reproduction

contraception

permanent: hysterectomy/tubal ligation, vasectomy

long term: IUD

other: hormonal contraception, condom, withdrawl, sponge/diaphragm, fertility awareness based, spermicide

hormonal contraception

combined: contain synthetic estrogen and progestin

• estrogen: ethinyl estradiol

• progestin: norethindrone, norgestrel, levonorgestrel (LNG)

single contain progestin

indications: prevent pregnancy, moderate acne, lessen painful periods

action: inhibits ovulation

routes:

• PO (oral)

• transvaginal ring: 3 weeks (taken out 4th for withdraw bleed)

• transdermal patch: 1 week (taken out 4th week for withdraw bleed)

• depo-progestin only injection: 12 weeks (deep IM) (can only get this for 2 years

• implant (progestin only): 3 years

PO: 21-28 day package most common

• 21: last 7 days of month don’t take any pills for withdraw bleed

• 28: last 7 days have blank/folic acid/iron pills for with draw bleed

progestin vs estrogen

estrogen: at risk for cardiovascular events or blood clots

progestin: no cardiovascular risk

hormonal contraception (2)

drug interactions:

• herbal: st john’s wort, black cohosh

• anticonvulsants (prevent seizures long term): carbamazepine, phenytoin (since it’s long term need to use non-hormonal contraception)

• antibiotics: amoxicillin, doxycycline, metronidazole

oral contraceptives increase seizure threshold, affect coagulability, increase blood sugar

contraindications: pregnancy, thrombophlebitis, DVT, PE, CVA, CAD, liver disease, undiagnosed vaginal bleeding, cancer, more than 15 cigarettes a day, 35 yrs old or older

caution: HTM, postpartum less than 3 weeks, lactation less than 6 weeks

can get depo injection postpartum

adverse effects: N/V, breast tenderness, vaginal bleeding, oligomenorrhea, amenorrhea, increased appetite, weight gain, acne, decreased bone density (depo only)

hormonal contracpetions: nursing considerations

assess BP (increased BP on pill)

assess last menstrual period, administer pregnancy test

assess weight

assess smoking status

monitor for adverse effects

patient education

proper use/when to take

when to start: first Sunday after the start of period OR start first day of period

ACHES call 911

take calcium and vitamin D (for bone density on depo injection)

follow up 3 months after starting —> yearly

ACHES

call 911

abdominal pain, chest pain (shortness of breath), headache (sudden and severe), eye problems (blurry vision, flashing lights, loss of vision), severe leg pain/swelling of legs and feet

hormone replacement therapy

menopause

combination of estrogen (lower doses) and progestin or estrogen alone (progestin only added if patient still has uterus —> protect from uterine lining overgrowth)

indications: treat vasomotor symptoms (hot flashes), vaginal dryness

contraindications: undiagnosed vaginal bleeding, severe liver disease, venous thrombosis, CV event, history of breast cancer or dementia

nursing considerations:

• routes: PO, transdermal patch, ring

• risk for thromboembolic events

• no smoking

preterm labor

20-37 weeks gestation

risk factors:

• history of preterm labor

• uterus infection

• multiple gestations

• anomalies of fetus

• smoking, drug use

• UTI

• hemorrhage during pregnancy

stopping preterm labor

tocolytics: meds used to stop pre-mature labor

indications: allow more time for the fetus to mature in utero (time for corticosteroids to mature fetus lungs)

tocolytics

given to relax smooth muscle (uterus)

terbutaline, magnesium sulfate, nifedipine, indomethacin

given to increase fetal lung maturity (betamethasone, dexamethasone)

terbutaline

beta adrenergic drug class

action: relaxes uterus (smooth muscle)

for short term use: less than 48-72 hrs

given subq 1 time

adverse effects: tachycardia, arrhythmias, cardiac ischemia

crosses the placenta (can increase fetus HR)

monitor: mother HR, fetal HR, contractions

magnesium sulfate

indications: tocolytic and to prevent/treat seizures in pre-eclampsia and magnesium replacement

action: relaxes smooth muscle (uterus and blood vessels —> decreased BP)

given IV as continous infusion

side effects: flushing feeling, N/V

adverse effects: decreased BP, CNS depression, respiratory depression (magnesium toxicity), neonatal depression

monitor: adverse effects, magnesium level (4-7), assess deep tendon reflexes, contractions, intake and output

antidote: calcium gluconate IVP

nifedipine

calcium channel blockers

action: relaxes smooth muscle

side effects: dizziness, hypotension, bradycardia

monitor: BP, HR, contractions, fetal HR

indoethacin

NSAID class

action: inhibits prostaglandin (induces labor)

do not use for more than 48 hours

side effect: N/V, gastritis

gestational HTN

starts in pregnancy, elevated BP less than 20 weeks

pre-eclampsia

less than 20 weeks

elevated BP and proteinuria

magnesium sulfate: used to prevent and treat seizures, monitor for toxicity (decreased or absent patellar reflex, respiratory depression, sedation, hypotension)

methyldopa: alpha-2 adrenergic agonist

• indication: decrease BP in pre-eclampsia

• side effects: sedations, peripheral edea, anxiety, depression, nightmares

drugs to stimulate uterine contractions: uterotropics

dinoprostone (cervadil), misoprostol (cytotec)

indication: used for cervical ripening to induce labor

action: synthetic prostaglandin stimulates contraction

preparation: gel, insert, tablet

sterile technique: vaginally or cervically

oxytocin: started 6-12 hours after gel or 30-60 minutes after insert is removed

keep patient in proper position after insertion

drugs to stimulate uterine contractions: uterotropics (2)

oxytocin

indication: induce labor, enhance contractions, treat postpartum hemorrhage, treat boggy uterus after delivery

action:stimulate smooth muscle

given through IV continuous infusion

side effects: uterine hyperstimulation

adverse effect: seizure, dysrhythmias, brain hemorrhage

drugs to treat postpartum hemorrhage

methyergonovine (methergine)

action: contraction of smooth muscle to controlb leeding after delivery

PO/IM

side effects: HTN, chest pain, siezures