Mastery Maternal newborn nursing ATI

Contraception

Intentionally preventing pregnancy from occurring

Abstience

a deliberate decision to avoid high-risk behaviors, including sexual activity and the use of tobacco, alcohol, and other drugs

Cotius interruptus

the most common form of contraception. it was basically pulling out. Can still cause pregnancy due to pre-ejaculatory fluid

calender rhythm method

Determining fertile days by tracking the menstrual cycle to estimate the time of ovulation.

Determining fertile days

Shortest menstrual cycle -18

Longest menstrual cycle -11.

Example shortest 8th longest 19th. 8-19 days is fertile period

Cycle Beads are especially helpful for

women in developing countries

cycle beads

red- first day menstrual cycle

white- fertility days (avoid intercourse)

brown- sex is okay/pregnancy unlikely

cycle beads disadvantages

unreliable, can loose track of days

basal body temperature method

a birth control method based on body temperature changes before and after ovulation

cervical mucus ovulation method

Tracks changes in the viscosity (stickiness) of the cervical mucus. After menstruation the vagina is rather dry. Dry days are relatively safe. The mucus discharge appears in the vagina that is first thick and sticky and white or cloudy in color. Sex should be avoided at the first sign of mucus. The mucus thins and clears, becoming slippery or stringy like raw egg whites. These are the peak days. Ovulation takes place after the ovulatory mucus appears. Sex may resume 4 days after the last peak day. Very hard to tell changes.

Two day method

Based on monitoring and recording cervical secretions

After 2 days without secretions you can continue intercourse

Lactation amenorrhea method (LAM)

Method of contraception using constant breast feeding to suppress the mothers reproductive cycle, effective for approximately the first 6 months after childbirth

Penile condom

A thin sheet used to cover the penis during sexual intercourse. Does not protect against STI

Vaginal condoms

Sheath made of nitrile, flexible rings on both ends that is pre lubricated with spermicide

Spermicide

chemical that kills sperm

spermicide client education

apply 15 minutes before using, effective for 1 hour.

Diaphragm (contraceptive)

rubber or plastic cup that fits over the cervix uteri; contraceptive

Diaphragm client education

-Keep in place for 6 hours after coitus

-Replace every 2 years

-Get it refit for 15-20 lbs weight fluctuation, after having a baby, or abdominal surgery

-Not recommended for pts with a history of toxic shock syndrome (if diaphragm is left in for more that 24 hours, it can increase the risk for toxic shock) cystocele, UTIs, or uterine prolapse

-spermicide must be reapplied with each act of coitus

-wash with mild soap and water

cervical cap

a contraceptive device that fits over the cervix by suction, thus blocking the passage of sperm into the uterus. Must be fit by a gynecologist. Can cause TSS

contraceptive sponge

a contraceptive device made of polyurethane sponge that contains enough spermicide to be effective for 24 hours after being inserted into the vagina

Contraceptive sponge application

Wet with water prior to insertion, doesn't protect against STI

Combined oral contraceptives

Hormonal contraception containing estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation

Progestin - only pills ( minipill

Oral progestins provide the same action as combined oral contraceptives , which decreases the chance of fertilization and implantation

Progestin - only pills ( minipill ) CLIENT EDUCATION

Take the pill at the same time daily to ensure effectiveness secondary to a low dose of progestin . Do not miss a pill . Might need another form of birth control during the first month of use to prevent pregnancy .

Emergency oral contraceptive

Morning - after pill that prevents fertilization from taking place by inhibiting ovulation and the transport

Emergency oral contraceptive CLIENT EDUCATION

The pill is taken within 72 hr after unprotected A provider will recommend an over - the - counter antiemetic to be taken 1 hr prior to each dose to counteract the adverse effects of nausea that can occur with high doses of estrogen and progestin . Be evaluated for pregnancy if menstruation does not begin within 21 days . Consider counseling about contraception and modification of sexual behaviors that are risky . • • A copper IUD can be used up to 5 days following the unprotected intercourse as an emergency contraceptive , Injections but a prescription is required .

ADVANTAGES

FYR This method is not taken on a regular basis . Anyone , regardless of age , is allowed to purchase • emergency oral contraceptive at a pharmacy . Directions are easy to understand ..

Transdermal contraceptive patch

Contains estrogen and progesterone or progestin , which is delivered at continuous levels through the skin into • Return subcutaneous tissue 18 months Inhibits ovulation by thickening cervical mucus

Transdermal contraceptive patch CLIENT EDUCATION

Apply the patch to dry skin overlying subcutaneous tissue of the buttock , lower abdomen , upper outer arm or upper torso front and back , excluding breast area Requires patch replacement once a week . Apply the patch the same day of the week for 3 weeks with no application on the fourth week .

Transdermal contraceptive patch ADVANTAGES

ADVANTAGES Maintains consistent blood levels of hormone Avoids liver metabolism of medication because it is not . absorbed in the gastrointestinal tract Decreases risk of forgetting a daily pill Can be used while in water such as when swimming

Injectable progestins

Medroxyprogesterone is an intramuscular injection given to a female client every 11 to 13 or subcutaneous weeks . inhibits ovulation and thickens cervical mucus

Injectable progestins CLIENT EDUCATION

Start of injections should be during the first 5 days of the menstrual cycle and every 11 to 13 weeks Injections in postpartum non breastfeeding clients thereafter . should begin within 5 days following delivery . For breastfeeding clients , injections should start in the sixth week postpartum Keep follow up appointments 230ATHAVAD Maintain an adequate intake of calcium , vitamin D , and bearing exercise to decrease the risk engage in weight osteoporosis . Do not massage after IM injections because it decreases the absorption and effectiveness of the medication .

Injectable progestins advantages

Very effective and requires only four injections per year Does not impair lactation Possible absence of periods and decrease in bleeding Decreased risk of uterine cancer if used long - term

Contraceptive vaginal ring

A flexible silicone ring that contains etonogestrel and ethinyl estradiol , which are delivered at continuous levels vaginally

Contraceptive vaginal ring CLIENT EDUCATION

Insert the ring vaginally . Perform ring replacement after 3 weeks , and placement of new vaginal ring within 7 days . Insertion should occur on the same day of the week monthly If removed for greater than 4 hr , replace with new ring and use a barrier method of contraception for 7 days .

Contraceptive vaginal ring ADVANTAGES

Does not have to be fitted Decreases the risk of forgetting to take the pill ● Vaginal route of delivery increases bioavailability of hormones , enabling lower dose and reducing adverse effect

Implantable progestin

Small , thin rods consisting of progestin that are implanted by the provider under the skin of the inner upper aspect of the arm Prevents pregnancy by suppressing the ovulatory cycle and thickening cervical mucus

Implantable progestin CLIENT EDUCATION

Avoid trauma to the area of implantation . Wear condoms for protection against STIS .

Implantable progestin ADVANTAGES

Effective continuous contraception for 3 years Can be inserted immediately after spontaneous or elective abortion , childbirth , while breastfeeding Reversible

Intrauterine device IUD )

A chemically active T - shaped device that is inserted through the cervix and placed in the uterus by the provider . Releases a chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization . The most effective contraceptive methods at preventing pregnancy are the long - acting reversible contraceptive ( LARC ) methods : implant and IUDS IUDS can be used by nulliparous and multiparous female clients .

Intrauterine device ( IUD ) CLIENT EDUCATION

The device must be monitored monthly by clients after menstruation to ensure the presence of the small string that hangs from the device into the upper part of the vagina to rule out migration or expulsion of the device . Sign a consent form prior to insertion . Pregnancy test , Pap smear , and cervical cultures should be negative prior to insertion . If pregnancy is suspected after IUD insertion , a sonogram can be needed to rule out ectopic pregnancy .

Intrauterine device ( IUD ) ADVANTAGES

IUD can maintain effectiveness for 3 to 10 years hormonal IUD 3 to 5 years ; copper IUD 10 years ) . Insertion can be immediately after elective or spontaneous abortion , childbirth , and while breastfeeding Contraception can be reversed with immediate return to fertility . Does not interfere with spontaneity . Hormonal IUDS decrease menstrual pain and heavy bleeding . Copper IUD contains no hormones , so it's safe for clients cautioned against hormonal birth control methods .

Transcervical Sterilization

Insertion of small flexible agents through the vagina and cervix into the fallopian tubes . This results in the development of scar tissue in the tubes , preventing conception . The FDA recently reports that manufacturer has discontinued production of this device . Therefore this method is not currently used . QEBP Examination must be done after 3 months to ensure fallopian tubes are blocked .

Transcervical Sterilization CLIENT EDUCATION

Normal activities can be resumed by most clients within 1 day of the procedure

Transcervical Sterilization ADVANTAGES

Quick procedure that requires no general anesthesia Nonhormonal means of birth control that is 99.9 % effective in preventing pregnancy Rapid return to normal activities of daily living

Tubal ligation ( bilateral tubal ligation [ BTL ] )

A surgical procedure consisting of severance and or burnigng of blocking the fallopian tubes to prevent fertilization. Must be at least 21 years of age.

Tubal ligation ( bilateral tubal ligation [ BTL

PROCEDURE : The cutting , burning , or blocking of the fallopian tubes with bands or clips ( highly reversible ) to prevent the ovum from being fertilized by the sperm .

SURGICAL Tubal ligation ( bilateral tubal ligation [ BTL ] ) ADVANTAGES

Permanent immediate contraception . This method can be done within 24 48 hr after childbirth . Sexual function is unaffected .

Vasectomy

A surgical procedure consisting of ligation and severance of the vas deferens , which prevents sperm from traveling

Vasectomy surgical PROCEDURE

The cutting of the vas deferens as a form of permanent sterilization .

Vasectomy CLIENT EDUCATION

Following the procedure , scrotal support , and moderate activity for a couple of days is recommended to reduce discomfort . Sterility is delayed until the proximal portion of the vas deferens is cleared of all remaining sperm approximately 20 ejaculations ) . Alternate forms of birth control must be used until the vas deferens is cleared of sperm . Follow up with the provider for sperm count testing . Sperm count must be zero on two consecutive tests to confirm sterility . Reversal can be done by complicated and expensive procedure . Prior to procedure , sperm can be banked for future use .

Infertility

Infertility is defined as an inability to conceive or sustain a viable pregnancy . Infertile is the inability SEMEN inability is of a couple to conceive despite engaging in unprotected sexual intercourse for at least 12 months . Subfertility is the potential of a couple to conceive with additional assistance . Common factors associated with infertility can include decreased sperm production , endometriosis , ovulation disorders , and tubal occlusions

Infertility ASSESSMENT

During an initial fertility counseling session , the nurse should conduct a thorough history from both partners to identify potential causes of subfertility and provide education .

PELVIC EXAMINATION

Assesses for uterine or vaginal anomalies

HORMONE ANALYSIS

Evaluates hypothalamic - pituitary ovarian axis to include blood prolactin , FSH , LH , estradiol progesterone , and thyroid hormone levels

POSTCOITAL TEST Evaluates

Evaluates coital technique and mucus secretions

ULTRASONOGRAPHY

transvaginal or abdominal ultrasound procedure performed to visualize reproductive organs .

HYSTEROSALPINGOGRAPHY

Outpatient radiological procedure in which the dye is used to assess the patency of the fallopian tubes, assess the history of allergies to iodine and seafood prior to beginning the procedure. Contrast media may not always be a contraindication inclines who have a shellfish allergy further assessment may be needed.

HYSTEROSCOPY

A radiographic procedure in which the uterus examined for defect , distortion , or scar tissue that can impair successful impregnation

LAPAROSCOPY

procedure in which gas insufflation under general anesthesia is used to observe internal organs .

SEMEN ANALYSIS

In 40 % of couples who are infertile inability to conceive is due to male infertility . This test is the first in an infertility workup because it is less expensive and less invasive than female infertility testing . It can need to be repeated .

ULTRASONOGRAPHY

An ultrasound procedure is performed to visualize testes and abnormalities in the scrotum . A transrectal ultrasound is performed to assess the ejaculatory ducts , seminal vesicles , and vas deferens .

THERAPEUTIC PROCEDURES NONMEDICAL , LIFESTYLE CHANGES , AND ALTERNATIVE MEASURES

Nutritional and dietary changes Exercise , yoga , and stress management Herbal medications , only if prescribed Acupuncture Avoid high scrotal temperatures

PATIENT - CENTERED CARE MEDICAL THERAPY

Ovarian stimulation - medications are prescribed to stimulate the ovary to produce follicles Clomiphene citrate Letrozole Other medications used to support ovulation : metformin Other medications used to stimulate the endometrium : exogenous progesterone Appropriate antimicrobial medications for preexisting infections

ASSISTED REPRODUCTIVE TECHNOLOGIES Intrauterine insemination

Procedure used to place prepared sperm in the uterus at the time of ovulation .

In vitro fertilization embryo transfer IVF - ET

Procedure of collecting the client's eggs from the ovaries , fertilizing the eggs in the laboratory with sperm , and transferring the embryo to the uterus

Gamete intrafallopian transfer

Oocytes are retrieved and immediately placed with prepared motile sperm . Both are placed together into a thin flexible tube ( catheter ) . The gametes are then injected into the fallopian tubes using a surgical procedure called laparoscopy .

Donor oocyte

Donated eggs are collected from a donor implantation , the recipient undergoes hormonal therapy embryos are placed in a recipient's uterus . Prior to by an IVF procedure . The eggs are inseminated . The to prepare the uterus .

Donor embryo embryo adoption

Donated embryo is placed in the recipient's uterus , which is hormonally prepared .

. Gestational carrier ( embryo host )

A couple completes the process of IVF with the embryo placed in another person , who will carry the pregnancy . This is a contract agreement with the carrier having no genetic investment with the embryo .

Surrogate

. A person is inseminated with semen and carries the fetus until birth

Therapeutic donor insemination

Donor sperm used to inseminate a person .

NURSING INTERVENTIONS

Encourage couples to express and discuss their feelings and recognize infertility as a major life stressor . Assist the couple to consider options , and provide education to assist in decision making Qecc Explain role of genetic counselor , reproductive specialist , geneticist , and pharmacist in providing psychosocial and medical care

COMPLICATIONS Ectopic pregnancy

Ovum implants in the fallopian tubes or abdominal cavity due to the presence of endometrial tissue . As ovum increases in size , fallopian tube can rupture , and extensive bleeding occurs , resulting in surgical removal of the damaged tube

Multiple gestation

Assisted reproductive technology is associated with an increased incidence of multiple gestations . This poses a risk for the client and babies .

SIGNS OF PREGNANCY QEBP PRESUMPTIVE SIGNS

Amenorrhea Fatigue Nausea and vomiting Urinary frequency Breast changes : darkened areolae , enlarged Montgomery's glands Quickening : slight fluttering movements of the fetus felt by the client , usually between 16 to 20 weeks of gestation Uterine enlargement

SIGNS OF PREGNANCY PROBABLE SIGNS

Abdominal enlargement related to changes in uterine size , shape , and position Hegar's sign : softening and compressibility of lower uterus Chadwick's sign : deepened violet - bluish color of cervix and vaginal mucosa Goodell's sign : softening of cervical tip

PROBABLE SIGNS

Ballottement rebound of unengaged fetus Braxton Hicks contractions false contractions that are painless irregular , and usually relieved by walking Positive pregnancy test

POSITIVE SIGNS

Positive signs are those that can be explained only by pregnancy . Fetal heart sounds Visualization of fetus by ultrasound Fetal movement palpated by an experienced examiner

VERIFYING PREGNANCY

Blood and urine tests menses . Production of hCG begins with implantation , peaks at about 60 to 70 days of gestation remainder of Higher levels of hCG can indicate multifetal pregnancy ectopic pregnancy , hydatidiform mole gestational Lower blood levels of hCG might suggest a miscarriage or ectopic pregnancy Some medications ( anticonvulsants , diuretics , tranquilizers ) can cause false - positive or false - negative pregnancy results

CALCULATING DELIVERY DATE AND DETERMINING NUMBER OF PREGNANCIES FOR PREGNANT CLIENT Naegele's rule

Take the first day of the client's last menstrual cycle , subtract 3 months , and then add 7 days and 1 year , adjusting for the year as necessary .

Measurement of fundal height

in centimeters from the symphysis pubis to the top of the uterine fundus between 18 and 30 weeks of gestation ) . Approximates the gestational age , plus or minus 2 gestational weeks .

Gravidity

number of pregnancies .

Nulligravida

a client who has never been pregnant

Primigravida

client in their first pregnancy

Multigravida

client who has had two or more pregnancies

Parity

number of pregnancies in which number of fetuses . Parity is not affected weeks of pregnancy , not the the fetus or fetuses reach at least 20 whether the fetus born stillborn or alive .

Nullipara

No pregnancy beyond the stage of viability

Primipara

has completed one pregnancy with a fetus or fetuses who have reached at least 20 weeks of gestation

Multipara

has completed two or more pregnancies 20 weeks of gestation or more

Viability

the point in time when an infant has the capacity to survive outside the uterus There are no specific weeks of gestation ; however , infants born between 22 to 25 weeks are considered on the threshold of viability .

GTPAL acronym

Gravidity Term births ( 37 weeks or more ) Preterm births from viability up to 37 weeks ) Abortions / miscarriages ( prior to viability ) Living children

Chloasma

an increase of pigmentation on the face

Linea nigra

dark line of pigmentation from the umbilicus extending to the pubic area

Striae gravidarum

stretch marks most notably found the abdomen and thighs

NURSING ASSESSMENTS for birth

Reproductive and obstetrical history

Medical history, nutritional history, family, history and recent recurrent illness current medications psychological history, and he has vers viral exposure, current exercise, abuse, history or risk

Blood type , Rh factor , and presence of irregular antibodies

Determines the risk for maternal fetal blood incompatibility erythroblastosis fetalis ) or neonatal

CBC with differential Hgb , and Hct : Detects

infection and HIV anemia .

Hgb electrophoresis

Identifies hemoglobinopathies sickle cell anemia and thalassemia

Rubella titer

Determines immunity to rubella .