to frequency of intercourse • Used with spermicide protects against STD

  30. Diaphragm • Complications • Toxic Shock Syndrome • Pg 1442 – 1443 Pillitteri

  31. 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

  32. 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)

  33. 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

  34. 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

  35. Cervical Cap • Complications • Cervical trauma • Client should have F/U 3 months then annually • Contraindications – p. 114

  36. 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

  37. 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

  38. Male Condom • Contraindications • Allergy to latex or collagenous tissue • Inability to maintain erections • Inability to use properly

  39. 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

  40. 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

  41. 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

  42. 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

  43. Vaginal Spermicides • Available without a prescription • Protects against STD’s

  44. Vaginal Spermicides • Contraindications • Allergy to spermicidal • Inability to use consistently at the time of intercourse • Physical / mental delays • Cervicitis

  45. 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

  46. 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

  47. 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

  48. 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

  49. Fertility Awareness Methods • Calendar Method • Basal Body Temperature Method • Cervical Mucus • Symptothermal Method • Ovulation Predictor Test

  50. Withdrawal – Coitus Interruptus • Male ejaculates outside vagina • Sperm are contained in pre-ejaculatory fluids • Interfere with sexual satisfaction of both partners • **LEAST reliable method of contraception

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