Ch.8 Contraception and abortion Lecture notes (Completed)

Overview and Definitions of Contraception

  • Contraception Definition: This refers to the intentional prevention of pregnancy occurring during sexual intercourse.

  • Birth Control Definition: This encompasses the specific devices and/or practices employed to decrease the risk of conceiving offspring or bearing them.

Contraceptive Assessment

  • Knowledge and Commitment: Nurses must assess the woman's existing knowledge regarding methods and the partner's level of commitment to any selected method.

  • Sexual History and Preferences: assessment includes the frequency of coitus, the number of sexual partners, and any specific objections to certain methods.

  • Physical Comfort: Determining the woman's comfort level and willingness to touch her own genitals or examine her cervical mucus is critical for certain methods.

  • Psychosocial Factors: Identifying misconceptions, cultural factors, religious factors, and evaluating both verbal and nonverbal responses during the consultation.

  • Life Planning: Consideration of the woman's "reproductive life plan."

  • Clinical Evaluation: A complete history, physical examination, and relevant laboratory tests must be performed.

Informed Consent: The BRAIDED Acronym

  • B - Benefits: Providing information regarding the advantages and success rates of the method.

  • R - Risks: Providing information regarding disadvantages and failure rates.

  • A - Alternatives: Offering information about other available methods.

  • I - Inquiries: Providing the client the opportunity to ask questions.

  • D - Decisions: Providing the opportunity for the client to decide on a method or to change her mind.

  • E - Explanations: Detail-oriented information about the selected method and instructions on how it is used.

  • D - Documentation: Ensuring the information given and the client's understanding of that information is documented.

Fertility Awareness-Based (FAB) and Calendar Methods

  • Coitus interruptus- “pull out” method.

  • Natural Family Planning (Fertility awareness-Based methods FAB): Methods based on natural biological indicators.

  • Calendar-Based Methods:

    • Calendar Rhythm Method.

    • Standard Days Method.

  • Symptoms-Based Methods:

    • Two Day Method: Monitoring secretions.

    • Cervical Mucus Ovulation Detection Method: Tracking changes in mucus consistency.

    • Basal Body Temperature (BBT) Method: Tracking the body's temperature at rest.

  • Biologic Marker Methods: Use of Home Predictor Test Kits for Ovulation to detect the surge in hormones preceding ovulation.

Spermicides and Barrier Methods

  • Spermicides:

    • Action: Reduces sperm motility by attacking the sperm flagella and body, preventing them from reaching the cervical os.

    • Active Ingredient: Most commonly uses Nonoxynol-99 (N-99).

    • Forms: Aerosol foams, tablets, suppositories, creams, films, and gels; these are sold without a prescription.

    • Usage: Must be inserted high into the vagina at least 1515 minutes to 11 hour prior to sexual intercourse. It must be re-inserted prior to each additional act of intercourse.

  • Male Condoms:

    • A thin, stretchable sheath covering the penis.

    • Acts as a barrier to sperm and some Sexually Transmitted Infections (STIs).

    • Should be used with water-based or silicone lubricants.

    • Polyurethane condoms are available for individuals with latex allergies.

  • Female Condoms:

    • A vaginal sheath made of non-latex synthetic rubber.

    • Features flexible rings at both ends: the closed end covers the cervix, and the open ring covers the labia.

  • Diaphragms:

    • Shallow, dome-shaped latex or silicone device with a flexible rim covering the cervix.

    • Available in 44 types and multiple sizes.

    • Must remain in place for at least 66 hours post-coitus.

    • Requires an annual gynecological exam to assess the fit; the device should be replaced every 22 years.

  • Cervical Caps:

    • Made of silicone and fits snugly around the base of the cervix.

    • Available in 33 sizes.

    • Must be left in place for at least 66 hours post-coitus.

  • Contraceptive Sponges:

    • Small, round polyurethane sponge containing N-99 spermicide that fits over the cervix.

    • Available as a "one size fits all" option.

Combined Estrogen-Progestin Contraceptives (COCs)

  • Mechanism of Action:

    • Suppresses the action of the hypothalamus and the anterior pituitary gland.

    • Leads to insufficient secretion of Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH).

    • Result: Follicles do not mature, and ovulation is inhibited.

    • Endometrial maturation is altered, making the environment less favorable for implantation.

    • Progesterone causes cervical mucus to become unfavorable for sperm penetration.

    • Monophasic pills provide fixed doses of estrogen and progestin, while others may alter amounts throughout the cycle.

  • Contraceptive Benefits: Improved sexual response and convenience.

  • Non-Contraceptive Benefits:

    • Regulation of menorrhagia and irregular cycles.

    • Reduction in the incidence of dysmenorrhea.

    • Treatment for endometriosis.

    • Protection against uterine and ovarian cancers.

  • Side Effects:

    • Estrogen-related: Breast tenderness, nausea, and fluid retention.

    • Progestin-related: Vaginal yeast infections.

  • Serious Adverse Effects: Stroke, Hypertension (HTN), and Gall bladder disease.

Warning Signs for Oral Contraceptive Complications (ACHES)

  • A - Abdominal Pain: May indicate a problem with the liver or gall bladder.

  • C - Chest Pain/Shortness of Breath: May indicate a possible clot problem within the lungs or heart.

  • H - Headaches: Sudden or persistent headaches may be caused by a Cerebrovascular Accident (CVA) or Hypertension.

  • E - Eye Problems: May indicate a vascular accident or hypertension.

  • S - Severe Leg Pain: May indicate a thromboembolic process (clot).

Alternative Combined Hormonal Delivery Systems

  • 9191-Day Regimen: COCs are taken in 33-month cycles, resulting in the woman experiencing fewer menstrual periods.

  • Transdermal Contraceptive System (The Patch):

    • Delivers combined progestin and estradiol.

    • Applied weekly on the same day for 33 weeks, followed by 11 week without the patch.

    • Application sites: Upper outer arm or upper torso.

  • Vaginal Contraceptive Ring:

    • A flexible ring worn in the vagina.

    • Delivers continuous hormone levels for 33 weeks, followed by 11 week without the ring.

Progestin-Only Methods

  • Mechanism of Action: Impairs fertility by inhibiting ovulation, thickening and decreasing the amount of cervical mucus, and altering the cilia in the uterine tubes.

  • Injectable Progestins Side Effects:

    • Decreased bone mineral density.

    • Weight gain.

    • Headaches.

    • Mood changes.

    • Irregular vaginal spotting.

  • Implantable Progestins:

    • A flexible tube or rod inserted under the skin of the arm.

    • Nexplanon is the version used in the United States.

Emergency Contraception and IUDs

  • Emergency Contraception (EC):

    • Available without a prescription.

    • Oral EC should be taken within 55 days of unprotected intercourse or a birth control mishap.

    • Prevents ovulation by inhibiting follicular development.

  • Intrauterine Devices (IUD):

    • A small, T-shaped device with bendable arms inserted through the cervix.

    • Irritates the uterine lining and affects sperm motility to prevent pregnancy.

    • The client must periodically feel for the device strings to ensure it is in place.

  • IUD Potential Complications (PAINS):

    • P - Period late, spotting, or bleeding.

    • A - Abdominal pain or pain during intercourse.

    • I - Infection exposure or abnormal vaginal discharge.

    • N - Not feeling well, fever, or chills.

    • S - String missing, shorter, or longer.

Sterilization

  • Definition: Surgical procedures intended to render a person permanently infertile.

  • Female Sterilization:

    • Bilateral Tubal Ligation (BTL): Can be performed immediately after birth or at any time the woman desires.

    • Methods: Laparoscopy, tubal electrocoagulation, or the application of bands or clips to cause tubal occlusion.

  • Male Sterilization:

    • Vasectomy: The surgical interruption of the vas deferens, which transports mature sperm to the urethra.

    • Recovery and Effectiveness: It requires 11 week to several months to clear the ducts of remaining sperm; additional contraception is required during this period.

Induced Abortion

  • Definition: The purposeful interruption of a pregnancy prior to 2020 weeks of gestation.

  • Classifications:

    • Elective Abortion: Performed at the woman's request.

    • Therapeutic Abortion: Performed due to concerns regarding maternal or fetal health.

  • First-Trimester Abortion:

    • Performed before 99 weeks via aspiration (vacuum or suction curettage) in a physician's office.

    • Medical Abortion: Using drugs such as Methotrexate or Misoprostol up to 1010 weeks after the last menstrual period (LMP).

  • Second-Trimester Abortion:

    • Performed up to 2020 weeks.

    • The cervix must be dilated; the procedure takes more time because the products of conception are larger.