Module 19 Sexuality Contraception non voice

Exemplar 19: A Family Planning

Genetics

  • Desired outcomes of pregnancy are often aimed at a healthy, perfect baby.

  • There can be grief and fear associated with the birth of a baby with defects or disease.

Contraception

  • Important to have a plan for family planning, which includes avoiding conception when desired.

  • Consideration of cultural and religious beliefs in relation to contraception use.

Fertility Awareness Methods

Overview

  • Methods involve natural family planning and understanding one’s ovulatory cycle.

  • These methods are safe, free, and acceptable to many religious beliefs. Extensive counseling is necessary for effectiveness.

Calendar Rhythm Method

  • Least reliable method that requires recording cycle for 6 months to ascertain longest and shortest cycle.

  • The first day of menstruation begins the menstrual cycle.

Basal Body Temperature (BBT) Method

  • Woman records her BBT upon waking to detect changes related to ovulation.

  • Generally, BBT drops before ovulation and rises and remains elevated afterward.

Ovulation Method (Cervical Mucus Method)

  • Involves assessment of cervical mucus for changes; mucus becomes clearer and more stretchable during ovulation.

  • Key signs: spinnbarkeit (stretchability) and fern pattern.

  • Abstain from intercourse from the first appearance of clear, elastic mucus until 4 days after the last wet mucus.

Symptothermal Method

  • Involves tracking cycle days, coitus days, changes in cervical mucus, libido, bloating, and Mittelschmerz (mid-cycle pain), along with BBT monitoring.

Situational Contraceptives

  • Options include abstinence and coitus interruptus (withdrawal), which is the least reliable.

  • Douching after intercourse is ineffective and may push sperm further up the reproductive tract.

Spermicides

  • Nonoxynol-9 (N-9) is available in various forms, including cream, jelly, foam, and vaginal film.

  • Though minimally effective alone, it can irritate skin and offers no STI protection.

Barrier Methods

Male Condoms

  • Effective when used consistently; proper removal after intercourse is crucial.

  • Should not be stored in hot conditions and offers protection against STIs.

Female Condom

  • A thin polyurethane sheath with a closed ring over the cervix and an open ring outside the vagina.

  • Can be inserted up to 8 hours prior to intercourse.

Diaphragm

  • Used with spermicidal cream, it is inserted before intercourse and must cover the cervix.

  • Must be left in place for at least 6 hours after intercourse.

Cervical Cap

  • Silicone device that fits snugly over the cervix, held by suction and has a strap for removal.

  • Similar advantages and disadvantages as the diaphragm.

Vaginal Sponge

  • Soft, absorbent sponge containing spermicide fits over the cervix.

  • Must remain in place for at least 6 hours and can be kept for a maximum of 24 hours.

Intrauterine Contraception

  • Safe and reversible method inserted into the uterus by a provider, effective for several years.

  • Possible side effects include discomfort, increased menses bleeding, and risk of perforation.

Types of IUDs

  • Copper T380A (Para Guard) lasts 10 years; Levonorgestrel-releasing systems (Skyla, Mirena, Liletta) last 5 years.

  • Works by altering cervical mucus and endometrial lining.

Hormonal Contraceptives

  • Combined estrogen and progestin methods inhibit ovum release, maintain thick cervical mucus, and create an atrophic endometrium.

Combined Oral Contraceptives (COCs)

  • Safe and highly effective; typically taken for 21 days followed by a 7-day break.

  • Extended cycles may be used (91-day regimen).

  • Monitor for ACHES: abdominal pain, chest pain, headache, eye issues, or leg swelling.

Benefits and Other Methods

  • Non-contraceptive benefits include relief from menstrual syndromes.

  • Progestin-only pill is safe for nursing mothers.

  • Alternative combined methods: skin patch, vaginal ring, long-acting progestin contraceptives (such as Nexplanon).

Depot Medroxyprogesterone Acetate (DMPA)

  • Highly effective birth control with a 3-month protection window.

  • Long-term use (beyond 2 years) can result in calcium loss.

Emergency Contraception

  • Must be used within 120 hours after contraception failure, unprotected sex, or rape.

  • Methods include Plan B, Ulipristal acetate (Ella), and Copper T380A IUD.

Operative Sterilization

  • Permanent prevention of pregnancy including vasectomy and tubal ligation procedures.

Vasectomy

  • Involves severing the vas deferens on both sides.

  • Follow-up sperm count is required at 6 and 12 months.

Tubal Ligation

  • Clips, ligatures or plugs are applied to fallopian tubes.

  • Possible complications with devices like Essure (microinserts).

Male Contraception

  • Options include vasectomy and condoms.

  • Hormonal contraception for males is still under development.

Discontinuing Contraception

  • Important to allow 2-3 normal cycles post-pill for conception.

  • Note that Depo-Provera may delay conception up to 18 months.

Collaboration

  • Multidisciplinary healthcare team may include geneticists, psychologists, gynecologists, urologists, and infertility specialists.

Diagnostic Tests for Infertility

  • Include BBT recording, cervical mucus assessment, hormonal testing, sperm analysis, and ultrasound.

Genetic Testing

  • Genetic issues involve screening techniques like ultrasound, amniocentesis, etc.

Nursing Process

Priorities

  • Identify specific needs, provide emotional support, and teach clients about available options.

Data Collection

  • Questions for evaluating sexual health history for both genders, including number of partners, contraceptive use, and sexual trauma history.

Women’s Specific Data

  • Assess breast cancer risk factors, menstrual history, and perform appropriate examinations.

Men’s Specific Data

  • Perform genital exams and inquire about sexual functioning.

Nursing Problems

  • Nursing problems may include:

    • Risk for disturbed body image.

    • Sexual dysfunction.

    • Deficient knowledge regarding family planning and contraception.

Planning by RN

  • Goals for clients include understanding treatment options, acknowledging impacts on personal relationships, and describing changes in body function.

Implementation

Promotion of Healthy Body Image

  • Encourage verbalization of feelings and provide resources.

Promotion of Healthy Sexual Function

  • Facilitate discussions regarding sexual health and address concerns.

Education

  • Inform clients about their sexual and reproductive health, focusing on risk factors and disease prevention.

Evaluation

  • Expected outcomes include informed decision-making and open expression of feelings regarding treatment.